HealthLeaders: ONC and CMS recently put forth their roadmap for making health information exchange the norm rather than the exception. What additional regulation or legislation do you think will be required to get to that point, beyond what you've already announced?
Mostashari: I don't know. It's going to be something where we continue to have the roadmap. We know where we're going. We know what the leaders are. We know what our immediate steps are. And we know what the destination is, and we have such a rapidly changing and dynamic field, both in terms of the technology, in terms of policy, and in terms of payments and market forces, that we have to remain agile, and have the ability to assess what's happening and react. So I think where we are right now is the best balance that we've been able to craft in terms of permitting for innovation and flexibility, while providing guidance where there's low regret that that's going to freeze things. But that may change, and if it does, we have to be prepared to act.
HealthLeaders: There's been a chorus of calls for longer timeframes for meaningful use Stage 2, but you have hung tough. What are your thoughts on that decision and all of the outcry about it?
Mostashari: I think we've gotten credit for really, seriously, actively soliciting and actively listening and engaging with the field. So yeah, have we heard providers and hospitals and vendors say…and the associations, 'Yeah, it would be good to have more time'? Yeah, we've heard that, and we understand about the pressures that folks are under, and the speed with which change is happening, and the competing priorities. On the other hand, we also appreciate the calls of the other side, from vendors who say 'No, we're ready. We worked hard to be ready. We see that as our competitive advantage. Don't slow down.' From providers who say, 'We're ready to go,' and from groups like payers and health plans and purchasers and consumers and others who say, 'We can't wait for the benefits.' But ultimately, it's not about stakeholders finding a metric mean.
Good policymaking is about finding what's in the public interest, as you incorporate all of the information you get. It continues to be my belief that we can talk about Stage 3 but Stage 2 rulemaking is done. We already extended Stage 2 by a year, and then by another nine months, and we have a final rule. It is my belief that people need to get with the program on that, and we'll have another round of rulemaking about the timing for Stage 3.…[For] those people who need most to get moving and not hope for delays, hope is not a strategy, and they need to act now. It's getting late, and they need to get a move-on.