Las Vegas was an appropriate metaphor for the Healthcare Information and Management Systems Society's annual conference, as bets are being placed on several health IT issues affecting providers: Will health care providers be able to meet Stage 2 of the meaningful use program? What will the timing be for ICD-10? Can health information exchanges survive? And of critical concern, how will slow-to-adopt physicians and community hospitals fare in this environment?
Ultimately, what shaped the sales pitches, product demos and migration paths at the HIMSS conference was not about technology at all: It was the market driver of health care payments moving from volume to value. Accountable care, whether it takes the form of an ACO writ large or in lower case, will compel health providers to undertake greater financial risk for managing population health. While the pace of this change can be debated, the trajectory is inevitable.
How did the transformational driver of health payments translate on the HIMSS exhibition floor? What was most visibly obvious was the word "connected" appearing in innumerable company taglines:
- "Connected health -- working better together:" Cisco;
- "Health connections brought to life:" RelayHealth;
- "Connecting care providers and the care they provide:" Siemens;
- "A connecting community of health:" Allscripts; and
- "Enlightened action. Connected care:" Intersystems.
Each of these companies, as well as with others with whom I spoke, has its own version of what "connected" means in health care -- and what health information exchange means, as well. Since health information exchange is a linchpin of health reform, as well as private sector care delivery, a lack of common definition is not a trivial point when billions of dollars and patient outcomes are on the line.
Connectivity of providers, patients and data enables two kinds of risk management: managing population health by identifying which patients have the potential to develop high-risk conditions, and financial risk. In the value-based health care world, care managers need to access patient data in real-time and analyze the information along the continuum of care.
The Big Data Story
John Sharp of the Cleveland Clinic told me, "The most innovative health care organizations and [health IT] companies are looking beyond meaningful use to big data -- how to exploit data from [electronic health records], genomics and medical knowledge stores to bring better clinical decision support and rapid research to bear."
Thus, big data and data analytics played a visible role at HIMSS12. Optum announced its cloud-based platform, working with partners and competitors to assemble a suite of health information services with the promise of delivering seamless care. Caradigm, the combined GE-Microsoft venture, is touting a similar concept, although it still is in beta form. SAS Institute, which hasn't had a booth at the annual HIMSS conference for several years, reappeared this year with a goal of providing health care with the kind of big data analytics that the company has provided life sciences, airlines and retail sectors for decades.
Data analytics will be extremely useful in 2012 as the Affordable Care Act will impose financial penalties for hospitals that re-admit patients with acute myocardial infarction, congestive heart failure or pneumonia within 30 days. Predictive modeling will be useful in identifying patients at high-risk for acute events resulting in readmissions and in greater downstream costs. Data analytics will be useful to improve care processes and better allocate resources, ultimately reducing health costs for a patient over the continuum of care.
In the very big data and long-term future scenario, IBM talked about Watson. IBM is now working with WellPoint and the health plan's 32 million members to address utilization management, as well as with the Cleveland Clinic on a variety of clinical innovations.
Bridges to Big Data
Before big data can be analyzed, the data need to populate EHRs and become liquid. Migrating to the larger connected health vision will mean building bridges to information in the shorter run.
John Glaser of Siemens talked about the "interstitial EMR." Siemens' take is that the provider environment for health IT is heterogeneous; the more health IT diversity, the more HIE is critical to bringing together different systems. Glaser said, "If you believe care coordination comes with lots of [health IT] diversity, HIE is so important."
Similarly, Dan Kinsella of OptumInsght pointed out, "In reality, most patients are under the care of multiple physicians who are using various [EHR] products." To the rescue: connectivity through the cloud, which can host collaborative tools and applications like lab tests, prescriptions, EHRs and guidelines, with security and authentication.
A Health IT System Built To Last?
A recent Deloitte report starts off by noting, "The national debate around health care reform and the quest for a sustainable system that provides higher-quality care at lower cost have highlighted the critical role of health information technology."
In our national dialogue about health care sustainability, health IT sustainability should now be a concern.
The U.S. health industry has a long list of grand and well-meaning health data integration projects -- such as Community Health Information Networks and Regional Health Information Organizations -- that were built on grants in their early phases. These programs ended up unsustainable, lacking sound business models that could find and generate revenue to enable the projects to sustain over the longer term.
Will HIEs follow CHINs and RHIOs into the health IT graveyard? HIE stakeholders are sober about their prospects: The eHealth Initiative's latest annual survey found 60% of leaders view developing a sustainable business model as a major challenge facing HIE projects.
Another sustainability question is how to manage the proliferation of health IT investments? The 2012 HIMSS Leadership Survey of senior health IT executives found that for the first time, the barrier to implementing health it isn't access to cash: it's access to staff that can implement and support the systems. A CHIME survey found that over 50% of hospital IT departments have open positions they've not been able to fill for more than three months.
This should be good news for a national economy with high unemployment. However, Kirby Partners, a job placement firm, has observed that health care CIOs have a large pipeline of applicants for open positions but find that graduates of federal health IT training programs may "not be ready for primetime," as Judy Kirby wrote in Healthcare IT News.
Finally, sustainability is affected by the national economy and the long-term problem of health care financing in the U.S.
John Reichard, editor of CQ HealthBeat, addressed HIMSS' 10th Annual Public Policy Breakfast. He talked about Capitol Hill's challenges in addressing the Medicare reimbursement system, saying the issue is becoming "the post-traumatic stress disorder for Congress."
While Congress recently passed legislation avoiding a cut to physician fees, hospitals took a significant financial hit, which could impact health IT spending, Reichard surmised. He advised the standing room-only audience to pay attention to the Medicare budget negotiations, the results of which could negatively impact health IT spending by health providers.
HIMSS12 had no lack of brilliant technology concepts, products and stories about leading health providers such as Cleveland Clinic, the Mayo Clinic, Kaiser Permanente, Partners Health System, Geisinger and many academic medical centers incorporating innovative approaches to care management and the adoption of data analytics.
There remains the gap between haves and have-nots in health care, where community hospitals and small physician practices may be disadvantaged for some time in the value-based environment. Sustainability will affect these providers who, in the short-term, may fall behind in health IT adoption and use.