I arrived at the HIMSS13 Conference (March 3-5 2013) with a unique perspective this year; having serving as an abstract reviewer for the Meaningful Use and HIE presentation tracks I had an inside view on what was yet to come. I reviewed about 50 presentations and although there was quite a range in quality and sophistication of the proposed project presentations, I was generally impressed at the level of expertise & persistence shown by the people doing the most interesting projects. I was much more interested in projects actually being done in healthcare organizations to implement some aspect of Meaningful Use or HIE participation than in the ‘meta-projects’, conceptual projects or thoughts about projects that some organizations proposed. My favorite, and the presentation that I moderated, was from the Marshfield Clinic (Marshfield, WI) that presented an effort to adopt a Computerized physician order entry (CPOE) capability in their homegrown, certified E H R . The thing I liked about this group was that they understood that technology was only one part, perhaps the smaller part, of the adoption effort, and they developed a process that included & engaged all of the involved groups at the clinic. It wasn’t easy, but it did work.
First, some general conference impressions: The conference was noticeably smaller this year, 33,000 attendees versus about 37,000 attendees last year. There were no uniformed service members or members of the U.S. Public Health Service Commissioned Corps (Uniformed Health Service) present. Well, I actually saw two or three people in uniform (including one U.S. Air Force Lt. Colonel who paid his own way). This was a far cry from the thousands of uniformed service members & uniformed public health service members at the conference last year. The fact that these constituencies were not present changed the tenor of the conference for me – not that they over influenced it in the past, but their absence, because of travel restrictions, was a real difference.
The other absence was of Federal employees. The ONC was well represented – Farzard Mostashari and his team seemed to be everywhere this year – as was the VA, but other government agencies (HHS, NIH, NSF, Commerce etc.) were poorly represented, again because of last-minute travel restrictions. It was not clear how much of this was related to the sequester, but it certainly had an effect. The absence of Agency personnel is a bigger deal than that of uniformed personnel as these people decide on and monitor federal grants and other project funding for healthcare , and are engaged in writing the regulations that are applicable to healthcare. Colleagues from AHRQ HHS and NIST with whom I’ve been working were not able to attend.
Another absence, at least in my opinion and the opinion of a number of people I spoke with, was the lack of innovation in product design and overall application of technology to healthcare problems. What did I expect to see? I thought I would see products/applications that would address issues such as continuity and transition of care, simplification of integration among products necessary for Meaningful Use & HIE participation, evolution of user interface (UI) to more fully facilitate clinical workflows and to simplify the steps of those workflows, etc. I did see some small improvements in these areas, but not the real efforts at addressing them that are needed. Every large (as well as most small) EHR vendors claim to be working on these issues, or to already have solutions for them. While athenahealth & Practice Fusion have certainly made headway here, they are numbers 9 & 10 on the ONC list of installed ambulatory EHRs (2.4% & 2.4% respectively), and accordingly, are pathfinders rather than influencers. In contrast, Epic & AllScripts are numbers 1 & 2 on the list with 20% & 13% installed EHRs nationally. Do I expect to see either Epic or AllScripts lead in addressing the hard issues for technology in healthcare? To the extent that they are business-model focused, I sense they will address these issues only if in alignment with their bottom-line goals. Well, I saw a lot of consolidation (more on that below), a lot of new versions of existing products, a lot of rhetoric about addressing pressing issues, but very little actual addressing of those issues in new and/or productive ways.
CommonWell Health Alliance, a new “independent”, non-profit trade association open to all healthcare companies (although apparently not to Epic), was a huge center of interest. CommonWell will focus on promoting and certifying a common, national-scale infrastructure for the sharing and use of healthcare data. Its initial focus will be:
- Patient linking and matching – providing cross-platform and cross-organizational capability for identifying patients regardless of setting;
- Patient access and consent management – providing a HIPAA-compliant, patient-controlled means to simplify the management of consents and authorizations for data sharing;
- Record Locator Service and Directed Query – Enable providers to match the locations of a patient’s previous health care encounters, no matter where the encounter occurred, and gain access to that data in an industry standard way.
Founding members hope to have the infrastructure and a ‘proof-of-concept’ available in 18 months. General interest notwithstanding, the real value of Commonweal is unclear. Both Dan Munro at Forbes and Adrian Gropper at the Health Care Blog seem to think that CommonWell is not as great a thing as the member companies make it out to be. I attended a session presented by McKesson & Cerner, in which the speakers implied that the companies in the alliance would continue with their current, independent development, but aim to be able to demonstrate a proof-of-concept on record sharing with identity disambiguation as well as integrated consent management by late next year
Also in the consolidation space, AllScripts announced their acquisition of both dbMotion & Jardogs. Motion was the last independent care coordination & HIE platform. Now the consolidation of these platforms is pretty much complete with large companies (like AllScripts) or payers (Aetna’s acquisition of Medicity) all accomplished. It could be argued that this is a good thing, but my experience is that there is generally very little opportunity for innovation after acquisition, as the focus is typically on revenue generation to cover the acquisition cost. Innovation in the data-sharing platform segment will have to come from elsewhere.
Jardogs was my pick of the HIMSS show last year & since then it has gone on to be the highest-ranked (KLAS) patient engagement platform – FollowMyHealth. I felt that its simple user interface and equally simple way of acquiring data fro EHRs, PHRs etc. made it a product to be watched. Apparently I wasn’t the only one to think so, and hopefully its acquisition by AllScripts will not impede its innovative
Don’t think I didn’t like anything at HIMSS – I did! . My pick of this year’s show is PilotFish (I appear to have a weakness for animal-related names). PilotFish is a healthcare interoperability platform that actually uses the model of an app store to allow a user to make integration selections among EHRs & other applications. It also has a drag and drop palate to visualize the integration and drop-down menus to make technical selections with respect to interfaces & data formats. If I’m right about PilotFish, they’ll be acquired by the next HIMSS Conference. I wish them luck…
The educational sessions this year were particularly good. The sessions seemed to emphasize several important themes. The most interest appeared to be around analytics. There were many sessions on data-based clinical care and use of ultra-large data sets (Big Data) to analyze and plan clinical and operational process as well as improvement of clinical outcomes. Increasingly, healthcare organizations are making the investment necessary – either directly or through networks, HIEs, and ACOs – to manage and analyze large amounts of data. The idea of evidence-based care is evolving to data or information-based care. There were several sessions that reported on hospitals using information in their own clinical data repositories in order to develop treatment plans for otherwise clinically challenging patients. This, along with projects reported on in public health prediction & biosurveillence areas, as well as large-scale outcomes analysis, made for some exciting sessions. Two of the best of these sessions were: Extracting Value from Healthcare “Big Data” with Predictive Analysis (Denver Health & Siemens) & Enterprise Business Intelligence: Empowering with Data to Enable Transformation (Cleveland Clinic).
A second area of emphasis was mobile health. Every healthcare application (well, almost every one) has a mobile extension and many sessions reported on using mobile apps & mobile devices to improve care. The most interesting mobile session I attended was titled Beyond the Device: A Comprehensive Mobility Strategy (CDW Healthcare). The big idea here was that the selection of a device to provide mobile applications is only one (small) part of a strategy that takes into account what your organization wants to do with mobile access, and for whom (providers, patients, administrators, all of the above…) as well as where you want to start, and where you want to be in 2 years (4years, etc.). This seems like Strategy 101, but it is worth making explicit.
There also were a lot of sessions on Meaningful Use. I did get the impression that users, even those who had qualified and were receiving the incentive, were not convinced that their EHR was enabling better care. This was not true of those organizations that were using data analytics, including for their EHR data, to improve care plans & outcomes, but these are only a small percentage of healthcare organizations are primarily large groups like Kaiser or Partners or large hospital groups. Of course, the most crowded session was the ONC Town Hall which was all about Meaningful Use. Dr. Mostashari made clear that the move in payment and delivery reforms from volume to value goes through EHR-based Meaningful Use. Acting CMS Head Marilyn Taverner reinforced this message. With all the talk of Meaningful Use, it’s important to note that 33% of all EHR buyers are looking to replace their software, according to a recent Black Book Ranking cited in an iHealthBeat Perspective on March 11, 2013. This survey found 17% of providers will switch in the next year, 8% with no specific timeframe and that another 6% want to switch, but cannot afford to. One of the primary reasons cited for this discontent was the lack of fit with clinical workflows and a sense that the purchasing group did not sufficiently study their options (& might have wanted to go with one of the smaller, more flexible vendors i.e. athenahealth, Practice Fusion, Greenway etc.).
The last area of emphasis was patient engagement. If only we could agree on what this means… Does it mean the engagement required for Meaningful Use, or for PCMH, the provision of fully transparent PHI/EHR access, compliance with non-healthcare directed federal regulations such as FIPS transparency & consumer engagement, the use of public & private social media for healthcare purposes – some of the above? All of the above? There is also the recent survey by Accenture that showed that 82% of U.S. physicians wanted patients to participate in the own healthcare (by updating their EMR/PHI), but only 31% felt that patients should have full access to their medical records. There were many sessions devoted to working this out, and most large vendors had a section of their booth/display focused on patient engagement. The best example of a patient portal that was both usable and useful was from Kaiser Permanente. Several of the sessions in this area that I attended predicted great things for patient engagement, especially for the use of social media in various forms, but also warned that there was the potential for real harm (e.g. the Kaiser “communities”). A good example of this was the presentation The Use of Social Media to Educate Patients (St. Francis Hospital, Hartford, CT)
With 200 sessions over four days, and nearly 1500 exhibitors you could find nearly anything you wanted to at HIMSS13. As always, however, the real reason to come to the HIMSS every year is the people. This year was no exception as I met and talked to many, many dedicated, smart people who have devoted their lives to improving healthcare.
David Hartzband, D.Sc. is Director of Technology Research for the RCHN Community Health Foundation