While meaningful use was everywhere in exhibit hall of HIMSS11, the annual Healthcare Information and Management Systems Society conference, there's a more subtle and exciting back story going on: Health care is an ecosystem, and providers, plans, suppliers, pharmacies and patients all have data that must move, combine and be analyzed in their communities.
Sure, there's the nearly one-half million square feet of exhibition space with some 31,000 attendees milling about to kick tires on electronic health records, data warehouses, business analytics systems and mobile communications networks. But the new-new message of HIMSS is that health care is an ecosystem of many stakeholders, and it's time for the data that each player generates to come together for purposes of individual patient health care quality, value-for-money and public health.
Of course, that's a vision, and there's a precursor-journey and miles to go before we get "there."
Meaningful Use, Jobs #1-4.
Over the next four years, providers will work very hard to get their ducks in a row to meet the HITECH Act's milestones for meaningful use of EHRs. If they don't, providers will not qualify for their share of $21 billion worth of incentive funding included in the act, which was part of the American Recovery and Reinvestment Act of 2009. The annual HIMSS Leadership Survey found that 81% of respondents said their facilities will meet Stage 1 meaningful use criteria in 2011 or 2012. Virtually every EHR vendor promises to incorporate meaningful use Stage 1 requirements into their EHR offerings. The wild card is what Stage 2 might hold for vendors. Earlier this week, Chuck Friedman, the Chief Scientific Officer for ONC, told vendors at the HIMSS Usability Symposium that they should expect Stage 2 to require them to incorporate usability into EHR development, coordinating through the National Institute of Standards and Technology. This could present an additional work stream challenge for vendors, whose approach to usability hasn't had to walk the disciplined line that medical device and other health care technologies have been doing for a decade.
Setting the health-political context for 2011.
Former Secretary of Labor Robert Reich's keynote kicking off HIMSS11 warned that the Great Recession of 2008 generated anger in the bottom 90% of people living in the U.S. That angst comes from the erosion of the American Dream: Falling property values threaten the financial security of most Americans who look to their homes as their primary asset. This anger has translated upward into the halls of Congress, where Reich sees the political debate on health reform focused on Republicans' objective to eliminate the mandate for individual health insurance coverage. Will the Republicans' objectives to shave President Obama's budget lead to the defunding of HITECH incentives for providers' adopting electronic health records? That remained an open question, but Reich concluded his speech on an optimistic note calling out health IT as a transformational enabler that will move U.S. health care financing and delivery toward paying for outcomes and getting better value for money. It's not Social Security or even Medicare in and of itself that need reforming; it's rising health care costs, Reich told the crowd. Health IT can get the U.S. to manage what the U.S. hasn't measured very well -- what the nation actually receives in the form of patient outcomes. Reich applauded HIMSS attendees for their work in health IT as the enabling factor that will enable performance-based payments in health care.
Going global with health data initiatives.
In another HIMSS11 tableau featuring partnering and collaboration, HIMSS welcomed the World Economic Forum to its attendee list this year. The U.S. isn't the only nation that hasn't been able to measure outcomes, quality and the public's health. Emerging economies have the opportunity to leapfrog and collect data the right way on open platforms from the start. Thus, the World Economic Forum -- those clever folks who annually meet in Davos, Switzerland -- convened the Global Health Data Charter. Since June 2009, working groups from the public and private sector have come together through e-mail, workshops and conferences held around the world to evolve the charter. At its center is the objective to act as a catalyst for better health data management globally. Clearly, this is a long-term project -- a marathon and not a sprint. The charter's goals make achieving meaningful use by U.S. health providers look like completing a jigsaw puzzle, compared with building a rocket ship from scratch. But the charter's goals embrace a vision of public health, and the outcome that this charter was actually accomplished with buy-in from all stakeholders involved is a huge first step on the long journey toward global health data liquidity.
Health IT staff shortage: Intensive care required.
A key limiting factor to enabling health transformation via IT is accessing health IT talent. The HIMSS Leadership Survey found that two-thirds of respondents expect to increase health IT staff in the next year -- especially jobs for clinical informaticists. Meanwhile, three-fourths of health IT executives plan to spend more resources on health IT. With demand outstripping supply for this labor pool, the American Medical Informatics Association designed the 10x10 program to train 10,000 new health informatics professionals by 2010. Throughout the U.S., community colleges are also targeting this job category in curriculum.
Social networking and mobile health come to Cleveland Clinic … and beyond.
Social networking is maturing at the annual HIMSS conference. Two years ago, HIMSS devoted a tiny space to a group of health bloggers (including myself) to share perspectives on the benefits and risks of health blogging. In 2011, HIMSS carved out a large hall space adjacent to the ever-expanding and functioning Interoperability Showcase, where 18 social media/health experts spoke on a variety of topics, from hospitals' successful deployment of social media projects to the future of social and mobile health. C. Martin Harris, president of HIMSS and CIO of the Cleveland Clinic, told a HIMSS press conference that he was recently appointed to a mobile application task force at his institution. Ed Bennett, who tracks hospitals' adoption of social media, estimates that over 800 U.S. hospitals now use some form of social media that interfaces with their communities.
Ecumenicism meets health IT.
That is, when it comes to developing new business models and connecting health technology and people. It will be a long and winding road before we have data liquidity -- that is, the ability to get disparate data from systems scattered through the local health care community and onto the desktops, tablets, and smart phone dashboards of health providers. The message of integration permeated HIMSS11 in the form of companies looking towards new partnerships and collaborations. Beyond the vendor community, the theme of partnership and collaboration also applies to adopting standards and openness, working collegially cross-discipline, cross-competitor and cross-border. But the most disruptive cross-border relationship might be the one between the IT industry and the ultimate end-user: the patient.
The patient at the center of care.
In no previous annual HIMSS conference was the presence of the patient as central as during HIMSS11. Miriam Paramore of Emdeon noted during a public policy breakfast sponsored by her company that the U.S. is largely "a payment-centric health system, not a patient-centric one." As health care is funded increasingly through the models of medical homes, ACOs, bundled payments and other regimes that ultimately pay for performance, health providers will innovative care through IT-enabled processes that put the patient at the center of the health ecosystem.