HIMSS14 - Evolution & Inertia...

I attended the HIMSS Conference in Orlando, FL on February 23rd-26^th 2014[1]. This is the sixth year I have attended HIMSS & the conference has evolved considerably during that time. This year there seemed to be some large underlying themes that I’ll mention here & cover in more detail.

The first strong theme was that most healthcare organizations (as opposed to vendors) were moving past Meaningful Use Stage 1 and looking for value in other areas. The second theme was that HIE was giving way to ACO as a more useful & sustainable model for information sharing. Finally, there seemed to be much more of an emphasis on information technology that works & provides value & leverage towards the Triple Aim; as opposed to information technology that is specified by regulation.

As always (at least always as long as I have been attending), it was huge. The final reported attendance was over 50,000, there were just over 200 presentation in 3.5 days & the keynote speakers included: Mark Bertolini (CEO, Aetna), Marilyn Tavenner (Administrator, CMS), Karen DeSalvo (the new National Coordinator for HIT, ONC) &, of course, Hillary Clinton. Then there were the exhibitors of which there were more than 1100. As I said, huge…

I was actually impressed with the general level of the presentations at this year’s conference. I felt that the quality was at least partly a result of the difficulties facing many healthcare organizations & their genuine attempts to address these issues. This was evident even in the topics covered. There were almost no presentations on EHR adoption, that has already happened & many organizations are looking past their EHRs to see what data from the EHR & other sources will give them financial & clinical leverage. There were a lot of presentations on use of data, analytics for both administrative & clinical data, patient engagement, population health, mobile HIT etc. There was also an emphasis on privacy & security of personal health information – not just in the EHR. In short, there was less emphasis on straight HIT & more on creative & interesting uses of HIT. 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. Several themes seemed to emerge from the presentations at the conference:

•         EHR vendor churn still appears to be an issue with a large number of organizations looking to change vendors, especially as they move toward accountable care.
•     Many organizations are exploring non-EHR applications for specific types of connectivity & information sharing. These include DIRECT Messaging, analytics packages that include: non-SQL storage solution, map reduce-like function, & a visual front-end, HIE & integration engine backbones, etc.
•     One specific dimension of the non-EHR movement is use of specialized applications for care transition, medication reconciliation & care continuity capabilities. This is occurring even though most EHR vendors claim to provide these functions.
•     Many organizations are also exploring advanced analysis capabilities to address issues of sustainability, financial planning & improvement of clinical processes.

The keynotes for this year’s conference were way better than average (quite a comment given that I usually think keynotes are a waste of time).     

• Mark Bertolini, CEO, Aetna – This was a surprise. Mark spoke about the need to substantially improve outcomes for 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. This was somewhat disingenuous (IMHO) given the attitude evidenced at the conference that Stage 1 was over (& not very “useful”), & Stage 2 might be a stage too far. Ms. Tavenner seemed somewhat unconcerned with these concerns, which may be why they seem relevant.
• 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. My first reaction to this is integration with & for what? If the focus, as it appears, is going to be to integrate current EHRs with other current HIT, without evolving the software on both ends to be more relevant to the Triple Aim, then this will be an empty effort. I have been architecting ‘interoperability’ of large-scale software systems for 25+ years & the most successful efforts I have been involved with always have a goal set & a technical requirements set. I’ll be more sanguine when I see these from the ONC. For the rest of Dr. DeSalvo’s talk, she recapitulated her experience in New Orleans during Katrina. If the lessons from this terrible event can be assimilated & put into practice by the ONC, that will be a great thing.
• Hillary Clinton, no introduction necessary – Secretary Clinton spoke about health care reform (mainly her efforts at it) for 20 minutes and then answered questions for 30 minutes.

With over 1100 exhibitors, the exhibition floor could be intimidating. I spent much of Tuesday & Wednesday afternoon on the floor & saw ~100 different companies. I emphasized small-to-medium companies for in-depth looks as I already have a pretty good idea of what Epic, Cerner, Oracle etc. do. Here’s a short list of some of the interesting companies/products I saw:

• Blueprint Healthcare – Blueprint has focused on the HIE to ACO transition & care coordination portals, my pick-of-the-show this year.
• Tableau Software – Tableau has an analytic & visualization platform that is very easy to deploy & use.
• Get Real Health – Get Real (no comment on the name) has focused on patient engagement & developed a very approachable & 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 & many more customers. They still have one of the more interesting products in this space, one that both CMS & the ONC are currently emphasizing.

Of course, you can’t summarize 1100 companies in a short report, especially when you have actually seen only about 10% of the exhibits, but again, some common themes come across:

• The EHR & large system vendors seem to me to be engaged in developing & 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. Your organization may not be involved with it yet, but you will be in the next 12-18 months. This has implications for not just your IT function, but admin & 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 & 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 & done the hard work to actually be able to normalize data semantics from multiple EHRs & other sources. There were many other examples from the conference (see above in Session & Exhibition sections).
• Healthcare organizations are looking for actual value & not just name recognition in IT acquisition. Healthcare organizations are looking for cost & capability value, they have to.

HIMSS15 is just over a year from now in Chicago. I can’t wait…

My next post will look at the recent study published in JAMA that calls into question the effectiveness & goals of Patient Centered Medical Homes. As always,… Stayed tuned.

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[1] A version of this material appears on the RCHN Community Health Foundation website. I am Director of Technology Research for the Foundation & they supported my trip to HIMSS.