CHICAGO — Overheard on the show floor at HIMSS 2015: “Hey, I like that analytics engine.”
HIMSS 2015 was a health techie’s wonderland, with plenty of partying, delightful chaos among hundreds of vendors and more than 43,000 attendees hoofing it across the vast expanses of the McCormick Place convention center, North America’s largest.
The conference and exhibition delivered on its promise of showcasing the startling breadth of the health IT business. It wrapped up today, April 16, with a closing keynote by Karen DeSalvo, M.D., the national coordinator for health IT. The keynoter the day before was former president George W. Bush, an unlikely forefather of modern health IT as the creator of Office of the National Coordinator of Health IT (ONC), in 2004.
One of the more entertaining plot lines of the show was the behind-the-scenes tussle over potential customers and sometimes quite public battle between the two giant EHR vendor foes, Epic Systems Corp. and Cerner Corp.
When Epic, a day into the show, abruptly suspended or canceled (we don’t know yet which) its $2.50- per-transaction fee for interactions with its homegrown health information exchange (HIE), Cerner, which had long called attention to the fee as an alleged price-gouging ploy, trumpeted the news on the walls of its expansive show floor booth.
Epic, meanwhile, dispatched its irrepressibly techie chief operating officer, Carl Dvorak, to an unlikely venue: a high-profile morning panel on HL7 International’s FHIR (Fast Health Interoperability Resources) draft standard, a rallying point for interoperability advocates.
Epic is a charter member of the Argonaut Project, the HL7-bred coalition that is developing FHIR, but the privately held company still has a reputation, fair or not, for building somewhat closed EHR systems.
For his part, Dvorak played his role with abundant good humor, jousting playfully with fellow panelists, including John Halamka, M.D., the celebrity CIO at Beth Israel Deaconess Medical Center in Boston. Halamka participated via a clunky phone connection that HL7 CEO Charles Jaffe, M.D., conducted by holding his mobile phone up to the podium microphone.
When it was Dvorak’s turn at the podium after Halamka delivered an animated speech about the benefits of FHIR and what he painted as the shackles of government over-regulation, Dvorak gestured toward Jaffe’s phone, which had just stopped crackling with Halamka’s voice:
“Can we put him on mute?” Dvorak asked.
The packed room erupted in laughter.
Over at the distinctive Epic booth, the installation was decorated in sort of a homey style with faux exposed brick, giant butterflies suspended from the ceiling and fanciful statuettes of the odd, dragon-like creatures that play a part in Epic’s unusual corporate culture.
The sheer volume of visitors to the show and the distances they needed to travel by foot – unless opting for one of the small, electric, wheeled “trollies” that cautiously criss-cross McCormick’s huge South and North exhibition halls – created some pretty amusing moments.
On Monday, the first day exhibits were open to the public, show-goers crowded four or five deep at the entrance to the South Hall just before the 11 a.m. opening bell as seen-it-all security guards shouted to the mass of eager HIMSS people to walk, not run, as they entered.
“We’re talking about safety here,” the security chief bellowed.
As for partying, the athenahealth, Inc. shindig at the Hard Rock Café Tuesday night was reportedly rocking, and it featured an appearance by the cloud EHR vendor’s famously exuberant CEO, Jonathan Bush, who arrived at the party with whipped cream on his face after being “pied” at a previous venue.
This morning as I came down the hotel elevator for breakfast, it stopped at a floor and in came a young guy carrying two stuffed bags and sporting a HIMSS 2015 badge.
“You ready to walk another 10 miles today?” the fella asked. “My feet are in pain. I told my boss no offense, but I’m not wearing shoes today.” Sure enough, the guy had his work slacks on with sneakers.
Ah, the life of a HIMSS attendee in Chicago.
The logistics of the show are impressive. Having done some prior work in event planning — on a much smaller scale than HIMSS, for the record — I know what a hellish week organizers are going through. Their role ranges from VIP handler to problem solver, to zookeeper.
If you’ve never been to McCormick Place — the huge conference center at which HIMSS 2015 takes place — it is a sprawling complex with four convention halls. Its buildings rise in a no-man’s land south of downtown Chicago that you can’t easily escape once you’ve arrived, unless you want to compete for a shuttle bus with few thousand of your colleagues or brave a taxi ride.
Watching the cabs come and go outside McCormick resembles the scene at O’Hare Airport a short distance away, except McCormick has a longer taxi line. And if you’re a cabbie, you’d better have strong skin to withstand the verbal assault thrown at you from the traffic directors who make sure the cars keep moving and the pedestrians have a clear crosswalk. One of the crossing guards — and “guard” is truly the appropriate word — was smoking a cigar while barking out orders from the side of his mouth like NBA coaching great Red Auerbach.
And then there are the feet — the feet of 43,129 attendees that are throbbing because of all the steps they take. For those who track their walking with wellness devices or pedometers, HIMSS is more like Mecca. For those of us — like me and the attendee in the hotel elevator — who are more concerned with comfort rather than calisthenics, there is no relief coming until we sit on a plane flying home.
I’m sure Alexis Normand, the healthcare development director at Withings, would disagree. Normand told my colleague, Shaun Sutner, that before he flew to HIMSS 2015, he ran a marathon in France. You won’t be surprised to hear his company produces wellness watches.
I should have taken the offer of a trip on the “HIMSS trolley” in the exhibit hall, a large, souped-up golf cart that rolled people from one end of the exhibit hall to the other. I laughed to myself the first time I saw the trolley; my feet and I are not laughing now.
Following through on a promise made earlier this year, the Centers for Medicare and Medicaid services released a proposal to relax meaningful use reporting requirements in 2015. A major piece of the proposal would shrink the meaningful use attestation period for eligible professionals from a full year down to a consecutive 90-day period.
The 90-day attestation period would also be offered to providers attempting to demonstrate meaningful use of EHRs for the first time in 2016 — if the proposal is accepted as it’s currently written. The CMS proposal aims to align the EHR reporting period with the calendar year, instead of the fiscal year. That move means repeat meaningful use participants will have to successfully attest to meaningful use requirements from Jan. 1, 2016 to Dec. 31, 2016.
CMS’ publication of a blog post in January, in which it declared its intention to shorten the 2015 reporting period, felt like a response to the pleas of groups such as the College of Healthcare Information Management Executives (CHIME). CHIME was on record as opposing the year-long reporting requirement in 2015, and had hoped CMS would replace it with a 90-day version before the end of last year.
The recent release from CMS offered changes to the patient engagement portions of the meaningful use criteria. As it stands, more than 5% of patients seen by an eligible professional (EP) during an attestation period must view, download or send their health information to third party. Instead, CMS now suggests only one patient must view, download or transmit their health information — only to prove this capability is in place and supported by the EP.
When I got into the taxi to catch my plane from Boston to the HIMSS 2015 conference, my cabbie didn’t know how to get to Logan Airport. He needed a GPS to guide him.
Then, in Chicago, the conference shuttle bus driver’s first words to those of us boarding for Sunday’s sessions: “I’m lost.” He had to use his brainpower to guide him to the McCormick Center, the home of the HIMSS event.
Attendees are also trying to find their way – in their case, through the rapidly evolving technology that flows through health IT.
“We’ve got security that’s a big issue. We’re looking at innovation. We’ve got big data . . . It’s overwhelming,” said Sonney Sapra, CIO at Tuality Healthcare in Hillsboro, Ore.
Even large vendors are feeling the uncertainty.
“We are excited we are now in the post-EHR world,” said David Delaney, M.D., chief medical officer at SAP. “But now it’s: So what?”
For SAP and other product developers in healthcare, the path to the future lies partially on the yellow brick road of precision medicine. Data volume, analytics, and EHR integration all promise to tailor patient treatment, such as for oncology, into a new model for care plans.
At Sapra’s hospital, IT staff members find new direction through organization-sponsored hack-a-thons to see if there are ways to penetrate the IS system. “It’s a lot of educating our staff right now and really getting them up to speed,” he said.
This week, as I raced between the rows and rows of vendor booths in the huge HIMSS 2015 exhibit hall in search for an upcoming interview, I took in all the choices before healthcare providers. Which way to go? Which product to explore?
As you find your way through HIMSS 2015 – the correct session room, the best place to avoid lunch lines, heck, even what half of the exhibit hall to head for – remember that your colleagues and product developers walk the same hazy route.
And just like my cabbie and bus driver, you’ll get there.
The march toward ICD-10 is on in earnest.
Along with apparent solid congressional and industry support for ICD-10 after last year’s surprise one-year delay in stepping up medical coding from ICD-9, it appears that CMS is addressing some of the last technical details before the planned Oct. 1 switchover.
CMS recently asked the Office of Management and the Budget (OMB) to approve an Outcome and Assessment Information Set C-1 set for ICD-10 that CMS had to change to a data set that could accommodate the continued use of ICD-9 for a year.
The data set now has to be revised to reflect a few technical coding changes to allow the implementation of ICD-10.
It includes five items mainly affecting home health agencies and the data they are required to collect in order to participate in Medicare. They are:
- Listing of each inpatient diagnosis and ICD-9 code at the highest level of specificity for only those conditions treated during an inpatient stay within the last 14 days
- Diagnoses requiring medical or treatment regimen change within the past 14 days
- Primary diagnosis and degree of symptom control
- Other diagnoses and degree of symptom control
- Payment diagnoses
As part of the OMB approval process, home health agencies can comment on the proposed changes until April 24.
The ICD-10 deadline hasn’t changed since a delay was signed into law more than a year ago. Just as the ICD-10 implementation date hasn’t budged since then, so too has the Workgroup for Electronic Data Interchange (WEDI) in its belief that the healthcare industry may not be ready for the new coding system in time for the Oct.1 conversion date.
A recent WEDI survey — part of a series dating back to 2009 — measured where the industry stands in overall ICD-10 preparedness. Some of the results of the Feb. 2015 survey were notable enough to be included in a letter sent to HHS Secretary Sylvia Mathews Burwell. Of the approximately 1,200 respondents, nearly 800 were providers. Only a quarter of providers had begun external testing of ICD-10 — in other words, determining how well vendors and other business partners are adjusted to the new coding set — according to the survey results. Slightly more than one-third of providers said they have completed an ICD-10 impact assessment, a figure that decreased since WEDI’s last ICD-10 preparedness survey.
The letter to Secretary Burwell wasn’t the only avenue through which the workgroup made its skepticism known. In a press release about the survey results, WEDI President and CEO Devin Jopp, Ed.D, said, “Unless all industry segments take the initiative to make a dedicated effort and move forward with their implementation work, there will be significant disruption on Oct. 1, 2015.”
WEDI’s previous ICD-10 readiness survey was completed in August 2014 and made it appear progress was being made in the external testing department. The number of health plans that had begun external testing in 2014 was more than twice that of the group that did so in 2013. Responding health plans also reported a spike in internal testing between the 2014 and 2013 surveys. Fewer than half had started internal testing in 2013 and almost 75% had started that process by August 2014.
EHR errors can cause serious problems.
The Joint Commission, the independent healthcare accreditation agency that functions as a quasi-governmental body, issued that warning in the days before the giant HIMSS 2015 (Healthcare Information Management and Systems Society) event, which is the health IT industry’s biggest conference and exhibition, set for April 12-16 in Chicago.
We don’t know if the timing was intentional.
But the commission’s March 31 Sentinel Event Alert, a statement that healthcare problems exist that may warrant corrective action and make providers subject to added scrutiny from commission surveyors, is a move that most healthcare providers should take seriously, and probably do.
In such alerts, the commission also sets out possible ways to correct problems.
In this case, while the commission explicitly recognizes the beneficial aspects and improvements in medical care that EHR systems have brought, the alert notes that the technology itself can be dangerous at times, and that medical mistakes sometimes are not just products of human error.
“Incorrect or miscommunicated information entered into health IT systems may result in adverse events,” the alert states. “In some cases, interfaces built into the technology contribute to the events.”
The commission flags three anonymized events stemming from such EHR mishaps:
- A chest X-ray ordered for the wrong person when someone mistakenly checked the wrong box in an EHR
- A doctor wrongly ordered an intramuscular injection when it was supposed to be done intravenously because the physician failed to choose the correct delivery method from the EHR’s drop-down menu
- A pharmacist had two patient records open and entered an order for acetaminophen for the wrong patient
“These examples show the risks inherent in health IT, and studies have documented mixed results in EHRs’ ability to detect and prevent errors,” the alert’s authors write.
So, the commission is urging stronger emphasis on creating a safety culture at healthcare providers, improving EHR processes, and building stronger leadership around safety in health IT.
These are eminently useful proposals.
Indeed, instances in which EHRs hurt rather than helped have been flagged at multiple healthcare providers over the years.
And ONC as part of its mission considers health IT safety. I spoke recently with a top ONC official who heads up the agency’s quality and safety group and he told me that EHR safety and usability are inextricably intertwined.The Joint Commission is welcome to join this space.
But considering that the group issued its last Sentinel Event Alert around health IT in 2008 (the commission says this year’s alert builds on the previous one), one has to wonder where the commission has been since then.
Many patients acknowledge there is a place for technology in their healthcare, but the majority of them still value face-to-face interaction with their physicians above all else.
A 3,000-person survey given to residents of the U.S., U.K. and Germany by Nuance Communications, Inc. provided more evidence for patients’ acceptance of healthcare technology. Nearly 40% of respondents have referred to online medical resources — such as WebMD — prior to making a doctor’s visit. A greater percentage of patients displayed a tendency to go straight the professionals with their medical concerns, as more than two-third of respondents said they have brought a list of questions to a doctor’s visit.
“Patient engagement is more than just the buzzword of the moment…the relationship between physicians and their patients is paramount,” Nick van Terheyden, M.D., chief medical information officer at Nuance, said in the company’s release.
The survey, Healthcare From the Patient Perspective, also gauged how patients thought their physicians’ use of technology affected their care experience. More than half (58%) believe healthcare technology has had a positive effect, 39% were neutral and only 3% were convinced technology has had a negative effect. Regardless of they may feel about technology in the exam room, most patients are aware of a change in its deployment in the last five years. During that timeframe, almost 70% have noticed a change in how often technology was used by their physician.
Patients’ approval of doctors using technology in the exam room varies depending on the device in question. More than three-quarters of patients in the U.S. and U.K. are comfortable with physicians using a desktop or laptop computer during a consultation. There is a steep decline to the next most-accepted device; only 27.4% of that group would be comfortable with physicians accessing mobile devices in the same scenario. At 18.2% and 7.5%, telemedicine and image sharing through the cloud were the next two technologies patients would be most secure with doctors using.
Pages and pages of stage 3 rules — and moving on from stage 2; population health’s ties to machine learning; UIs hamstring VNAsathenahealth, CHIME, CMS, EHR certification, meaningful use stage 2, meaningful use stage 3, population health management, Storage and PACS, VNA, Wearable devices
Spring break sure sounds good to me after CMS dropped 700-plus pages of proposed regulatory rules for stage 3 meaningful use and EHR certification for the healthcare IT industry to study up on. Opinions quickly flew around the Web about the most important parts of the proposals.
Reporter Shaun Sutner grabbed thoughts from two influential players in healthcare IT — athenahealth Inc. and the College of Healthcare Information Management Executives (CHIME) — and then followed up by looking at a critique of the proposed CMS rules that is bound to get attention because of who wrote it: Beth Israel Deaconess Medical Center CIO John Halamka, M.D., and Massachusetts eHealth Collaborative President Micky Tripathi.
CHIME and athenahealth expressed tepid responses to the CMS release, while Halamka and Tripathi jabbed the agency about the proposal’s page count.
As Sutner wrote, Tripathi and Halamka’s review “delves into the critical realm with sections labeled the ‘good,’ the ‘bad,’ and even the ‘ugly.'”
In better-looking news, the new issue of our premium e-zine Pulse came out this week on the related topic of transitioning from stage 2 to stage 3 meaningful use. The theme of the issue is whether providers are ready for the change, and I expect more answers to that question at the upcoming HIMSS 2015 conference in a couple of weeks.
Population health management will also be a trigger topic at HIMSS 2015. As contributor Reda Chouffani noted in his piece about curbing rising healthcare costs, machine learning can improve population health efforts. Machine learning focuses on creating computer programs that teach themselves to grow when exposed to new data.
The CMS stage 3 proposal also touches on population health by inviting opinions about how to best use patient-generated data from wearable wellness devices and tracking systems.
Meanwhile, I weighed in on the buzz about vendor neutral archives, which don’t seem quite ready to take over from picture archiving and communications systems — the VNA versus PACS debate. Technology pros and cons aside, VNAs users get hampered by user interfaces that aren’t easy to, well, use.
Scott Wallask is news director at SearchHealthIT. Follow him on Twitter @Scott_HighTech.
The health IT world reeled when CMS and the Office of the National Coordinator (ONC) for Health IT unleashed more than 700 pages of proposed rulemaking for meaningful use stage 3 for healthcare providers and EHR vendors.
Now two of health IT’s leading thinkers and innovators — Beth Israel Deaconess Medical Center CIO John Halamka, M.D., and Massachusetts eHealth Collaborative president Micky Tripathi — have essentially deconstructed the verbiage in a co-written post on Halamka’s widely read blog.
Now rocketing around the Internet, their analysis is a mostly factual condensation of the sprawling proposed rules released last Friday, whose length and byzantine construction the authors gently make fun of.
“Providers and vendors alike were all hoping for something lean and clean,” write Halamka and Tripathi, who are colleagues in the Argonaut Project, a new coalition of competing vendors and other health IT players that have come together to develop the emerging Fast Health Interoperability Resources standard, or FHIR.
But their post also delves into the critical realm with sections labeled the “good,” the “bad,” and even the “ugly.” These two sometime iconoclasts chide federal health IT officials, with whom they have worked closely for many years, for what they see as needless complexity and trying to please too many people and thereby failing to prioritize.
As for the good, the authors call the proposed rules, which now will go through what is likely to be a spirited 10-week comment period, “a good first draft.”
Halamka and Tripathi say that while the rulemaking is long, CMS should be commended for essentially streamlining and consolidating “stray threads” from meaningful use stage 1 and stage 2.
They also give good marks to both CMS and ONC for their work on the new certification rules and their strong emphasis on APIs. This direction, they note, is in line with on dramatically boosting interoperability, efforts by ONC’s Health IT Standards Committee (HITSC), and the goals of the Argonaut Project, which is housed at Tripathi’s eHealth Collaborative.
Halamka is vice chairman of HITSC, Tripathi was a member of the JASON Task Force, and both advocate for stronger interoperability capabilities for EHRs.
The bloggers also say it’s good that all players will start off with stage 3 in 2017 and 2018, as opposed to stages 1 and 2, which have found different providers attesting to different stages in separate years.
Now for the ugly.
While they say stage 3 is more focused than previous stages, Halamka and Tripathi are convinced that meaningful use is still an onerous burden for the most part on providers and vendors.
Overall, they argue that meaningful use in many areas is disconnected from how physicians practice medicine in the real world.
“The sheer number of requirements may create a very high, expensive and complex set of barriers to product entry,” they write. “It may stifle innovation in our country and reduce the global competitiveness for the entire U.S. health IT industry by over-regulating features and functions with complicated requirements.”