Leaving Las Vegas: Pondering Clarity, Convergence, Innovation, Opportunity and Challenge, at HIMSS16

Oct. 4, 2016
The words that come to mind as HIMSS16 closes in Las Vegas are these: clarity, convergence, innovation, opportunity, and challenge. It was an exciting and bracing time to participate in healthcare IT’s annual industry-dominant conference this year.

As 41,000-plus attendees scramble to get onto planes and into cars to leave HIMSS16, what have we learned? As an attendee and journalist who has covered the HIMSS Conference 25 times in 26 years, HIMSS16 was of particular interest for me. Much has happened since HIMSS15 at the McCormick Place Convention Center in Chicago, and coming into the Sands Expo Center in Las Vegas this week for HIMSS16—and on Monday, for the CHIME CIO Forum—I was very curious as to whether what I and my fellow editors at Healthcare Informatics had been reporting on and analyzing for the past year would be affirmed at HIMSS16 or not. In a few words, the answer is yes, it was all affirmed, and more.

Indeed, a quarter-century into the HIMSS Conference phenomenon, I would have to say that this was the most validating conference yet, for a few reasons. First, I need to put this into context by referencing my first HIMSS Conference back in San Francisco in 1991. I had to look this up, but a history of the HIMSS organization records that there were 1,800 attendees at 164 exhibiting companies back then. (And yes, I look back in astonishment at the momentous growth of the conference over the years. And I am thankful to the HIMSS Legacy Workgroup for publishing an updated history of the organization and of its conference, in January 2013.) The key point is this: back then, there was no unity of vision or assessment in the healthcare IT world; indeed, until the very late 1990s, healthcare IT was still seen as a backwater by many senior executives in U.S. healthcare. Keep in mind that the CIO title was still very new back then, and there were almost no CMIOs, at least not in the contemporary sense of that role.

And because there was no consensus vision of where U.S. healthcare and healthcare IT were going, and because the information technology was primitive compared to now, the HIMSS Conference experience was a very different one back then. Vendors touted very closed systems; there was a ton of “vaporware,” meaning solutions hawked on the exhibit floor that were not yet capable of delivering on their promise; and above all, healthcare IT leaders were challenged to figure out how to move their organizations forward into the future, as the future appeared very cloudy.

Towards True Payer-Provider Convergence

Fast-forward 25 years, and the world really has become a different place. With healthcare reform and value-based purchasing solid realities, and with the direction from both the public (federal and state) and private purchasers and payers of healthcare clearer than ever. As the U.S. healthcare system and indeed society faces an astonishing cost cliff in its near future (as I’ve discussed previously, last fall, the Medicare program’s actuaries predicted that the U.S. healthcare system would go from costing $3.1 trillion a year currently to $5.2 trillion over the next 10 years), the need for all stakeholder groups to come together to address the cost, accountability, transparency, care quality, care management, population health, and efficiency requirements of the new healthcare has come sharply into focus in the past few years. (As Samuel Johnson’s immortal quote put it, “Nothing focuses the mind like a hanging.”) And if Benjamin Franklin was right in saying (in a very different context, of course) that “If we do not hang together, we shall surely hang separately” (yes, he was speaking of the events in the American Revolution, not of healthcare policy- and payment-related issues, I know), then there is a very sound reason for the convergence between payers and providers that we’re seeing right now in U.S. healthcare.

Indeed, as I wrote earlier this week, payer-provider convergence to move the needle forward in all those areas was present along a number of dimensions at HIMSS16. As I wrote in a blog on Tuesday, “The closing keynote presentation in the Business of Healthcare Symposium on Monday at HIMSS16 really helped crystallize so much about this moment in healthcare. Even the professional title of the presenter spoke to it. The presenter was Veeneta Lakhani of the Indianapolis-based Anthem, which insures 38 million covered lives across the U.S., and which has contracts with 796 hospitals and 54,000 providers, and has over 4.5 million members in more than 154 ACO contracts nationwide. Ms. Lakhani’s title? Vice president, provider enablement.” What’s more, Ms. Lakhani’s presentation followed immediately after the excellent presentation by Douglas J. Van Daele, M.D., vice dean for clinical affairs at the University of Iowa Health Care, who had just spoken about the “ROI of ACO.” And the similarity of their perspectives and perceptions was striking, given that one was a payer executive and one was a provider executive.

So as I’ve been commenting on it recently, I believe that payer-provider convergence is a real thing. It remains, certainly in many markets, relatively fragile. And there are still local and regional healthcare markets in the U.S. with considerable payer-provider mutual suspicion and even open conflict. But the overall cost trajectory of the U.S. healthcare system is pushing everyone, sometimes awkwardly, forward, into a mindspace focused on improving care quality, care management, clinician and operational efficiency, and on bending the cost curve.

Federal Health Officials: We’re Listening

And that’s where the information technology comes in, because clearly, there is no way that any of this can be fully accomplished without robust IT facilitation.

It is undoubtedly in that context that, as I reported on Monday, Health and Human Services Secretary Sylvia Mathews Burwell announced to an audience of 7,000 gathered for the opening keynote address of HIMSS16, a new initiative. As I reported then, Mathews Burwell announced that “[C]companies that provide 90 percent of electronic health records [EHRs] used by hospitals nationwide as well as the top five largest private healthcare systems in the country have agreed to implement three core commitments,” according to a Department of Health and Human Services (HHS) news announcement released at the same time. Those commitments, as Mathews Burwell elaborated, center on ensuring consumers’ access to their electronic health information; eliminating information-blocking; and facilitating the implementation of national, federally recognized interoperability standards.

Mathews Burwell’s speech seemed carefully calibrated to on the one hand emphasize that she and other senior federal health officials were and are listening carefully to the concerns of providers nationwide and desiring to work through industry challenges collaboratively and together, while on the other hand, continuing to make it clear what their (federal officials’) priorities are, and keeping the industry focused on those priorities.

Another sign that federal health officials want providers to know they’re listening carefully: as HCI Managing Editor Rajiv Leventhal reported on Wednesday, “Physicians who have moaned about the government not taking their frustrations with technology seriously should feel some satisfaction after Centers for Medicare & Medicaid Services (CMS) Acting Administrator Andy Slavitt acknowledged at HIMSS16 that it's time to make IT work better for doctors. Slavitt echoed these sentiments during a small briefing with health IT reporters on the afternoon of March 1,” Leventhal reported, “Slavitt's speech was brutally honest as he admitted that while progress has been made in health IT, still too often technology hurts doctors rather than do as intended, which is to help them. ‘I'm not bashful about where we need to be better and take our game up,’ Slavitt boldly said. ‘We need a user-centered approach to designing policy. The consumer is more mobile, more demanding than ever before," he said.’”

Of course, everyone was taking everyone this week at HIMSS16. As Leventhal reported following the Monday pre-conference symposia, “In his opening keynote for the Physicians' IT Symposium at the HIMSS16 conference in Las Vegas, John Halamka, M.D., CIO of Beth Israel Deaconess Medical Center in Boston, reflected on how health IT has progressed in the last decade, and what the industry can do better moving forward. As part of the pre-conference education,” Leventhal wrote, “Halamka's opening keynote, "Are We There yet? Health Information Technology's Report Card," at the Sands Expo Convention Center, started off by looking at how the health IT industry has evolved from the days of when David Brailer, M.D., was the National Coordinator for Health IT. Halamka narrowed in on several areas of focus, from electronic health records (EHRs) to interoperability to patient engagement to big data and analytics, and finally, to the cloud and mobile health (mHealth). He then gave report card grades to each of these areas before outlining his call to action on how to improve.” Many at HIMSS16 appeared to agree with Dr. Halamka’s grades of C+ for EHRs (per optimization issues) and interoperability, per the lack of an enabling infrastructure to support “pull” information-sharing.

Innovation is Happening Everywhere

Still, progress is being made on the ground, and evidence of it was everywhere.

As HCI Assistant Editor Heather Landi reported on Wednesday, leaders at the Durham, N.C.-based Duke Medicine are leveraging mobility in order to provide patients with patient-centric tools. As Landi reported, Ricky Bloomfield, M.D., director mobile technology strategy, has been leading “the effort at Duke to integrate Apple’s HealthKit, and is helping to facilitate its use among faculty for both clinical and research purposes. One pilot project aimed at patients with hypertension collects, via patients’ MyChart app, patient-generated health data from devices such as activity trackers and blood pressure devices. The MyChart app is connected to the MyChart patient portal so that patient-generated health data is transferred into Duke’s electronic health record (EHR). The goal of the project is to for providers to use the patient-generated health data to monitor patients and reduce patient readmissions.” Dr. Bloomfield shared with his audience his belief that wearables are moving forward rapidly to support care management and consumer health enhancement.

Meanwhile, in his interview with me on Thursday, Martin A. (Marty) Lupinetti, executive director of HealthShare Exchange of Southeastern Pennsylvania (HSX), a major Philadelphia-based health information exchange (HIE), shared with me the progress his HIE is making in truly connecting providers and payers across the southeastern Pennsylvania region. As Lupinetti noted, the success to date of HSX has been founded on two fundamental factors: first, HSX has been providing users with what they want and need, first of all, notifications of patient events, via Direct messaging; and because it is providing services that users want, area health insurers have been willing to foot two-thirds of the bill, with hospitals taking up the remaining third. In other words, strategic practicality really does work.

It was also very heartening on Thursday to be able to report on the exciting cognitive computing initiative involving the collaboration of Denver’s Centura Health, and the Denver-based Welltok and IBM, through its Watson division. As I reported yesterday, Pam Nicholson, Centura’s vice president for strategic integration, and Jeff Margolis, the well-known former founder of Trizetto and Welltok’s founder, described “a project to create what is called CafeWell, a consumer-facing app that helps guide consumers who have chronic illnesses through lifestyle choices, including asking basic health questions and selecting healthy food and restaurant choices, among other choices.”

All of these initiatives are worth mentioning, at a time when healthcare IT leaders are feeling more pressure than ever before to move forward into innovation with more restricted resources and under more challenging conditions. It is in that spirit that we hosted our annual Healthcare Informatics Innovator Awards reception, which we held at 1 Oak in the Mirage Hotel on Tuesday evening. It was wonderful to be able to recognize our Innovator Awards winning teams and semi-finalist teams, for their tremendous strides forward in innovation at a time of challenge and opportunity in U.S. healthcare. And it was also very gratifying to be able to recognize the winning companies of our Leading Edge Awards as well, as they innovate forward in their sphere.

The Bottom Line: Clarity, Convergence, Opportunity, Challenge

The bottom line in all this? To reference Charles Dickens in the opening paragraph of his immortal A Tale of Two Cities, “It was the best of times, it was the worst of times.” There is absolutely no question that these are the most challenging of times for healthcare and healthcare IT leaders, as the U.S. system is being compelled forward to transform itself, both by external forces and by internal ones. And healthcare IT leaders in particular are having to work forward with relatively fewer resources and with to-do lists that are making nearly everyone shudder. But this is also a time of tremendous opportunity in healthcare, and the industry advances through a phase of enormous ferment, with bracing policy and payment clarity, and some of the brightest and most passionately motivated people in the country (and beyond) all applying their skills and insights to the challenges ahead.

There has never been a more fascinating and meaningful time to cover the U.S. healthcare industry than now, and covering HIMSS16 was a privilege and a pleasure (if a grueling pleasure, as always!) for me and my dedicated team of editors. We all look forward to the year ahead, and to finding out what unfolds a year from now in Orlando at HIMSS17. Forward into the future, and best wishes to all! I do hope everyone has had a successful HIMSS16.

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