The recent HIMSS Conference in Orlando, FL on February 23rd-26 was huge. The final reported attendance was over 50,000 and there were just over 200 presentations in 3 and a half days.   There were also over 1,100 exhibitors. So much activity packed into a short time frame might have been overwhelming, but my experience this year – my 6^th year in attendance – is that the conference has evolved considerably, becoming more substantive and focused on key issues and themes.

First, I was actually impressed with the general level of the presentations I felt that the quality was at least partly a result of the difficulties facing many healthcare organizations and their genuine attempts to address these issues. This was evident even in the topics covered. At long last, there were almost no presentations on EHR adoption; that ship has sailed and many organizations are looking past their EHRs to see what data from the EHR and other sources will help them create financial and clinical leverage. On the other hand, there were a lot of presentations on use of data, analytics for both administrative and clinical data, patient engagement, population health, mobile HIT, as well as  an emphasis on privacy & security of personal health information – not just in the EHR. In short, there was less emphasis on straight HIT and more on creative and interesting uses of technology. Key issues that emerged from the presentations:

• EHR vendor churn continues, with a large number of organizations looking to change vendors, especially as they move toward accountable care.
• Though most  EHR vendors claim to support extended functionality, specialized non-EHR applications for specific types of connectivity and information sharing are where it’s at. These include DIRECT messaging, analytics packages that include: non-SQL storage solutions, map reduce-like function,  a visual front-end, HIE and integration engine backbones, etc.
• One specific dimension is use of specialized applications outside the core EHR for care transition, medication reconciliation & care continuity capabilities.
• Analytics is essential. Many organizations advanced analysis capabilities to address issues of sustainability, financial planning & improvement of clinical processes.
• Most organizations are done with EHR adoption & Meaningful Use Stage 1 qualification. Many organizations are questioning the value of MU Stage 2 qualification at this time and are looking to defer qualification while they work on other issues.

This year was also marked by substantive and interesting keynote presentations – a real change from past years and for a change, worth hearing.

• Mark Bertolini, Chairman, President and CEO, Aetna – Mr. Bertolini spoke about the need to substantially improve outcomes for those with chronic conditions, especially for people with multiple conditions and comorbidities. Aetna is putting strategies in place to deal with this problem (including preventative processes).
• Marilyn Tavenner, Administrator, CMS – Ms. Tavenner’s keynote was primarily about staying the course on meaningful use. Interestingly, this contrasted markedly with the general buzz at the conference that Stage 1 was over –and not very “useful”, and Stage 2 might be a stage too far.
• Karen DeSalvo, National Coordinator, HIT, ONC – This is the third time I have heard Dr. DeSalvo speak since her appointment as National Coordinator. Her talk emphasized how far we have come with HIT, but also how far we have to go. Her focus will be on ‘integration’, at least for the foreseeable future Dr. DeSalvo recapitulated her experience in New Orleans during Katrina. If the lessons from this terrible event can be assimilated and put into practice by the ONC, that will be a great thing.
• Hillary Clinton, no introduction necessary – Secretary Clinton spoke primarily about health care reform.

Finally, I spent much of Tuesday and Wednesday afternoon on the exhibit floor visiting about 100 different small to medium vendors. While it’s impossible to summarize al the companies, especially when I was actually able to visit only 10% of the exhibits, the vendor displays illustrated some common themes, largely consistent with the presentations:

•           The EHR and large system vendors seem to be engaged in developing and trying to sell more of the same, despite the fact that the consensus seems to be moving away from these heavyweight, awkwardly integrated solutions that emphasize a view of HIT that is in the process of evolving.

•           Accountable care is here. Those organizations not yet engaged in ACOs will be in the next 12-18 months. This has implications not only for IT functions, but administrative and clinical functions as well.

•           Innovation is being done at the edge (as usual); not just in small-to-medium size companies, but also in healthcare organizations, many of which have high-quality, but limited staff and other IT resources. A very good example would be the work on semantic integration reported by the Medical Information Technology Group at the University of Pittsburgh Medical Center. They have thought through and done the hard work to actually be able to normalize data semantics from multiple her and  other sources.

Here’s a short list of some of the most interesting companies/products I saw:

• Blueprint Healthcare – Blueprint has focused on the HIE to ACO transition and care coordination portals, my pick-of-the-show this year.
• Tableau Software – Tableau has an analytic and visualization platform that is very easy to deploy & use.
• Get Real Health – Get Real (no comment on the name) has focused on patient engagement and  developed a very approachable and easy to understand patient portal to be used in conjunction with EHRs, clinical registries etc.
• Applied Pilotfish – Pilotfish was my pick-of-the-show last year (HIMSS13). They were back this year with their visual integration canvas and  many more customers. They still have one of the more interesting products in this space, one that both CMS & the ONC are currently emphasizing.

Synthesizing the many keynotes, presentations, educational sessions and vendor displays, several strong themes emerge. The first is that most healthcare organizations are moving past Meaningful Use Stage 1 and looking for value in other areas. Next, health information exchange  Is giving way to the ACO paradigm as a more useful and  sustainable model for information sharing. Finally, providers and vendors alike are looking toward information technology that works, provides clear value and offers leverage toward the Triple Aim, as opposed to information technology that is specified by regulation.

Reflecting on Dr. DeSalvo’s comments, I would note that these themes indicate that integration needs to go well beyond integrating current EHRs with other current HIT.  To be both relevant and successful, integration efforts must be clearly defined, and have specified goals and technical requirements but most importantly, must be focused on helping providers attain both quality and value. Healthcare organizations are looking for more than just name recognition in IT acquisition, and defining and attaining value is at the core.HIMSS15 is just over a year from now in Chicago. I can’t wait to see how far we’ve come by then.

David Hartzband, D.Sc. is Director for Technology Research at the RCHN Community Health Foundation.