Take. So lets a for get about the number on sequestration but the up front cuts on sequestration and doesnt allow you to property monitor sequestration to sustain readiness and sustain us. And we have to cut things, because it becomes too expensive to cut it and you dont get any savings if you cut it very fast. Until the out years. From the out years. What is the net readiness impact . And some say it is plus or minus there is no middle grund on it. And how serious of an issue is it . So let me put in very simple terms. A brigade, which is the center piece of what the army delivers to our security for, our joint security forces. Theyre not going to the National Training center. They dont have dollars to train at their home station. And so we still have brigades, but if we ask them to go, they are not trained properly. And so what does that mean . That means when they go, it will take them longer to do it, and they might have more casualties, and so to me, that is not acceptable. And so the problem with us is were really it is about the future. What im telling you we have to deploy people in the future and theyre not going to be ready right now. That is a problem to me. There are those who look at this, i mean almost everybody agrees it is damaging for National Security. At one point almost all parts of the political compass respected that and come together to at least find an accommodation. That doesnt seem to be the case. Have you been up there a million times explaining why this is bad and you have taken staff out and members out to show the impact and that is improvable. And why is there what is it going to take to drive this point home . Is this a credibility issue for the service chief and the defense leadership . What is the way to move the ball forward on this . Well, there are a couple of things. First off, what im trying to make people realize is the sequestration, if we end up doing sequestration, we are planning for, it but the bottom line is everybody has to realize, between now and 2019, we have significant risks. Because we will not get rebalanced until then. And so that is a sixyear period to be unbalanced and what i worry about that the world we live in is incredibly uncertain. I dont know what is going to happen. There are lots of possibilities. I certainly hope we dont have to deploy soldiers but my job is to make sure we are ready to deploy them and if we have to do it in the next six years, we have significant problems because i dont think they will be trained or equipped the way we think they should be as american soldiers to do their job. You vowed that are you not going to send, you said it earlier, you said it before, that you have vowed that you want a balanced force at the end of this process and you will not protect end strength at all cost and you will not send unready troops that are ill equipped. Will you have a hois . No, i wont. My goal is to make sure we never send a soldier into harms way without the right capables. We talk about taking care of soldiers. How you take care of a soldier is make sure he is trained properly, and has the right equipment when we ask him to do his job. Thats how we take care of soldiers. And thats what im worried about. So what we are going to have to do is we are going to have to go into a significantly readiness cycle where we have we are going to fence certain units and they will get all our money, so we will try them to the highest possible capability. And then are you going to go to your readiness group. And it is extreme tiered readiness model. Where only a very small portion of the force is going to be ready and everyone else will be at a significantly Lower Readiness level. And that is just because if we have to deploy somebody, i want to make sure that at least the beginning part of them are prepared. There has been a sense that the pentagon has been waiting for congress to come and ride to the rescue with more money. Sort of force balling the hard decision. It was a mistake to wait as long as we did . And will flexibility, at least budgetary flexibility, solve the problem, like not needing to build two simultaneous budgets that folks say neither one of which are particularly realistic . First of all, again we havent had a budget. So all we have had is continuing resolutions. Right. So if we get a budget, we can plan towards that budget. And we have planned toward these budgets. So we have a sequestration budget, we have planned for that, we know what it means, and we know what a 15 to 19 budget would look like so we are prepared to execute that. Again, the bottom line is sequestration was a tool that was supposed to force compromise in congress. It was not a tool developed to properly manage the down sizing of the department of defense or the army. And thats the problem. The tool is not right. Well, i think that everybody, everybody agrees, everybody agrees with that. One of the challenges, and i think the secretary has discussed this as well, almost everything you have now is more expensive than the last downturn. Equipment costs more. Training costs more. And at the end of the day is it fully sunk in that the cuts are going to be in capabilities and people and everything, a lot more significant, than anybody imagined at this point. They like to compare it, in 2001 your budget was here and now it is going to be here, and it is about the same, why dont you have the same capabilities. The cost of soldiers has gone up. The other piece is we fought war for 12 years and we have wounded warriors. We have to take care of our families. We have to take care of soldiers. That costs money and we have to invest in that. And there are other things like the ability to sustain equipment is more expensive today than it was then because costs go up over time. So for us, if it is the same budget, it is a reduction in the budget. And so that is one of the things we have to deal with. And the challenge of long term entitlement reform. Or benefits reform. And that is the other thing. The price of a soldier since 2001 to 2012 is almost doubled. By 2023, we think it will be 80 of our budget. We have got to work with congress, that we slow the rate of growth of compensation, in many different areas, and we think we can do that, and still sustain a good all volunteer force. The best all volunteer force. Coming up, more with general ray otorino. You are watching this week in defense news. Da thoughte guys walked from the name of it, it was gonna be packed with sailors. So i immediately picked out the biggest guy in there. And i walked straight up to him. Now he looks me square in the eye, and, i swear he says, welcome to Navy Federal Credit union. Ha whoa friendly alert i got a great auto rate outta that guy. With rates slashed across the board, its a great time to buy a car. 4 million members. 4 million stories. Navy federal credit union. Were back with general ray otorino chief of staff of the United States army. Sir, do you guys need, the entire military leadership of service chiefs, go off and build along the lines with colin powell as the base force where the military chiefs map the draw down themselves rather than make it to the political process . I think the defense for you gives you the opportunity to do this. And i think that secretary hagel and the chairman have discussions about how we want to move forward and this might be one of the solutions and we would probably include the Combatant Commanders in that as well as we think our way through this pros. And i think that is one thing that is on the table. And i think that is a good way to go after this. We will see if that is where were headed. There is a fierce debate with army intellectuals what youre fueling with the long range study payments that you are putting together. What is it that you want to achieve from that . What is the future of the force, as you envision it . Well, first, i think the force of the future, strategy land powers are kind of the comment that were using and a lot of people dismiss the fact we really dont need Ground Forces anymore. There is not going to be a necessity to use Ground Forces and my view is that is a bit naive. Because i believe it is about the human domain. The humandy mention. And you have to be able to compel humans to do things. And the way you compel humans is by having soldiers and by means on the ground, and this can be an engagement, it can be deploying and conducting operations across a broad array of missions that we might have to do. And i think that is key. Especially in this complex world we live in. That we have to have that capability. The president and the National Security team wants to have a variety of capabilities available. And you certainly dont want to dismiss this. And im afraid there are too many people who are dismissing that as an alternative for the future. And in the future, the team, there is a sense that some have, that it is go going to support the status quo. They have come up with the same conclusion in the army and navy. Is that the case this time or do you think different kinds of views . I think were looking at different kinds of views and we are looking at new alternatives what we are going to do in the future. We have to learn from the last 10 or 12 years because our adversaries look at what has happened over the last 10 or 12 years and we have to be prepared to be operating in that environment. I think the environment is going to be more complex. And i think we have to prepare or ooh leaders and our units and we have to prepare our training and development another to meet the complex chealings and thats what were focused on. Is there an area you think there is a more focused area to drive down on . I think it is a combination of things. We will still have to deal with some sort of an insurgency wherever we are. We still might have to deal with stability operations. All simultaneously while we may have to deal with a military action of either state or nonstate actors. So it is a combination of all of those things that we are going to have to do. Which is incredibly complex. We know it has to be a simple military solution. And we know it has to be maybe a multinational solution but all of that requires a lot of preparation and training and capability in order to accomplish it. I want to get to your Regional Focus concept again which there are a lot of folks who say it is really the right way for the service to be going. But i want to talk a little bit about the Counter Insurgency debate that is going on within the service. There are those who say hey look, it is time to get back to real soldiers and to do the massive combined arms evolutions and some voices say we have learned too many very expensive lessons and paid for in blood, to retain some of these skills. And what is the right balance . And how do you retain highly perishable skills . You talk to troopers here, they have already been out three years, and so that is already gapping the force and imagine three or four years after afghanistan, you have a potential training challenge. If you went out to our Training Centers today, you wouldnt recognize what were doing. Because what were building out there is a very complex environment that when a brigade goes out there, they have to do Counter Insurgency. They have to do some level of combined arms maneuvers. They have to do some stability operations. All at one time. And the scenarios are very complex. And it also weaves in conventional special Operations Force integration. So these are the lessons we have learned. But now, were moving them forward into an even more complex environment. What we think we are going to have to fight in the future. And we will constantly update that environment out there, as we learn more and think more about where we have to go. So that is how we capture it. We have to do all of those things. We cant lose those skills. But i think what gets misinterpreted is we havent focused at all on combined arms so people are anxious to do that because they feel we have a weakness there. And so we want to focus on that. But we are not going to walk away from Counter Insurgency. But you guys were doing brigade level operations as part of a Counter Insurgency. It is different kind of operations. It takes different synchronization and difference capabilities. From a man power standpoint, 490 is the target but there are some who say 380 is the place you have to go to build the balanced force that you want. How does that change the whole dynamic . Again, a full sequestration comes about, we have to get smaller than 490. I am not in the 380 camp. We do not need to go to 380. We can do it, we can meet the requirements of full sequestration, probably somewhere around 420, 425. I think and still be modernizable. And still have a modernized ready force. People talk about what is the right capabilities you need for the future. Well in some cases, capability is capacity. So it is a combination of capacity and technological modernization. I think that gives us the right balance. If we have to go down and execute that way. And you proved that you could go up relatively quickly if you need to. Not really. See my issue is that it took us 32 months to build a brigade combat. That is not fast enough. Thats not fast enough. Thats have i have to be careful about the capacity thing. There are people who can assume that we can do it right away. It take 32 months to build a brigade. There is a big question, youre going from 45 to 32 brigade combat teams, and 12 announced, one hasnt, and it is widely expected to be the one in korea, what is the holdup on that decision . Well, i mean first off, we will make that decision in the future. And you know, it is about rotating brigades, and were working very closely with the republic of korea on that. I think we will move forward on that pretty quickly. Probably execute that some time in the near future. I am confident we will be able to do that. But they are our strong partners. We will make sure were Building Confidence that they understand that we will provide them a more ready brigade, a more capable brigade if we rotate. Which is your message across the region. Right. Up next, we are continuing our conversation with the chief of staff, of the United States army general ray otorino. Stay tuned. We wwhen we realized wed ome left gear behind. Rain we were up the creek without a paddle. I mean, we literally needed paddles campbell had left em in his garage. Thankfully i had my Navy Federal Credit union credit card on me, so we got new paddles and earned cash back. Next time well remember the paddles. Seriously . And forget campbell. 4 million members. 4 million stories. Navy federal credit union. Were continuing our conversation with army chief of staff general rotorino. Sir, i want it start off with what may be a delicate question. The vietnam era friends of mine have said, look, you know, after the vietnam war, what are the things we saw . We saw Substance Abuse problems and psychological problems accompanied with suicide. We saw a lot of domestic violence. And child abuse. And that none of these things should be surprising in the coming years. And yet, the military leadership occasionally appears sometimes to be surprised. Why is it a challenge getting our arms around some of this . First of all i dont ink this it is a surprise. We have massive programs in place for Substance Abuse, would he have programs in place for domestic abuse, we have programs in place for helping us to deal with our wonded warriors, our ptsd, tbi, we have Centers Across the army that we have never had before. So i think were prepared. But we still have the same challenges. It is about people first being comfortable coming forward with Substance Abuse issues, and it is about people coming forward that they have pts issues, and were better but were still not where we need to be. And we now have a system in place to treatment them. It is about making them comfortable coming forward and telling them you can still stay with us, this is correctable, we can help you and you can continue to serve. And i think that the down sizing of the army, makes this even difficult and people worry if i come forward with a problem, i will be the one they take out of the army as we make it smaller. So it is a combination of all of these problems that i think make it more difficult. It is not that we dont have programs in place to handle it. But it is a very complex problem in trying to help our soldiers. And the families by the way. Are you encouraged by the metrics youre seeing . I am a bit. But i never overstate those too much. What i would tell you is we are seeing more alcohol abuse. It is going up. Suicides are down a little bit. And were seeing more people come forward for post traumatic stress, so there are some positive signs but still lots of work to do. And this is something that will go on for many, many more years. For decades do you get the feeling that people dont understand the magnitude. We are not worried about it three years from now, five years ago, 10 years from now where we have to continue to fund the programs and run the programs. Update a soldier 2033 as well as women am combat. Were in the process of doing common standards, and for all of our moss, that is going very well, and we use a lot of outside resources, who are helping us to take a good strong look at this. We are learning a lot about ourselves as an army as we do this. And were looking at how we best integrate women to set them up for success in the new moss that will be open to them. So we are reporting out regularly. I think were progressing very well. Im very pleased with how this is going. And i think by the end of 2015, we will be prepared to do this. From a Sexual Assault problem, it has been a challenge for all of the military services and there is a lot of soul searching on that and that is something you and i have talked about before in terms of a commitment to try to get it right. And give us an update where you feel you are relative to that challenge. First of all, it is a problem, would he all mow it and we have to put a lot we all know it and we have to spend a lot of time on it and we have to put resources toward it and most importantly people understand it is a top priority, a number one priority, we have to include all harassment, to include sex ule harassment, and we are seeing great progress in people coming forward and action being taken. I amed a mant it is commanders who i am adamant that it is commanders that will make it work and we have a few inside the process. And the large majority of our commanders have done the right thing and we need to lead them in the process. Toxic leadership is a focus of yours and your view is you can be a demanding leader but you cant beat your troops up. Are you doing a 360 evaluation process but it sun lear who is going to be doing the evaluating. Are you any further down the road, in figuring out how you are going to do this . We are running a pilot. We are running one pilot and running a second one. And we are talking about do we use mentors and people, looking at the results, and do we have the senior reader involved, the boss involved in doing this . So were running pilots to see what the results will be. And i think well, im pleased with how it is is going. I suspect in a few months that we are going to announce where we are headed with this. Once i get the final results of the second pilot that we have done. Are you concerned at all that in this phase, and with all of the challenges that were facing, that some of the best people in the army are simply going to decide i need to go do Something Else because this is not going to be as exciting . The indications i have so far are good. That we are keeping good people. Our best people. They are wanting to stay. It is about making sure they understand we still have a significant mission ahead. The region forces, and being globally engaged i think it helps them with something exciting and i say it is their responsibility to build the army for the future and thats what is important, we need our best leaders to do that and so far they are moving ahead with the mission. We will continue to monitor it. It is something were very cognizance of and we look at very closely. Sir, thanks for joining us. Appreciate it. Very much. Thank you. Coming up my notebook. We wwhen we realized wed ome left gear behind. Rain we were up the creek without a paddle. I mean, we literally needed paddles campbell had left em in his garage. Thankfully i had my Navy Federal Credit union credit card on me, so we got new paddles and earned cash back. Next time well remember the paddles. Seriously . And forget campbell. 4 million members. 4 million stories. Navy federal credit union. Anyone who knows general ray otorino knows he is a passionate and forcele leader. He is the armys chief of staff at a diff time dealing with budgetary uncertainty, continuing resolutions, sequestration and a Government Shutdown resulting in readiness short falls that have left the army with only two fully come bat ready brigades. That is grime news for an all professional force that is the best in american history. Instead of mapping a sensible and strategic draw down the sequestration is hitting readiness again along with acquisition accounts undermining key american war fighting advantages. This as the sort that resets itself as iraq and afghanistan to renew equipment and retain the right hard fought lessons like complex Counter Insurgency skills. Now, instead of focusing on their jobs, soldiers will again start pulling gate guard, kitchen patrol and lawn mowing duties. That worked when whee a draft and plenty of low wage man power but with not todays seasoned all volunteer source. Sticking them with these menial tasks is the surest way to drive the best talent from uniform. The four congressional budget negotiators try to forge a debt deal they should visit military bases to understand what their cuts mean and give the pentagon and other agencies the ability to plan wisely and cut strategically now while it is still time to get it right. Thanks for joining us for this week in defense news. Im vago muradian. You can watch this show online at defense news tv. Com or e mail me. And a special thank you to the United States army and army public affairs. We will be back next week at the same time. Until then, have a great wike. Week. You woulda thoughtalked from the name of it, it was gonna be packed with sailors. So i immediately picked out the biggest guy in there. And i walked straight up to him. Now he looks me square in the eye, and, i swear he says, welcome to Navy Federal Credit union. Ha whoa friendly alert i got a great auto rate outta that guy. With rates slashed across the board, its a great time to buy a car. 4 million members. 4 million stories. Navy federal credit union. The online melt down. Is this what we can expect from health care i. T. . We will ask the former Obama AdministrationHealth InformationTechnology Czar and ask him what has gone wrong and wright with health i. T. And his prescription for the path forward. Im steve oleston. Welcome to biocentury this week. Glitches in federal Health Care Exchange web sites have focused the worlds attention on the role of Information Technology and health care. And starting on octoberer 1, private plans will actually compete for your business. And you will be able to comparison shop online, there will be a marketplace online, just like you would buy a flat screen tv, or plane tickets or anything else you are doing online and you will be able to buy an insurance package that fits your budget and is right for you. The problem has been that the web site that is supposed to make it easy to apply for and purchase the insurance is not working the way it should for everybody. Will is no sugar coating it. There is no sugar coating it. And i think it is fair to say that nobody is more frustrated by that than i am. As important as the affordable Exchange Sites are they are only a small part of the Government Health care i. T. The Obama Administration started down the path of using Information Technology to Reform Health care long before the enactment of the Affordable Care act. The Stimulus Investment and the health i. T. Requirements in the Affordable Care act are banking on technology to create the kinds of efficiencies in health care that have transformed retail and service industries. And the hope is that technologies like mobile apps can empower patients. One individual personified the governments efforts to drive health i. D. , harzod moffettashary who recently resigned as coordinate ner health and Human Services and we will hear his vision for data to transform medicine and empower patients and a candid assessment of what is going wrong and right in health i. T. To discuss the past and future of Health Information, im pleased to be joined by dr. Mustashar ry. I know you havent been involved in doing it but i have to ask people because people have the expectation, how did the federal online exchanges get so screwed up . Well, as you started off by acknowledging, that wasnt my area of involvement. But you got as good of as an informed outsider have you about as good a position as everything. I guess i could speculate as everyone else is speculating about the insurance exchanges. I guess the insight which is not a very novel insight is i. T. Is hard and if you look at a single hospitals information system, getting that set up and running can be a journey of several years. And this was a pretty big undertaking. But fundamentally, i think, the idea that i want to make sure people understand is the Affordable Care act is not a web site. And the provisions for people to get insurance and to be able to do that, they are certainly going to be greatly aided by the ability to do Online Shopping but that is not the only thing that is available. And the only way in which insurance eligibility is expanded, including through medicaid. But also, people i think are not understanding how the Affordable Care act wasnt just about insurance for the 15 of the population who doesnt have insurance, and it is really important to help them get Affordable Health insurance. That is really important. But everybody else is not getting very Good Health Care either. I want to go back to that. But one other question, about the exchange, and then we will move on to the other things that we really want to talk about, is if you look at it, when you were a coordinator for health care i. T. , your job wasnt to write code or to organize or to even buy code. It was to set standards, and then to kind of set the marketplace. And if you look at, it maybe there is an analogy in the online exchange, the federal government sets the standard for the state, and the states have been far more successful than the federal government. And better and the federal government didnt want to be in the business of running those exchanges. And in fact, the law really imagined and provided funding for the states to set up the marketplace, and it was only really by default that the federal government had to take on the work of those state exchanges. But youre right, that in my role, as National Coordinator for Health Information technology, it was about helping doctors and hospitals adopt health care i. T. To use computers to take care of their patient, not just their billing. And so the way i look at it, there are two things. Health i. T. In itself is not an end. There are two things that are really interesting that it can do, as far as im concerned. The first is patient empowerment. And we will talk about later in the show. And the second one really is facilitating improvement of the way medicine as a whole work, the way that payment reform can work and the way that providers can integrate with each other and so on. Population health. Exactly. Can you talk a little bit about that and the context of the Affordable Care act . Yes, so the Affordable Care act, also made some really significant changes in how health care is paid for. To move us away from they say you get what you pay for, so traditionally we have been paying for things to be done to people, heads in beds, and we have been paying for visits, we have been paying for procedures, we have been paying for stuff to be done. And stuff gets done. And guess what . Where we end up with is a lot of procedures, a lot of hospitalizations, a lot getting done but were not incentivizes outcome so if i talk to a primary care provider and i say spend that extra time on helping the person quit smoking, and theyre like, im going to go broke. Thats what is best for the patient but it is going to keep them out of the hospital so the first point is, the Affordable Care act said we are going to change how health care is paid for. My mom got admitted to a hospital, a few years ago, for a routine knee operation. And she had complication after complication. And unfortunately, that is so common. One out of every three medicare patients has some sort of complication during a hospitalization. If she gets readmitted back to the hospital, if she gets discharged, they dont have very good followup instruction, very good coordination, or a good pass off to the primary care doctor, if she got readmitted back to the hospital within 30 days, that hospital made more money. Think about that. If that hospital invested in reducing the complications, they made less money. That is fundamentally broken. It is indecent. That is one of of the things that it is supposed to change in the Affordable Care act. The Affordable Care act changed that. Well, it is changing that. I wouldnt say it changed it overnight. I dont think you would. But we will talk about it when we come back. And first, i want to talk about the veterans administration. And the use of medical data to empower patients. This is a look at the Blue Button Initiative that started at the v. A. And has been widely adopted. Veterans will be able to go to the v. A. Web site, click a simple blue button, and download or print your personal Health Records so you have them when you need them and can share them with your doctors outside of the v. A. That is happening this fall. Gun without a background check. Ithe dangerously mentally ill. Criminals. Endangering our families. Ken cuccinelli opposed closing the gun show loophole against comprehensive background checks at gun shows for criminals and the dangerously mentally ill. Siding with the nra and undermining law enforcement. No wonder the Washington Post calls cuccinelli polarizing, provocative and partisan. Cuccinelli. Too extreme for virginia independence usa pac sponsored this ad. Quickly followed by skydive. And paris romance. There was a quick interlude. Then mighty aphrodite. But then the day came marry me. And she thought and thought and then she chose freedom trail. Theres a deep, rich, enduring color for everything, including love and happiness. Benjamin moore. For everything that matters. Were talking about using data to transform medicine and empower patients. Doctor, we just looked there, we saw president obama talking about the Blue Button Initiative. What is it . And what is that an example of, of what can be done with patients, what they can actually do with data . What it fundamentally says is you have a right to your data. And knowledge is power. And if we open up and if we let patients have their own information, whether it is the v. A. Doing it, whether it is 37 Million Medicare beneficiaries, like my mom and dad, and being able to download three years of every claim medicare has paid on their behalf, or whether it is now increasingly, if you go to are doctors office, or the hospital, youre going be able to go online and download your medical records, to have, and also to access a whole variety of apps and services that are going to be built up to help you manage your health care. And that is the key thing. Because the big thing in advancing health, as opposed to advancing kinds of the business of health, is going to be changing behaviors. It is going to be reducing smoking, smoking cessation, and weight loss. And medication taking. Adherence, yes. And how can absent data help with those practical things that have really important . That is the exciting thing. Instead of us prejudging that and we want somebody to build a service ha will do x, y or z, you let the market and the Silicon Valley startups and this is the hattest area of Venture Capital investment right now is this, taking data and helping People Find Services and help them manage their health and their health care, and their health care finances. Because increasingly there is going to be just not the responsibility on patients but the ability for them to be able to have transparency in terms of price and quality and in terms of what providers they choose. So that is people empowering people and one of the things ive seen, and if you talk to people anecdotally about is that the way that some Electronic Health i. T. Is integrated into the medical system is that it is a computer that is literally between the doctor and the patient. Yes. We try to tell docks not to do that. Thats what i want to get to. Is that something that is inherent in integrating computers in medicine or something wrong with the technology or something wrong with the way doctors are using it. I think it takes time to learn how to use the Different Technology best so what we teach providers to do is have it be a triangle, this is the screen literally, and you can both look at the screen and you can say, here is what im saying, you had it for three weeks, and you can chart it, and you can graph it, and then that becomes a tool for patient education. Instead of, you know, a laptop that is hidden from the patient. So it is really all about how do we take this technology and how do we change how we deliver care to make it better . So one of the things that people also have an imagination about, when they think about the government making standards that are going to require a lot more electronic Health Records, can you imagine, there are giant Health Record outs there, and your Insurance Company is going to get it and maybe your employer is going to get it and things like that. Is that what that means . There is no vast government database of all of your medical records. What we did is we said doctors and hospitals need to be able to have their patients information electronically, and they need to be able to share it with each other. This is where the second stage of meaningful use, technical term, will come in, and really importantly, there is a place where all of your medical information can be aggregated. You. You will have the ability to say give me all of my records. You can go to your health plan, you can go to your hospital. Go to your hospital. You can say give me my data. And i will put it in one place if i want to and i can share it with whoever i want to share it. And will it be in a standard so that from all of these other different places that can be combined . Exactly. We set the standards. And this was an indispensable role for government to say we are going to convene people across the industry, competitors and we are going to say lets choose one set of standards. For how the vocabulary is used, how it is packaged, how it is transported securely, and privately, and so that you can the systems can understand each other. And that is going to take effect over the next 12 months. And we will talk about that more. The socalled meaningful use state. When we come back. More in a moment. Now back to biocentury this week. Dr. Farzad mostashari, the former hhs National Coordinator for Health Information technology. Dr. Farzad mostashari, i think a lot of people watching the show will say that is wonderful stuff that youre talking about but im not seeing that in my life. Amazon and itunes do a lot better job of integrating my technology than my doctors do. How far, can you give us an idea of how far we have come in the last couple of years and where we are and then where we are going to get to where youre talking about . The big thing that changed everything, was the hightech in 2009, the year before the Affordable Care act. Part of the act that said that the doctors and hospitals could get incentive payments if they not only bought Health Records but they used them in certain ways like sharing information with patients or with each other or sending electronic prescriptions and at that time four out of five did not use electronic Health Records and 9 out of 10 hospitals did not use Health Records to order prescriptions and take care of patients. That is in 2009. 2009. And today . It doubled and tripled and quadruple and quintupled among hospitals and now we see two thirds of doctors offices and three quarters of hospitals, they are on this path towards meaningful use of electronic Health Records. That is only the first stage. The first stage. And you will have undoubtedly seen this in your own doctors experiences, where they are going through a transition and now theyre trying to think about how to use these computers. And cursing at them. Yes, cursing at them. But that is just the first step. That is just digitizing it. But the next step in the process is where it gets really exciting which is the sharing. And that is stage two. Of inter operability. Which is the standards now, they have been promulgated, in the 2014 certification requirements, for these electronic Health Records. And if we can continue on the same accelerated path we have been on, in 014 you will see 2014, you will see huge differences. What does that mean in a practical way for patients in the medical system . And that means if you get discharged from a hospital, your primary care doctor will be able to get the information from your discharge. When you show up at a specialist, they will have your records, instead of turning to you and saying, why are you here . So you are not going to be going out and filling out on a clipboard again. I sure hope not. You will be able to get your own medical information and there will be inter operability between those two systems so the drugs you get here and the drugs used in the other place will be synced up with each other. That is stage two of meaningful use, the inter operability piece of this. But once when the data starts to flow, what is is really exciting is the ability to learn from it, for systems to learn from it and learn what is working and what is not working and moving to a better outcome. And were just taking the baby steps to the Data Revolution that has transformed every other industry finally coming to health care. And amazon, does a pretty good job of predicting what kind of books i would like and with the doctor, there is nothing to predict what might happen and what systems are happening and when do we get to that . Well, maybe that is stage three. And some of the other things that people talk about is using electronic data to track disease, for example. Thats right. And there is an example that people like to talk about, about google that they could track flu symptoms and predict where the flu was, and that isnt such a simple story, is it . Well, you know, i think the main point is, that with a lot of data, you can make a lot of inferences. But the problem is, you generate some of the data, some insights but you got to get to action. You got to be able to test it. There are a lot of signals that happen. There is a lot of potential out there, but you still need the boots on the ground. You need the public helmet workers and you Health Workers and you need the doctors and the Emergency Room Physicians to be able to write down and get to what is actually happening on the ground. And i think that is why we cant just have big data in the sky. We need to have small data in the clinic and in the health department. Okay. And what are the kind of things that need to happen then to make big data actually something that is going to change peoples lives. And change them . I think we have to unleash the creativity of american entrepreneurship on this. As we do this, there is one key thing that we really have to constantly be aware of. It is privacy. And there should be no surprises for people. And lets talk about privacy issues and how you get that privacy. When we come back. We will talk to Farzad Mostashari about that and get some final thoughts. Were back with dr. Farzad mostashari, talking about privacy and data. Dr. Farzad mostashari, you ended there, and were you talking about privacy. What do we have to do to ensure privacy on a personal level, and at a societal level . Everyone has to do their part. And patients really are putting their trust in their health care providers, their doctors, and hospitals, to keep their Information Private and secure and those providers immediate to take that utmost seriously. I hear every day, laptops that are stolen, where the information wasnt encrypted. That should never happen. If are you going to put patients information on a thumb drive or a laptop, first of all think carefully about why youre doing it and second of all, for goodness sake, just encrypt it. Server rooms should be locked. There are basic protects that are part of hipaa and the security rule and meaningful use that should be taken seriously. And also the vendors that they work with, the Business Associates often times they use passing off of data to analyze it and clean it for you. Those instances now, with the hipaa modifications, that took effect, those also have that same responsibility. But it is also patients. And if you use a service, to store your personal Health Information, and increasingly it will be more and more Services Like this, right . From Microsoft Health vault to box. Com. To no more clipboard. A whole host of Services Like this now. And make sure you understand their privacy policies. And there should be a simple onepage comment that says, that explains what they do with your data. If you dont see that simple explanation of what they do with your data, who they share it with, and so forth, dont use that service. And make sure that you take the steps you need to make sure the information that if you store it, it is encrypted or it is not on your device. And so if people have their health data on their computer, on their smartphone, you should encrypt the information. Or make sure you have good pass word protection. And what are the other things . You started earlier, you said that there is one place where all of the data is going to be and that is going to be with the patient. That puts a lot of one hand responsibility on the patient and the other hand the ability to do things with it. Most patients think that medicine is something that happens when youre with a doctor and actually health is something that happens all the time. What can people do with data in practical ways and ha can they do in the future . I think it is going to change and i think youre exactly right there. Is responsibility, and with that, empowerment. And those are the two sides of that coin. And now, i think we hear about ways in which the Health Care System doesnt serve patients well. There are safety problems. So for the one thing, right, ask to see your record. If youre there and the doctor is typing behind you, and you dont know what theyre typing, you have every right to see what is in that record. What are the medications they have you on . Check it. Maybe it is not right. Often times it is not right. And that could be a potentially fatal issue for you. So taking that responsibility. And doing what were doing, doing it for your family members, your loved ones. And you know, people with diabetes, their risk of dying in the next three years is cut by 50 if theyre on a statin. And only half of people who should be on that are on a statin. I want that conversation flipped. Instead of the doctor wagging the finger at the patient saying you should do this, and you need this, and you should get this or whatever, i want it to be turned the other way where the patient says to the doctor, hey, based on the best scientific evidence, i need, i deserve, i should have, right . That, i think it is going to be a profoundly different thing in our Health Care System and profoundly positive. That is something that can be enabled by the apps were talking about and patients are knowing exactly what the standard of care is that they should have. Yes. Thanks. A fascinating conversation. I would like to thank nye guest dr. Farzad mostashari. Remember to share your thoughts about todays show on twitter. Join the conversation by using the hash tag bio sentry tv. Im steve oleston. Thanks for watching. Captioning made possible by johnson johnson, where quality products for the American Family have been a tradition for generations osgood good morning. I am Charles Osgood and this is sunday morning. Halloween is almost upon us. The night when even some of the grown up among us revert to the playful way of children. One game that can be played all year around is the game of tag which involves declaration, youre it, and it is not strictly kid stuff either as lee cowan will demonstrate to us in our sunday morning cover story. How far would you go to stay in touch with your best friends . A group of High School Buddies a monthlong game