HIMSS

HiMSS08 wrap up: Transition time for health IT

Fri, 29 Feb 2008 06:59:59 -0500

Well, as expected, the HiMSS08 show was a sprawling affair, attended by 27,000 seemingly happy party-goers. Without a doubt, it was an impressive display of professional knowledge and technical wizardry--not to mention an overdose of product information from more than 900 vendors.

In my original pre-show note on HiMSS, I'd complained that I didn't see much innovation on the program, but I stand corrected. In fact, what struck me about this show was how many of the projects and solutions I saw were focused on "almost there" trends and technologies.

There were vendors like Orion, Axolotl and Wellogic, which focused on the still-nascent health information exchange market; countless sellers of electronic medical records, each pitching their own variations on the form; tools to support email based medical visits; security firms pitching their emerging healthcare options; and so on. Google made a modest appearance--when you've got a brand name like that, you don't need a big booth--to demo its brand-spanking-new personal health record repository.

Sure, IT is always in transition, given the fluid nature of the business and the changing needs of businesses. But I've got to say, it's remarkable how many technologies and business models are in transition right now--and my experience at HiMSS only underscored that point further.

As the exhibit hall demonstrated, healthcare providers have an unusually long list of new, disruptive technologies to understand. At minimum, I'd argue, health execs soon will need to understand and support EMRs, Internet-based medical practice, health information exchanges, personal health records and tighter security over the next year or so.

As you make that transition, I'm eager to hear from you, and learn what challenges you face, so write to me any time. And I look forward to catching up with you again at HiMSS09 and finding out how it went! - Anne

Live from HiMSS08: A Covert operation, online

Wed, 27 Feb 2008 06:59:59 -0500

What if, when you planned out a new hospital, you built the entire thing on Second Life first and let your staff explore and critique the design? That's just one of the many experiments executives at Palomar Pomerado Health have engaged in as they plan almost $1 billion in new construction.

Yesterday, I had the chance to discuss the project with PPH president and CEO Michael Covert, who came to HiMSS to tell a Cisco user's meeting about the system's IT plan. Working with Cisco, the health system has set up a virtual model of Palomar West, its planned 450-bed facility, which will be completed in 2011. Using avatars, visitors can walk through the whole facility, rather than being limited to small mock-ups or blueprints typical of the standard construction process.

Not only does the Second Life-based version of Palomar West duplicate the building's layout, it's also demonstrating key technical features of the new facility, including a nifty new 3-D holographic medical imaging system, RFID-based systems that guide visitors through the facility and a network that links up, not only data systems, but also clinical systems, communication infrastructure and even facilities functions like ventilation, air conditioning, security and signage.

Covert says he's tremendously excited by the opportunity to put the facility on Second Life, which will net him feedback not only from his patients, staff and clinicians, but also, he hopes, from the general public. "The real question is how to prepare for and plan for innovation [generally,]" Covert says. "One way was to create a virtual hospital, but that's just the beginning."

I don't know about you, but I find this quite exciting. I'm not sure whether walk-throughs in cyberspace will really be that much more effective a planning mechanism than building mock-ups of key areas like operating theaters. And doubtless, the project wasn't cheap (Covert has the advantage of spending cash generated by a government-backed bond issue.)

Still, I'm convinced something good can come out of this approach. It may actually teach us something about how to get stakeholders excited about IT. - Anne

Live from HiMSS08: Mike Leavitt touts local health exchanges

Tue, 26 Feb 2008 06:59:59 -0500

Today at HiMSS, audiences were treated to a speech from Mike Leavitt, head of almighty HHS. Leavitt, who comes across as far more relaxed and informal than you might expect from a guy with his authority, gave an extended pitch for the power of local relationships to build the health information exchange movement.

His take on building local trust comes from bitter experience, he said. As Governor of Utah, Leavitt told a packed auditorium, he found out quickly how protective people are of personal data when he proposed a plan to add a magnetic data-collection strip to driver's licenses. As he soon learned, his plan upset many citizens. "I learned that people have real worries about what happens if they don't have control of their information," he said.

To build health exchanges, providers will have to overcome even deeper privacy and security fears--and the only way to do so, in his view, is to build consumer confidence from the ground up. "The key here is trust, and trust is built locally," Leavitt said. "Trust is achieved one heart and one mind at a time--and they trust people they know. They intuitively don't trust distant bureaucracies."

For that reason, HHS is working to inspire local action. In fact, it's in the process of launching a new entity known as a "Chartered Value Exchange," a locally-based health information cooperative that exchanges not only clinical data, but also price and quality information. To date, HHS has named 14 quality and data sharing groups across the U.S. as CVEs. In return for agreeing to form the exchange, HHS is helping out by sharing relevant Medicare data.

Of course, cooperative spirit or no, HIEs won't work if they can't interconnect technically. That is the point where the federal government should get involved, as a harmonizer and organizer of standards, Leavitt argued. Groups like the Certification Commission for Health Information Technology, which certifies EMRs, and the American Health Information Community, which promulgates standards, will both play a role in helping groups connect with each other, he noted.

Still, even where standards are concerned, local entities have a big role to play, Leavitt said. "There needs to be an organization in every community that can apply national standards in local ways," he said. "My mantra is 'National standards but local control.' "

All told, despite the obstacles that still exist to forming health information exchanges, Leavitt seems rather optimistic. "We're not as good at this as we need to become, but we're making progress, not just in technology but in sociology," he told the rapt audience. "I truly believe we're on the cusp of a revolutionary change in healthcare."

- Anne

Editor's Corner

Wed, 28 Feb 2007 19:01:39 -0500

After an extremely stimulating (and overwhelming) few days, it's time to ring the curtain down on HIMSS '07. Though I did my best to take it all in, I feel a bit like someone who was trying to drink the ocean with a straw. Still, a few things stood out for me.

First, and least surprising, was that there seems to be little--if any--uniformity in the EMR products displayed so lovingly on the exhibit floor. While I didn't take a deep dive into the EMR systems, even a quick take suggested that we're dealing with an embarrassment of very incompatible riches. We're talking different interfaces, different integration options, different assumptions about underlying workflows--the works.

I'd like to believe that at HIMSS '08, we'll have a more widely-accepted set of common assumptions as to how EMR core functions should be defined. In the mean time, vendors with flexible clinical portal technology shouldn't lack for opportunities.

Another lasting impression from HIMSS was that RFID and WiFi based asset tracking solutions are getting their fifteen minutes of fame. I spoke with several vendors who were either offering or integrating with asset tracking solutions, and many show attendees who were eager to hear what these vendors were doing. I don't know why there's so much buzz around this solution now, but clearly, it's on a lot of minds.

Still another theme that stood out for me was that the industry is still getting its arms around the whole consumer-driven healthcare thing. As I noted yesterday, several companies were showing consumer-facing applications, but my sense is that they were still just beyond the test-bed stage.

Sure, given that the ROI on PHRs, consumer-facing kiosks and other emerging consumer applications still isn't clear, it's not a huge surprise nobody's gung-ho. But they may be sorry later when, say, payors suddenly mandate that all providers use PHRs. I predict a stampede to whatever software vendor has gotten ahead of this issue. It's going to be a hot one soon. - Anne

Editor's Corner

Tue, 27 Feb 2007 19:01:39 -0500

So, HIMSS is already beginning to slow down, even though the show doesn't officially end until tomorrow. (It could be that people are exhausted after walking the exhibit hall floor--we're talking a brightly colored, flashing, extremely loud hall stretching several city blocks in length from one end to the other. Vendor overload!) All in all, HIMSS has had a landmark year, attracting a record 20,000 plus attendees and several hundred exhibitors.

Despite the overwhelming scale of the show, one theme still stood out for me. I believe this year may have been a turning point for consumer-facing applications. While the majority of companies attending have been pitching standard categories of business solutions, a number were showing off technologies that touch the consumer at key points on the care process, too.

Relay Health, for example, demoed its "e-visit" technology, a Web-based question-and-answer form which allows consumers to communicate with doctors through a Web form. What makes their approach neat is that Relay Health has convinced some health plans (CIGNA, for example) to pay doctors for analyzing and responding to these e-visit questionnaires.

Other vendors, including Relay Health parent company McKesson, were showing off applications which will allow consumers to register for ambulatory or ED visits at a kiosk. McKesson's demo also included a credit card/debit card option, allowing the consumer to pay their visit co-pay up front. Makes a lot of sense, as consumer-driven healthcare comes roaring down on the industry--collecting payments up front may cut the number of unpaid bills. (And some observers are predicting that there will be a problem there, as some consumers will face a high deductible but have little money in their HSA.)

There was one surprise, however: While I was expecting to see a bunch of competing PHR solutions, there weren't many in evidence at this year's show. Most of the consumer-oriented applications I saw were designed to solve process problems in moving patients through the system, rather than encourage patients to maintain med lists, allergy lists or any of the other standard catalogs of personal information the industry has been abuzz over the past few months. In short, despite some well-publicized posturing on the PHR issue by insurers and employers, it seems the vendor community hasn't caught up yet.

Still, I'm very confident we'll begin to see new PHR applications roll out over the next several months. And we're not talking about static PHR records, but smarter, more-integrated PHRs which use consumer-driven information to directly affect physician's decision-making picture. (ActiveHealth Management's CareEngine technology is one model for this.) In the mean time, clinical managers and health IT execs will want to research and develop their own ideas as to how they can make use of patient-reported health records. When the blizzard of consumer apps hit at HIMSS '08, you'll be glad you did. - Anne

Editor's Corner

Mon, 26 Feb 2007 19:01:39 -0500

Pick a project and stick to it--or national health IT adoption may never happen. That's the message Gov. Phil Bredesen (D-TN) had for attendees at today's HIMSS morning keynote session. Bredesen, who co-chairs the State Alliance for E-Health, has been getting his hands dirty with health IT for some time (and though he didn't tout it in his speech, he can boast the proudly geeky credential of a physics degree from Harvard).

A former managed care executive who built his own company from one employee to about six thousand, Bredesen allowed that he knows something about healthcare, but more about the "art of getting things done." And in that role as government intermediary, Bredesen had a few modest suggestions as to how the industry might speed up the health IT adoption process.

Time to focus. Right now, Bredesen noted, the healthcare industry has more than enough technology to meet its needs--but can't seem to pick a few accessible targets for health IT adoption. Instead, he suggested, health organizations have ended up shooting for the moon rather than finding a project that interests most stakeholders."We've gotten ourselves in the complexity business, and that's no good," he said.

Bredesen, like other state governors, believes that implementing e-prescribing is a great place to start, given that it's a conceptually simple approach, cuts across more or less all patients and can have a meaningful impact. Just as importantly, he said, "it raises and requires solutions to many important problems" in health IT adoption.

Make adoption attractive--and necessary. Right now, health IT adoption is driven mostly by health plans, provider groups and medical practices that are willing to experiment. But that isn't going to get the job done long-term, Bredesen contended. "We have to stop tinkering around with pilots and grants and make things happen," he said.

If planners focus on a widely-understood technology like e-prescribing, it gets simpler to offer incentives--and impose penalties--that get stakeholders into the game. For example, it's not hard to demonstrate the short-term benefits of adopting e-prescribing, but to get the laggards on board, it would probably also make sense to impose say, a CMS requirement. "Healthcare is just too big for a (completely) voluntary model," Bredesden argues. (It sounds like he's a bit frustrated with the progress of the volunteer RHIO efforts going on his home state.)

Let government lead. Finally, he suggested, getting the federal government involved is a key piece of the puzzle. While in theory, the healthcare industry already has the resources to solve its own problems, it's going to take an outside party to bring all of the interested parties to the table, he suggested. "It's time to move e-health out of the lab and into the real world," he told the audience. "And it's something only the federal government has the standing to do." - Anne

P.S. Thanks to all who made our HIMSS party such a success last night at Utopia. It was great to meet you!

Editor's Corner

Sun, 25 Feb 2007 19:01:39 -0500

Welcome to the first day of our HiMSS '07 coverage! Over the next few days, we'll be bringing you updates on the technology, personalities and events here at the Morial Convention Center in downtown New Orleans, and try to offer some perspective on how they'll affect you.

Today, the show started off with a keynote address by Steve Ballmer, the peripatetic CEO of Microsoft. Ballmer, whose presentation was thronged by eager attendees, stuck mostly to the standard script for health IT industry gatherings, with the usual talk about clinical data integration, improved efficiencies and consumer-driven control of health data. But one thing he said did stand out: that Microsoft officially has the healthcare market in its sights.

"We have traditionally focused on all vertical industries, but this industry is too important not to have a dedicated focus," Ballmer told the crowd, which filled one large auditorium to bursting and packed an overflow room as well. "We're building distinct capabilities and products, because there's so much opportunity in healthcare to change the way people work and live. We so enthused about this that it's unbelievable."

Explosion of information

In his talk, Ballmer spoke about the explosion of data clinicians and consumers must digest, and the pressures that this puts on healthcare systems.

Right now, he noted, most healthcare organizations figure out how to manage clinical data on their own, creating costly islands of information that don't link up with other institutions. In the future, Ballmer said, the problem will only get worse, as healthcare organizations integrate clinical research, genetic data, digital imaging and other digital resources into their work. "The notion that each hospital, health plan and provider will be able to fund its own R&D is not going to last," Ballmer says.

At the same time, healthcare organizations must also address the needs of an increasingly wired consumer, and help that consumer manage their own care online, he said. "The people we serve expect to have a rich interaction with technology," Ballmer noted. "The consumerization of information technology we see elsewhere will also apply in healthcare."

The software solution

Not surprisingly, Ballmer said that the solution to these problems is new and better software which can simplify access to this vast pool of information. The hardware which can get this done already exists, but the industry still hasn't created the software solution which can link it all together, Ballmer said.

"Healthcare is the largest industry in the world, but we don't see the same standardization in this industry that we do in other industries. That's because we're not meeting providers' needs," he said. While the industry doesn't have a comprehensive solution yet, service-oriented architectures and XML are going to going to be "very, very important" ways to link up existing data, he said. (Of course, he didn't mention that he's assuming all of this will be hooked up using Microsoft development tools, but that's hardly a stretch.)

Being the CEO of a company with a giant consumer presence, Ballmer couldn't resist giving a pitch for the future of consumer healthcare as well. He spoke glowingly of a coming "smart home" in which consumers get care alerts and access health information not only from their PC, but from their interactive television, smart watch, video game system and other devices. "We see the home as a healthcare environment," he said.

All in all, Ballmer's talk didn't break a lot of new ground on the clinical side, but expect to hear a lot more from Microsoft on this subject in coming months. In the mean time, I wouldn't be surprised if you see the company introduce some pretty interesting technology for the "healthcare environment" in the home.

If I read Ballmer's presentation right, be on the lookout for PCs and multimedia devices for the home to have new healthcare-oriented features. I'd also bet that that Microsoft and partners will introduce one or more slickly-designed, iPod-esque devices for consumers that automate remote clinical data capture, funnel videos and imaging data to providers, connect to WiFi networks and more. On the provider side of the industry, look for Microsoft to take an aggressive position in clinical data analytics, but interestingly, perhaps even more on the research side of the industry.

All told, Ballmer's talk focused more on vision and less on specifics. Still, over the next couple of years, it looks to me like the healthcare world should be more interesting with Microsoft in it. - Anne

Editor's Corner

Thu, 15 Feb 2007 19:01:39 -0500

Late this month the industry will make its annual pilgrimage to the giant HIMSS '07 show, which, for the non-technical reader, is the must-attend annual event for health IT types. Our sister publication, FierceHealthIT, will cover the event in depth, taking over this Editor's Corner for the duration of the show to cover the action each day.

While we usually stick to management and administrative issues in FierceHealthcare, given the excitement around HIMSS, we thought you might find it interesting to get an exclusive insider's look at what the IT folks are thinking about this year as they get together.

As you probably know, EMRs are among the hottest topics in the industry (thanks, in part, to frequent mentions by federal and state politicians), but they're far from the only topic the health IT pros are examining at this pivotal show. Here's some other important concepts which are getting a lot of attention at HIMSS:

Technologies collecting health information from patients: The PHR (patient health record) is getting more popular by the day, the idea being that physicians can get a lot of benefit out of data self-reported and stored online by patients. We expect to see a lot of PHR-type technologies taking a prominent place at the show. Provider-oriented companies seem convinced that getting the patient involved in charting lifestyle, symptoms, social supports and more will be increasingly important as time goes by.
RHIOs (regional health information organization) systems: This year RHIOs are hot in the industry, and also at HIMSS, where some execs are running RHIO demonstrations on the show floor. Governments, in particular, are excited about the idea of building RHIOs, which share clinical information across groups of providers, clinics, ancillary service providers and the like across an entire city, county or region. It's far from clear what kind of technology is needed to make all of these groups "talk" to each other effectively, but the IT industry seems dedicated to making it happen somehow.
Tools improving medical interaction between patients and doctors: Finding it hard to keep up with your chronically ill patients' needs? That's just one of the problems a new group of interactive technologies are trying to fix. We're not talking about some enhanced Webmail system here--we're talking about a complex dialog. For example, a patient might enter a note that he's diabetic in your introductory Internet questionnaire. Such a system automatically alerts the physician, whose system triggers another online tool designed to assess diabetes. The patient's responses to that tool might then kick out a targeted care plan which the physician and patients can work with together.

If you're interested in learning about other vendor technologies with some momentum at HIMSS, please tell me what interests you and I'll be sure to give those vendors a look and report back to you. There should be something there for everyone! - Anne

P.S. FierceHealthcare will not be publishing on Monday in recognition of President's Day. Enjoy the holiday and look for us on Tuesday!

SPOTLIGHT: National Health IT Week kicks off in D.C.

Sun, 04 Jun 2006 20:01:33 -0400

Monday marks the start of National Health IT Week, which runs from June 5 through 9 in Washington D.C. Expect a steady trickle of health IT related stories in the news as the official conference gets underway. Headliners include the usual suspects: Dr. McClellan, the Center for Health Transformation's Newt Gingrich and Carolyn Clancy. Meanwhile, a decent number of HIMSS members will be swarming Capitol Hill, perhaps suggesting that a little more money might be found for healthcare IT projects. Web site

PDA makers targets healthcare

Mon, 15 May 2006 20:01:35 -0400

As smartphones with PDA capacity get more common, there's a major push from both Microsoft and Palm to get them into healthcare. Palm released its Treo 700W, which runs Windows Mobile, earlier this year. The PDA goes after healthcare applications that are not written for the Palm OS and was featured at the HIMSS show. Yesterday Palm released the Treo 700P, a new Palmsource-OS based smartphone. The 700P is on the EvDO broadband network, which will help it compete with RIM's Blackberry for email. Mobile messaging is becoming increasingly important for physicians of whom over 55 percent already have a PDA. The 700P has an improved screen and 1.3 Megapixel camera that could be good enough for basic clinical telemedicine applications such as in dermatology and wound care.

- see this release from Palm