On the Way Home from Orlando: My HIMSS17 Takeaways

Another HIMSS conference has come and gone, which can mean only thing—time to sleep! But before I get that much-desired rest, I'd like to take this time to reflect on the 2017 conference, full of 42,287 attendees (at last check according to HIMSS press) with more than 1,200 exhibiting companies on that ever-so-long show floor. And, I encourage all of you to read our wall-to-wall coverage from this week right here. Alas, here we go—my HIMSS17 takeaways from Orlando:

All quiet on the HIT policy front—The change in White House leadership was certainly felt in Orlando this week, as federal agencies such as the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) did not make major announcements, or quite frankly, have much of their leadership present. This makes sense, as just-confirmed HHS Secretary Tom Price was never going to come to the conference just days after his confirmation. Meanwhile, on the CMS side, the Senate has not yet confirmed Seema Verma, so she obviously was not going to attend either. If you read our HIMSS17 Survival Guide earlier this month, Leslie Kriegstein, vice president of congressional affairs, the College of Healthcare Information Management Executives (CHIME), noted that there isn't a whole lot in the form of pending rulemaking, and with many of the folks in these federal agencies in interim positions, she predicted that it would be very quiet on the policy front. She was right. But still, it felt weird. Last year, then-HHS Secretary Sylvia Matthews Burwell made a major federal policy announcement, dubbed "The Pledge," which was essentially a data sharing and access commitment which many leading health IT companies signed onto. 

You might ask, what about The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), since the first reporting period in the "transition year" of 2017 has kicked off? Yours truly figured that any MACRA session at HIMSS17 would have essentially been a repeat of the rulemaking that's already in place, with not much in the "new information" department; my intuition was confirmed after speaking with people who attended these briefings. So while those sessions were probably helpful to many Medicare clinicians who are not ready for MACRA/MIPS, the information is hardly newsworthy. 

Meanwhile, on the health technology-specific front, the Office of the National Coordinator for Health IT (ONC) was similarly quiet at HIMSS. In the agency's annual Town Hall, staffers gave department updates and acting National Coordinator talked about 21st Century Cures as ONC's main priority, but Jon White also noted that there would not be a lot to discuss about what the new administration might have in store. Industry stakeholders are waiting for a new National Coordinator to be named by the Trump regime, and Healthcare Informatics is hearing that this process could take months, with Renee Ellmers, former U.S. Representative (R-N.C.) as a possible leading candidate. In the past, Ellmers has worked on legislation that would reduce Meaningful Use reporting burdens on doctors, which means that her views could be right in line with those of Sec. Price's. 

Interestingly, the biggest buzz from HIMSS17 on the policy front may have been created by former CMS Administrator Andy Slavitt, who said that providers hate the technology they're using, placing blame on both the developers and the end-user physicians. Slavitt, who has always been frank and upfront, also said that vendors should stop spending $2 million on exhibitor booths at HIMSS until they have "thrilled their customers." 

A powerful keynote—It was fascinating to listen to the HIMSS17 opening keynote on Monday morning, where IBM global CEO Ginni Rometty told attendees that cognitive computing could lead to a “golden age” in U.S. and global healthcare, if governed and managed wisely. Rometty said that IBM Watson health, which was launched at the 2015 HIMSS conference, is now more than 7,000 people strong, while the Watson technology is being used in 45 countries, 20 different industries, spanning 1 billion consumers. When asked in a Q&A by HIMSS president and CEO H. Stephen Lieber about why IBM decided to be so invested in healthcare at this current moment, Rometty said, "This was a big decision, not only to make it a moonshot. But we’ve invested heavily now, billions and billions of dollars. I think it is the right moment now, for two reasons. A, there’s no bigger grand challenge that’s important to the world. And B, there is a confluence of things that could make it be the right time. Health is not a formal system, per se, and that’s always been the challenge. And many companies have never really been products, they’ve been features, so you have all these little islands everywhere. But we have the mechanisms now to pull this together, including platforms, the cloud, connectivity. And this is technology that can free the practitioner—the physician, the nurse, any clinician—from current time constraints around the ability to access knowledge to improve diagnostic and treatment capabilities." 

Interestingly, a Forbes report released the day before Rometty's keynote revealed that the partnership between IBM and MD Anderson Cancer Center, part of the University of Texas, has soured to the point where the $62 million project for the cancer center to deploy Watson has been scratched. Bizarrely, the Forbes report noted that MD Anderson is still on the hook to pay for the whole thing and that its leader in charge of the project never got approval for the implementation from the center's IT department. Questions remain regarding MD Anderson's current relationship with IBM, but the article is a worthy read and the timing of its release is interesting, to say the least. Nonetheless, it would be silly to question the success that Watson Health has achieved in such a short time; Rometty said in her keynote that Watson's cognitive computing ability has proven to find more clinically relevant applications than human physicians in many patients' medical cases. IBM officials also state that it's Oncology Expert Advisor product, powered by Watson, agreed with MD Anderson experts 90 percent of the time. Needless to say, the vibe for Rometty's keynote was tremendous and had people talking.

The next hot new health IT buzzword is...blockchain! It's probably close to hitting the peak of the hype mountain, but blockchain—a tool that has the potential to keep secure data in a distributed ledger, and could be shared across networks—got a lot of attention at HIMSS this year. Indeed, the conference held a day-long blockchain event on Wednesday in which industry experts discussed possible use cases in healthcare and current challenges. The general consensus seems to be that health IT leaders are bullish about the technology's potential, but equally are hesitant to call it the "magic bullet" for interoperability and security.

During one of the blockchain sessions, David McCallie Jr., M.D., senior vice president of medical informatics, Cerner, compared the hype level to the Direct standard for secure email exchange. McCallie noted that the talk about Direct at the time was that nothing could go wrong as the technology part was settled, as was the vendor buy-in part, and the open source implementation, too. But "everything else" other than the IT created problems, including a lack of trust. In the same session, Srinivas Attili, a leader at IBM Global Services, said he is a big fan of blockchain, that his company participated in ONC's Blockchain Challenge last year, and that use cases he has seen "are real with fabric." Meanwhile, Mac McMillan, co-founder and CEO of consulting firm CynergisTek, agreed with Cerner's McMallie, noting that blockchain "will require real investment and adoption. And people will have to trust it." McMillan, a notable healthcare data security expert, added, "Here’s something interesting: why did Bitcoin fail? Because people didn’t trust it. It worked great—in fact, it worked so well that all the bad guys got into it. But [because of well-publicized incidents involving fraud and wrongdoing], people lost confidence in the technology, and it failed."

What's top-of-mind for some CIOs right now might surprise you. Usually when I ask CIOs at HIMSS this question, cybersecurity is always the top response. While I definitely heard some of that again this year, another concept came up often as well—consumerism. As Marc Probst, vice president and CIO at Salt Lake City, Utah-based Intermountain Healthcare, told me, "Where we need to up our game is thinking about how to engage with the consumer, and how can we do that to modify our overall operations and become a digital healthcare delivery system. We have huge aspirations in that space at Intermountain, and we are confident we can get there." Indeed, as patients' insurance deductibles continue to rise, they are going to have "more skin in the game" and look at what their healthcare is actually costing them (as one C-suite leader put it to me, "most people understand their auto insurance coverage better than their health insurance"). As such, provider organizations are now understanding that they will have to respond to this trend—and how they do so will be critical in determining how healthcare's future plays out.