Singin’ the Blues: visions deferred at HIMSS health IT conference

The main concerns of health reformers don't rise to the top of health provider agendas

HIMSS, the leading health IT conference in the US, drew over 32,000 people to New Orleans this year (with another thousand or two expected to register by the end of the conference). High as this turn-out sounds, it represents a drop from last year, which exceeded 37,000.

Maybe HIMSS could do even better by adding a “Clueless” or “I don’t believe in health IT” track. Talking to the people who promote health IT issues to the doctors and their managers, I sense a gap–and to some extent, a spectrum of belief–in the recognition of the value of gathering and analyzing data about health care.

I do believe that American health care providers have evolved to accept computerization, if only in response to the HITECH act (passed with bipartisan Congressional support) and the law’s requirements for Meaningful Use of eleectronic records. Privately, many providers may still feel that electronic health records are a bad dream that will go away. This article presents a radically different view. I think electronic health records are a bad dream that will go on for many years to come. I’ll expand on this angle when blogging from HIMSS this year.

I’m Watching The Clock: what matters in health IT, and to whom

At the opposite end of the rejectionists are those who hope to smash through the barriers set up by providers and researchers, fortifying their isolation through secretive vendor tools hedged around with licensing restrictions on sharing information. I believe that HIMSS management veers away from this view, but understands that the future of the health IT industry lies in such advances as standardization and data exchange.

In her introduction to the conference, HIMSS board chair Willa Fields pointed out the gap between HIMSS leadership and the wider medical community, commenting that most providers resent taking time away from patients to struggle with computers, and that skepticims exists about whether electronic records can lower costs. (The latter comment is certainly a reference to a notorious Wall Street Journal article of September 17, 2012, which accurately reported rising Medicare reimbursements but made some interpretations that were widely disputed by health IT proponents.)

Somewhere further from the position of openness, along this spectrum, cluster the nearly 300 executives who responded to the annual HIMSS survey. These industry leaders are investing heavily in IT. A large percentage will spend more than $250,000 to qualify for Stage 2 of Meaningful Use and a similar sum to implement the ICD-10 diagnostic categories. Improving quality and avoiding errors are major goals.

They are distracted, however, from some of the larger goals of providing patients with data, remote patient monitoring, and external data sharing by the pressing goals of meeting regulatory requirements for Meaningful Use, HIPAA, and ICD-10. One can well understand the urgency of racing toward the deadline for these requirements, but one wonders how well the systems will work for the goals that really matter–the goals that motivated the regulations in the first place.

Also around this point in the spectrum lie the concerns of hospitals hiring CIO and CMIO executives. For a glimpse into their thinking, I had a chance to meet with B.E. Smith, an executive recruitment firm.

Along with the usual concerns for competency and a deep knowledge of health care, hospitals are seeking executives who can bring about interoperability and handle communications well. The main level where they have to practice these skills are internally to a single institution, which could easily have 20 different EHR or EMR systems. Data exchange outside the institution is secondary.

My B.E. Smith interviewees also said that hospitals are also dealing with the conversion to electronic records, a theme that came out in the HIMSS survey as well. Until they can get 55 to 60 percent of their patients in their database, they can’t benefit from analytics. The interviewees predicted that hospitals will contract with leading outside firms for analytics instead of trying to develop capabilities internally, and certainly there are vendors at HIMSS offering such skills.

These scattered reports from my first day at HIMSS add up to an assessment that the pressing concerns of reformers in health care–data exchange, patient engagement, telehealth–are just tiny blips at the edge of the radar screen for health care providers. They are certainly not opposed to these reforms, and they may in fact be putting in place the tools to build them. But we won’t know till they try. The ONC and CMS regulations guiding Meaningful Use payments specify the ability to exchange data and empower patients. Meanwhile, the history of proprietary systems–hard to use and hard to extend–warns us against premature celebration.

You’ve Got The Right Key But The Wrong Keyhole: patient engagement and health records

The progress of two companies I met with yesterday show where innovation hits barriers.

GetWellNetwork provides educational materials and interactive guidance to patients through hospital TV screens and other devices, somewhat like the company Healthcare Information that I recently profiled. If a patient needs a pain reassessment once an hour, a prompt can now come up on the TV screen instead of requiring a nurse to go down to the patient’s room.

The basic GetWellNetwork is very slick, but they also make it easy for the hospitals to add apps, surveys, and other tools through standard HTML5 interfaces. I believe that the evolution of their systems–from proprietary TVs to x86-based PCs running Linux, and soon to Android devices–reflects a trend in health care toward standards and low-cost, off-the-shelf components.

Realizing that patient care extends beyond the hospital stay, GetWellNetwork also lets the patient sign up for alerts and interactive apps at home. Overall, the goal of their system is overcome the passivity that most patients descend into when they go to the hospital; the prompts and interruptions on th TV keep them active and make them aware of their own role in their recovery.

Integration with patient data is key to providing each patient with the right intervention and storing the results. HL7 has made it possible for GetWellNetwork to extract data from current EHRs, but modern apps, such as dietary monitoring and RTLS, want spiffier XML and JSON interfaces.

Integration with the EHR is also central to another service I talked to, Vital Interaction. They check the EHR to deliver automatic alerts to outpatients in whatever format works best for the patient (text message, email, or phone call). Based on the powerful Twilio platform, Vital Interaction’s key accomplishment is to give and take data from EHRs, but each one has a different access method.

Everyone in health IT loves to talk about apps, but data is fundamental. Any mission as simple as Vital Interaction’s or as ambitious as GetWellNetwork depends on access to patient data, And this leads to the innovator’s dilemma I described last year: forcing these companies to got to each EHR vendor separately and figure out how to access its data (sometimes requiring permission to do so) is a formula either for suppressing apps or consolidating EHR vendors.

Warner Thomas, head of a major New Orleans hospital chain, the Ochsner Health System, boasted in his keynote that they had just moved from a home-grown EHR to Epic, The migration took 18 months, which is considered fast for this industry. How long will it take Ochsner to break out of the box Epic has put them in and get access to the myriad of health care analytics, remote monitoring, and patient engagement solutions on the way?

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  • http://twitter.com/HankKearney Hank Kearney

    Oh to be king.

    Or at least have the ability to set standards.

    Mr. Oram is right: without a uniform structure that allows access to the data, the business that is EMR/EHR will continue to flounder. And with growing resentment.

    Malaysia just this month announced all hospitals – state and private – will have a uniform data exchange….within 12 months time. Done.

    Oh to be king. Or at least in the US market to be one of the last survivors.

  • http://twitter.com/leonardkish Leonard Kish

    I suspect, and will be writing about for next week, that the data will flow despite the clinic. Where there are ACOs or ACCs http://healthpopuli.com/2013/02/25/the-accountable-care-community-opportunity/, it’ll happen even faster.

    As you correctly point out, the momentum is growing in the 99.99 % of the health decisions are made and where shared savings will be won or lost: outside the clinic

    Meanwhile inside the clinic, we aren’t ever going to get universally accepted standards until there’s a business model and a drive to have them. Health care hasn’t seen that drive yet, so we get complexity, trying to please everyone, but pleasing no one, and the lack of standars then becomes a convenient excuse to do nothing and to share nothing.

    None of this can be considered outside of the economic drivers. The technology has always existed, just not the will: http://www.hl7standards.com/blog/2012/12/18/whydontweshare/

    The Web and communities that will enable transformation are interdependent. Even we lived in a world of perfect interoperability, there wouldn’t be data flow until there was a business model or motivation for it.