Can Healthcare “Step on a Scale” Today?

At the Healthcare Forum, Dr. Farzad Mostashari posited an important question: Can healthcare step on a scale today?  Embedded in this question is the idea that healthcare should have a simple way to measure the quality of care it provides.  Dr. Mostashari suggested that most practices today can’t step on the proverbial scale.  However, the technology is now available for us to measure and track how well we are doing at providing care.

The problem with stepping on the scale is that the feedback it provides can often be difficult to accept.  Our normal first response to stepping on the scale is to exclaim, “this scale must be broken.”  Dr. Mostashari suggested that “There isn’t a healthcare provider in the world who doesn’t think they’re doing better than they are.”  This isn’t a condemnation of the healthcare providers, but a simple reality of our own self evaluations.  The way to solve this reality distortion is to provide trusted data which illustrates the realities of the situation.

This proverbial “scale” isn’t some high level concept, but is part of a major shift that’s happening in healthcare measurement and payment.  Dr. Mostashari said that “Reimbursement will be tied to how well we manage a population.  People will have to answer, ‘How am I doing?'”  This shift in payment models is happening quickly and healthcare IT will be the tool that measures our progress in key healthcare quality measures.  We must have the courage to step on the scale and face the reality of our baseline metrics.  We must set goals and take action to improve our performance.

The unique promise of technology is that it can make things better.  One of the core beliefs of Dr. Mostashari and his predecessor, Dr. Blumenthal, is the equation:  man + computer > man

Dr. Mostashari offered some high level ways that technology can help to improve healthcare.  He said, “What we need isn’t necessarily big data in the sky.  We need small data in every interaction we have.  We need to learn from the healthcare interactions and learn from what we’re doing.”  What a drastically different view of health data than what we often see in the market today.  We are collecting a lot of data, but are we using that data in ways that will improve care?  This is the promise of technology in healthcare.

Another way technology could be used to improve healthcare was described as learning as we deliver care.  Think about putting together an A/B trial for emails or letters sent to patients who need to return back to the office.  We can take these care experiences and learn from them.  Our hospital CEOs know what our length of stay is to multiple decimal points, but does our CEO really know what population health management will do for our workflows?

Healthcare is no longer an individual sport.   Healthcare is now a team sport that will require interoperability of healthcare data.  The purpose of clinical notes are no longer short notes for myself or long notes for the CMS auditors, but are data to be used to improve care.

Healthcare improvement needs to happen across the spectrum.  This includes improvement at the community, practice and personal level.  The shared values of health IT are that healthcare can be better, data is the key to making it better, and an optimism that the future will be better than today.  As Dr. Mostashari concluded, “We can use information and tomorrow will be better, faster, and cheaper than today.”

Check out the full Healthcare Forum presentation by Dr. Farzad Mostashari embedded below:

The Breakaway Group, A Xerox Company, sponsored this coverage of the Healthcare Forum in order to share the messages from the forum with a wider audience.  You can view all of the Healthcare Forum videos on The Healthcare Forum website.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference,, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.


  • Quality measures exist in abundance today from various agencies and specialty societies.

    They come in 2 general flavors:

    Simple ones dummied down to allow their being extracted from the minimal data set held in today’s crop of EHRs (Did this 40 plus year old woman have a mammogram in the past year?) These simple minded measures have some value but miss very important issues (Should that patient have had 2 mammograms in that year? Did she have a positive mammogram that was not acted upon? How well did the radiologist do reading that mammogram? How many women under 40 needed a mammogram?) None of the more important issues can be found in the scant EHR data set.

    So the second type of quality measure is one that measures something really important and germane to high quality care. (How many cancers had a clear margin? Was the cancer diagnosed by needle biopsy?). These questions can only be answered by hours of chart review. The data is not structured in the EHR.

    Unfortunately, EHRs are being made to sound important by discussing what they SHOULD do as opposed to what they ACTUALLY do.

    I think defense of the $40,000,000,000 of taxpayer’s money wasted on EHRs should be limited to functionality that EHRs actually possess.

  • Reading John’s piece today reminded me of this from earlier this year:

    The records in medicine still can’t be scrutinized and checked to determine what works and what doesn’t. “Medicine is a $2.3 trillion industry with no accounting system,” Weed said, and “it’s killing us financially.” – Dr. Lawrence Weed, age 89 is recognized as the father of the problem-oriented medical record and the SOAP note (Subjective, Objective, Assessment, Plan) structure of clinical practice & documentation.

    The lack of structured data and interoperability that still exists today is…well, shameful. Progress is certainly being made, but far too many organizations are finding it necessary to engage a plethora of expensive consultants just to report a scant data set. I completely agree with Kevin (comment above) that most conversations around EHR today are still about what they SHOULD, and hopefully soon, will provide.

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