Inside a massive Orlando convention center last week, the future of health IT was on full display.
Beneath massive colorful banners hanging from the rafters, more than 1,300 companies represented consumer brands like Google and Amazon as well as old-guard health IT companies like Epic and Cerner at the Healthcare Information and Management Systems Society's (HIMSS) annual conference and exhibition.
It was sensory overload as the vendors vied for the attention of passersby, offering live demonstrations along with everything from magic shows to freshly baked cookies, fully stocked bars and Pelaton bike giveaways.
“It is like Las Vegas,” said B.J. Boyle, VP and GM of post-acute insights for PointClickCare, an EHR for post-acute care settings and one of the hundreds of vendors trying to find a way to stand out in the crowd.
Amid the organized chaos of the lights and the noise was a common promise: Their technology was already helping to share data—or would be the solution to share data in the future—like it had never been seen before.
Yet, as CMS Administrator Seema Verma took the stage, she admonished companies for their failure to connect data or make records readily accessible to patients. She was addressing them just days after the Office of the National Coordinator released a proposed rule that aimed at ending information blocking by payers, EHR vendors and health systems and said it was past time to take action.
"The game of pointing fingers and feigning innocence has to end," Verma said. "We are all part of what makes the healthcare system work, and similarly we all are … insurers, providers and the government … culpable for the lack of data sharing."
The disconnect felt stark. But for some, it also seemed to signal a sea change.
"This year is really unique because there is so much focus on interoperability. It’s not a side issue, it’s a matter that’s been addressed on the main stage," said Mariann Yeager, who is the CEO of the Sequoia project, which advocates for nationwide health information exchange.
Surescripts Tom Skelton agrees.
“I’ve been doing this a long time, I’ve seen a lot of hype cycles come and go,” he said, recalling when the HIMSS meeting was small enough to fit into a hotel room. “We’re either in the middle of the biggest hype cycle I’ve ever seen, or we’re actually poised to fix a lot of things in the next few years. I’m choosing to believe it’s the latter.”
'It's the same challenge'
Among the themes of HIMSS this year was an idea hammered home by federal officials multiple times: Data needs to more accessible.
“There’s a theme at each of these HIMSS conferences. Last year it seemed like it was predictive modeling and AI; this year it seems like it’s interoperability," Bala Hota, M.D., vice president and chief analytics officer at Chicago-based Rush University Medical Center, told FierceHealthcare.
"And CMS, as a credit to them, they’ve really taken the lead in this information blocking messaging and how they won’t tolerate it anymore," Hota said. "I think the hope is that the patient can become the owner of their care and the information to drive that care. There are so many places where that will have an impact.”
But that's also where the frustration comes in. For many attendees, data sharing has been a promise they've heard year after year.
“It’s the same challenge that’s been here this entire time—interoperability,” said Rhonda Medows, M.D, president, population health management for Providence St. Joseph Health, and CEO, Ayin Health Solutions. For population health leaders like Medows, the biggest challenge continues to be sharing health data with organizations outside the health system.
"My son is 27 years old now and when he was a little kid, I went to a HIMSS conference and they talked about interoperability," Medows said. "I saw the CMS and ONC announcements and I said: 'Before I become a grandmother, can we please act on putting in more effective APIs?”
'It's too quick, too soon'
Publicly, the industry responded positively to the information blocking rules.
“We’ve been talking about it for 12 years. It’s important to be open, it’s important to prevent data blocking, it’s important to ensure patients have access, it’s their record,” Paul Black, Allscripts' CEO, told FierceHealthcare. He pointed out that Allscripts has a vendor-agnostic interoperability solution that facilitates exchange between 360 unique data sources, including every large vendor, most of the smaller ones, labs and imaging solutions. Allscripts has also supported open APIs since 2007.
But they offered plenty of warnings that it wouldn't be an easy transition for the commercially insured market.
Jitin Asnaani, executive director of CommonWell Health Alliance, an association that provides an interoperability platform and services for its members, including many of the top health IT vendors, told FierceHealthcare he supports what ONC and CMS are doing in spirit. “Clearly, the impetus of the rule is patient empowerment. I’m worried that it took them 1,000 pages to say that. I haven’t read the entire thing, but are they asking for a lot? Is there going to be a whole lot of burden in making it happen? Those are some concerns I have.”
Hal Wolf, HIMSS' president and CEO, said some healthcare organizations will balk at the rules. They will say "'We hear you, but we just can’t go there now. It’s too quick, too soon,'" Wolf said during a panel with executives from Google, Microsoft and IBM Watson.
Aashima Gupta, director of global healthcare solutions at Google Cloud, agreed. “I think we need to be empathetic to the industry,” Gupta said. “There’s standards and there’s implementations. Often in healthcare, we lead with the standard. I think that’s the opportunity for us to give those implementations the tooling to help the community adopt the standards.”
The move toward open standards is an opportunity for some. For example, it's a great development for cloud providers, said Peter Lee, corporate vice president at Microsoft Research.
“It’s important for Microsoft and for the entire cloud ecosystem to be as supportive as possible of what ONC and CMS are trying to do, to throw our weight behind this," Lee said. "It’s a big legacy modernization issue. The moves that we’re all making and our embrace of open standards is giving us all an opportunity to provide solutions, to provide the plumbing, and to provide services that help everybody come into compliance once these rules come into effect.”
However, he added, “This is the right thing that needs to happen; it’s a smart move. Undoubtedly there will be some unintended consequences.”
Asnaani believes ONC’s stance of “no excuses,” as set out in the proposed rule, is needed as he has seen concrete examples of information blocking.
“We have seen, unfortunately, time and time again, organizations making excuses for why they will not share data, including technology organizations and provider organizations," he said. "I call them lame excuses. This set of rules makes it very clear, unless they are legitimate reasons that you can defend, you better exchange the data, for patients, providers and others. That’s what I have taken out of the rules: patient empowerment, provider empowerment and no excuses.”
Boyle, of PointClickCare, echoed the sentiment.
"Some of the challenge has been provider driven. Is that my data? What am I going to do with the data? Do I want to share the data? Some of its been vendor driven. Is it easy to do? How do I enable that?" Boyle said. "I think we need to stop having academic discussions about it. I think that’s really her point: 'Let’s stop talking about it and let's start doing it.' I think the rules will impact it but there’s still work to be done.”
Asnaani envisions that the healthcare landscape will change to one of services on top of interconnected networks, with CommonWell as one spoke on the network.
“If we create a digital health economy that’s built off the ability to easily move the data, then we can facilitate an ecosystem that looks very different from today. Tomorrow’s EHRs are not going to look like today’s EHRs; I don’t know if there will be EHRs. I think tomorrow there will be services that act on the data to provide an insight to provide a lifesaving treatment that helps a clinician to provide better care.”