电子医疗系统引领医生迈进21世纪

    传播艾滋病的纽约妓女、传播致命病菌的蚊子、身携炭疽病毒的恐怖份子、到处是病人和穷人的城市……法扎德•莫斯塔沙瑞需要应对很多挑战，上面所说的这些只是其中一部分。莫斯塔沙瑞是一名从耶鲁大学毕业的医生、流行病学家，另外他还自认是一名“电脑怪胎”。目前他的使命是：将医生们从古腾堡时代带进21世纪。莫斯塔沙瑞建议刚入门的人首先从在办公室里使用电子邮件开始。

    不要以为这是件容易的事。美国虽然在尖端医疗技术领域走在世界前列，但面对电子通讯，美国医学界却普遍持保守态度。根据美国疾病控制与预防中心（Centers for Disease Control and Prevention）的估算，2010年大约只有百分之十出头的私人诊所医师拥有“功能完备”的电子病历系统。除了账单，只有不到一半的私人诊所医生会使用电脑做记录。许多医生的电脑通讯技能还不如一个在家里开eBay网店卖烧烤围裙的人。这是实话。

    今年43岁的莫斯塔沙瑞是联邦办公室的一位主任，负责领导医疗数字化工作，他正力图改变这种状况。他总喜欢说：“数据就是力量”。他的头发剃得干干净净，打着领带，看起来热情四射，身上散发着一种优秀销售员的气质，谈话时会碰碰拳头，甚至和人击掌相庆。虽然他的个性也帮了不小的忙，但莫斯塔沙瑞最大的王牌还是钱。他用270亿美元的联邦刺激资金作为激励，分配给那些安装了电子病历系统，并证明自己正在有效使用电子病历系统的医生和医院。一个医生在6年的时间里最多能拿到6.4万美元的奖金，而医院则可能拿到数以百万美元计的款项。

    莫斯塔沙瑞相信，电子病历系统不仅可以降低成本，提高个人护理水平，还可以带来更多的好处。现在大量的人口数据要么被孤立地装在成千上万的牛皮纸信封里，要么锁在专用的电脑系统里。而电子病历系统的普及可以使这些数据得到即时监控，从而可以警告疾病的爆发，找到证据证明哪种疗法最有效，也有助于发现创新性的治疗方法。另外，无论是医院、保健门诊还是小型私人诊所，都可以通过分析这些整合的数据来削减不必要的成本，同时也有助于对抗医疗价格的上涨。

    哈佛大学（Harvard）教授大卫•布鲁门萨尔也是莫斯塔沙瑞在美国卫生部（the HHS）的前任，他说：“他正在试图改变整个医疗系统。这不是一个技术工程，而是一个社会变革工程。”

    莫斯塔沙瑞小时候学习刻苦，成绩出众，当时他自己也颇以此为傲。14岁的时候，莫斯塔沙瑞离开祖国伊朗，搬到纽约上州地区，与姑姑住在一起。伊朗是个崇拜数理化的国家，莫斯塔沙瑞以为，凭着自己在科学、数学和电脑上的才智，他在美国也会很受欢迎。不过他错了。同学们都嘲笑他，但他自己却一直锲而不舍。

    莫斯塔沙瑞从哈佛大学公共卫生学院（Harvard School of Public Health）流行病学专业毕业，后来又进入耶鲁大学（Yale）医学院深造。他希望把实际的医疗经验与流行病学对模式识别的抽象追求结合起来。在一个早期的项目上，他统计了HIV病毒在静脉注射药物人群（包括妓女）中的流行度。受雇于纽约市健康与心理卫生部（New York City Department of Health and Mental Hygiene）后，他被任命为首席调查官，负责调查西尼罗病毒爆发的原因。2001年，美国爆发了令全国陷入恐慌的炭疽邮件袭击。随后，他应用数据模式开发了早期的恐怖警报信号。

    约纽市长迈克尔•布隆伯格把他放在了目前这个位子上，现在他的任务是要把信息技术带给一大群极度贫困的病人。2005年，莫斯塔沙瑞负责了一个项目，帮助全市的医院、诊所和社区医疗中心建立数字病历系统。这个系统现在已经覆盖了200多万名病人。

    今天，莫斯塔沙瑞正在试图把这些经验推广到全国。值得注意的是，在这样一个党派政治当道的时代，莫斯塔沙瑞的计划同时获得了两党的支持——或者说，至少是得到了两党的容忍。尽管2009年只有三名共和党议员投票支持刺激法案（正是该法案为莫斯塔沙瑞的计划提供了资金），但却很少有人公开反对这个计划本身。事实上，信息技术产业本身也是该计划的一个主要支持者，IBM、微软（Microsoft）、通用电气（General Electric）、惠普（Hewlett-Packard）等科技巨头和许多小型的专业医疗技术公司都表示了支持。

    New York hookers spreading HIV. Killer mosquitos. An anthrax-toting terrorist. An urban-scape rife with the sick and poor. These are just some of the challenges tackled by Farzad Mostashari, a Yale-educated physician, epidemiologist and self-confessed computer nerd. His current mission: moving doctors from the Age of Gutenberg into the 21st century. For starters, he'd like them to use email at the office.

    It's a tough nut. The U.S. leads the world in advanced medical technologies, but when it comes to electronic communication, American medicine remains a backward culture. The percentage of private-practice doctors with "fully functional" electronic health record systems was in the low double digits in 2010, according to estimates from the Centers for Disease Control and Prevention. Less than half of solo practitioners keep computer records for anything other than billing. An eBay merchant who sells funny barbecue aprons out of his living room is better equipped for computer communication than many physicians. For real.

    As head of the federal office charged with leading the digitization effort, Mostashari, 43, aims to change that. "Data is power," he likes to say. A shaved-head, bow-tied bundle of enthusiasm, he radiates a good-salesman vibe, fist-bumping and high-fiving through conversations. While personality helps, Mostashari's trump card is money. He is distributing $27 billion in federal stimulus funds as an incentive to doctors and hospitals who install electronic record systems and demonstrate they are meaningfully using them— a bonus that works out to as much as $64,000 per physician over six years. Eligible hospitals will receive payments in the millions.

    Mostashari believes the benefits will go well beyond improved individual care at lower cost. Rich stores of population data – now isolated in tens of thousands of manila envelopes, or locked in proprietary computer systems -- could be monitored to warn of disease outbreaks, find evidence for which procedures are most effective and help discover innovative approaches to care. Hospitals, managed care clinics, and even small doctor offices could analyze agglomerated data to carve out unnecessary costs and to help keep a lid on health price inflation.

    "He's trying to change a health care system," says David Blumenthal, a Harvard professor and Mostashari's predecessor in the HHS job. "It's not a technology project, it's a social change project."

    A proud nerd in childhood, Mostashari at age 14 moved from Iran to upstate New York to live with an aunt. He made a mistake thinking his prowess in science, math and computers — a trait revered in his native land — would also be considered cool in the U.S. Classmates mocked him, but he persevered.

    He graduated as an epidemiologist from the Harvard School of Public Health, then medical school at Yale. His intent: combine on-the-ground medical experience with epidemiology's more abstract pursuit of pattern recognition. In an early project, he tallied the prevalence of HIV among intravenous drug users, including prostitutes. Hired by the New York City Department of Health and Mental Hygiene, he got named lead investigator in the West Nile virus outbreak. In 2001he applied data patterns to develop early terror warning signals in the wake of the anthrax-by-mail attacks that terrorized the nation.

    New York Mayor Michael Bloomberg put him on his current path: bringing information technology to a large group of have-nots -- desperately poor patients. In 2005, Mostashari headed a program to help doctors' offices, community health centers and hospitals throughout the city set up digital record systems that now cover more than 2 million patients.

    Now he is attempting to apply those lessons nationally. Remarkably, in an era of partisan government, Mostashari's program enjoys bipartisan support -- or, at least, bipartisan tolerance. While only three Republicans voted for the stimulus bill in 2009, which provided the program's funding, few have spoken out against the program. The fact that the information technology industry is a big supporter — giants such as IBM, Microsoft, General Electric, Hewlett-Packard and a host of smaller health-care specialty technology companies — doesn't hurt.