Electronic Medical Records have transformed the way we practice health care, making patient data readily accessible to health care providers, facilitating collaboration within and across large medical teams, increasing transparency, and drastically improving the legibility of patient charts and prescriptions. But despite these benefits, many physicians cite the electronic medical record as a primary driver of burnout, pointing to the overwhelming volume of documentation it requires. In this episode, we explore how the launch of EMRs within the context of America’s predominantly fee-for-service health care system led to the technology falling short of its promise — and how transitioning to value-based care models might redeem the technology, revitalize physicians, and recenter public health.

Our guest on this episode is Farzad Mostashari, MD. After completing a degree in public health at Harvard, medical school at Yale, and residency at Massachusetts General Hospital, Dr. Mostashari spent over a decade working in public health: first for the CDC’s Epidemic Intelligence Service and then for the New York City Department of Health. From 2009 to 2011, he served as the National Coordinator for Health IT at the Department of Health and Human Services where he helped oversee the nationwide transition from paper to electronic medical records. In 2014, he founded Aledade, a company that helps primary care physicians form value-based care networks in the US.

Over the course of our conversation, Dr. Mostashari shares how his childhood in Iran pushed him towards public health, how his experience watching his father being cared for in the hospital drove him towards medicine, and how he has spent his career in the liminal space between public health and medicine. We discuss the rollout of EMRs, and how fee-for-service payment models led to EMRs being optimized for documentation rather than patient care. We explore how value-based care not only solves the problem of over-documentation, but also better aligns the goals of patients, physicians, and even insurance companies. Dr. Mostashari maps out the progress we have made toward this kind of model and the hurdles we have to clear before we have a system that incentivizes preventing stroke as much as treating stroke.

In this episode, you’ll hear about:

3:35 - How Dr. Mostashari became drawn to the intersection between the intimate work of doctoring and the wide lens work of public health.

12:12 - Dr. Mostashari’s experiences modernizing health IT systems and learning to optimize for the number of lives saved rather than the number of technological solutions implemented.

16:05 - Dr. Mostashari’s assessment of the rollout of the electronic medical record in the US.

25:09 - How Aledade frees primary care physicians to prioritize patient outcomes and reduces the burden of EMR documentation.

38:57 - What the US can learn from international health care systems.

41:00 - Challenges in transitioning to outcome-based models of primary care.

50:30 - How Dr. Mostashari’s medical training has shaped his career in public health.

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The Promise of Value-Based Medicine | Farzad Mostashari, MD