????傳播艾滋病的紐約妓女、傳播致命病菌的蚊子、身攜炭疽病毒的恐怖份子、到處是病人和窮人的城市……法扎德?莫斯塔沙瑞需要應對很多挑戰(zhàn)，上面所說的這些只是其中一部分。莫斯塔沙瑞是一名從耶魯大學畢業(yè)的醫(yī)生、流行病學家，另外他還自認是一名“電腦怪胎”。目前他的使命是：將醫(yī)生們從古騰堡時代帶進21世紀。莫斯塔沙瑞建議剛入門的人首先從在辦公室里使用電子郵件開始。

????不要以為這是件容易的事。美國雖然在尖端醫(yī)療技術領域走在世界前列，但面對電子通訊，美國醫(yī)學界卻普遍持保守態(tài)度。根據(jù)美國疾病控制與預防中心（Centers for Disease Control and Prevention）的估算，2010年大約只有百分之十出頭的私人診所醫(yī)師擁有“功能完備”的電子病歷系統(tǒng)。除了賬單，只有不到一半的私人診所醫(yī)生會使用電腦做記錄。許多醫(yī)生的電腦通訊技能還不如一個在家里開eBay網店賣燒烤圍裙的人。這是實話。

????今年43歲的莫斯塔沙瑞是聯(lián)邦辦公室的一位主任，負責領導醫(yī)療數(shù)字化工作，他正力圖改變這種狀況。他總喜歡說：“數(shù)據(jù)就是力量”。他的頭發(fā)剃得干干凈凈，打著領帶，看起來熱情四射，身上散發(fā)著一種優(yōu)秀銷售員的氣質，談話時會碰碰拳頭，甚至和人擊掌相慶。雖然他的個性也幫了不小的忙，但莫斯塔沙瑞最大的王牌還是錢。他用270億美元的聯(lián)邦刺激資金作為激勵，分配給那些安裝了電子病歷系統(tǒng)，并證明自己正在有效使用電子病歷系統(tǒng)的醫(yī)生和醫(yī)院。一個醫(yī)生在6年的時間里最多能拿到6.4萬美元的獎金，而醫(yī)院則可能拿到數(shù)以百萬美元計的款項。

????莫斯塔沙瑞相信，電子病歷系統(tǒng)不僅可以降低成本，提高個人護理水平，還可以帶來更多的好處。現(xiàn)在大量的人口數(shù)據(jù)要么被孤立地裝在成千上萬的牛皮紙信封里，要么鎖在專用的電腦系統(tǒng)里。而電子病歷系統(tǒng)的普及可以使這些數(shù)據(jù)得到即時監(jiān)控，從而可以警告疾病的爆發(fā)，找到證據(jù)證明哪種療法最有效，也有助于發(fā)現(xiàn)創(chuàng)新性的治療方法。另外，無論是醫(yī)院、保健門診還是小型私人診所，都可以通過分析這些整合的數(shù)據(jù)來削減不必要的成本，同時也有助于對抗醫(yī)療價格的上漲。

????哈佛大學（Harvard）教授大衛(wèi)?布魯門薩爾也是莫斯塔沙瑞在美國衛(wèi)生部（the HHS）的前任，他說：“他正在試圖改變整個醫(yī)療系統(tǒng)。這不是一個技術工程，而是一個社會變革工程?！?/p>

????莫斯塔沙瑞小時候學習刻苦，成績出眾，當時他自己也頗以此為傲。14歲的時候，莫斯塔沙瑞離開祖國伊朗，搬到紐約上州地區(qū)，與姑姑住在一起。伊朗是個崇拜數(shù)理化的國家，莫斯塔沙瑞以為，憑著自己在科學、數(shù)學和電腦上的才智，他在美國也會很受歡迎。不過他錯了。同學們都嘲笑他，但他自己卻一直鍥而不舍。

????莫斯塔沙瑞從哈佛大學公共衛(wèi)生學院（Harvard School of Public Health）流行病學專業(yè)畢業(yè)，后來又進入耶魯大學（Yale）醫(yī)學院深造。他希望把實際的醫(yī)療經驗與流行病學對模式識別的抽象追求結合起來。在一個早期的項目上，他統(tǒng)計了HIV病毒在靜脈注射藥物人群（包括妓女）中的流行度。受雇于紐約市健康與心理衛(wèi)生部（New York City Department of Health and Mental Hygiene）后，他被任命為首席調查官，負責調查西尼羅病毒爆發(fā)的原因。2001年，美國爆發(fā)了令全國陷入恐慌的炭疽郵件襲擊。隨后，他應用數(shù)據(jù)模式開發(fā)了早期的恐怖警報信號。

????約紐市長邁克爾?布隆伯格把他放在了目前這個位子上，現(xiàn)在他的任務是要把信息技術帶給一大群極度貧困的病人。2005年，莫斯塔沙瑞負責了一個項目，幫助全市的醫(yī)院、診所和社區(qū)醫(yī)療中心建立數(shù)字病歷系統(tǒng)。這個系統(tǒng)現(xiàn)在已經覆蓋了200多萬名病人。

????今天，莫斯塔沙瑞正在試圖把這些經驗推廣到全國。值得注意的是，在這樣一個黨派政治當?shù)赖臅r代，莫斯塔沙瑞的計劃同時獲得了兩黨的支持——或者說，至少是得到了兩黨的容忍。盡管2009年只有三名共和黨議員投票支持刺激法案（正是該法案為莫斯塔沙瑞的計劃提供了資金），但卻很少有人公開反對這個計劃本身。事實上，信息技術產業(yè)本身也是該計劃的一個主要支持者，IBM、微軟（Microsoft）、通用電氣（General Electric）、惠普（Hewlett-Packard）等科技巨頭和許多小型的專業(yè)醫(yī)療技術公司都表示了支持。

????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.