BB&T National Editor

CHICAGO – The annual conference of the Healthcare Information and Management Systems Society (HIMSS; Chicago) is one of the livelier, more entertaining medical conferences around.

And this year it could afford, more than ever, to be lively, since positioned on the cusp of a veritable 21st century Gold Rush – in the form of $19 billion-plus in potential stimulus money, funding serving to term the "lemon" of economic downturn into the "lemonade" needed by U.S. healthcare, transformation of the long-predicted promise of e-health technologies into reality.

So while most other industries are having difficulties attracting attendees to their conferences – or even speakers, given shrinking travel budgets – HIMSS obviously was having no such difficulties, enticing more than 27,000 attendees and 900 exhibitors, in 30 product categories, to the Windy City and the lakeside sprawl known as McCormick Place.

The past two or three HIMSS conferences have been infused with promise of HIT, the organizers predicting big e-health breakthroughs that haven't yet broken through, this lag highlighted by a continuing flimsy minority of physicians utilizing electronic health records (EHRs), e-prescribing or even basic e-mail for contact with patients.

The promise of a Big Bang-sort of advance for HIT was even more in evidence at this conference though, driven by the feeling that healthcare reform in the U.S. has now reached an all-or-nothing tipping point. That was fueled by Barack Obama's campaign promises to reform the country's healthcare system, and his administration's apparent commitment to that promise.

One of the keystone features of that commitment is an emphasis on not just hoping that HIT will transform U.S. healthcare but providing large economic incentives – "sticks," in the forms of potentially withholding funds from providers not using IT systems, as well as the "carrots" of additional dollars – to push these technologies into physicians offices.

A 3rd 'revolution'

In a special feature section, The Economist billed this longed-for development as a third revolution for modern healthcare, the first being the Watson/Crick discovery giving us an understanding of DNA, the second, the mapping of the human genome (April 18, "Medicine goes digital"). The Economist writers say these new "clever" technologies can solve two big problems for worldwide healthcare: "overspending in the rich world and underprovisioning in the poor world."

However, they point to one of the key barriers for this revolution for U.S. healthcare: While other countries, even those far down on the "industrialized" scale, can integrate HIT into their systems "from scratch," as it were, the U.S. must reengineer its systems, retrofitting a polyglot of legacy systems, the already-referred-to inertia of physicians to adopt these new systems and the generally unsystematic character of U.S. healthcare.

At the same time they point to a whole range of changes already taking place in healthcare in the U.S., and everywhere, as a result of HIT, in a whole range of ways: the availability of huge digitized databases to better understand diseases and the efficacy of therapies in huge populations, the use of HIT for improved patient safety and improved pathways for patient self-management of their health and (in perhaps the "unexpected" consequence" category) the erosion of the paternalistic attitudes and powers of physicians as patients become better informed about diseases and therapeutic options.

The HIMSS conference addressed these issues, while also providing perspectives concerning how U.S. healthcare will do in general over the coming decades.

Safety first

Though it wasn't the primary focus of the conference, patient safety via new IT systems received the initial attention for attendees and allowed the society to flaunt its star power, capped at the end by a presentation from former Fed head Alan Greenspan.

The initial star, Hollywood style, was Dennis Quaid, movie actor turned healthcare activist. Quaid recounted the near tragedy he and his wife experienced and led him to establish his own foundation to promote patient safety using HIT. He provided an hour-by-hour account in 2007 of returning their months-old twins, Thomas Boone and Zoe Grace, to Cedars Sinai Medical Hospital (Los Angeles) for treatment of low-level staph infections.

But twice the twins were injected with huge overdoses of heparin, resulting, he said "in thinning their blood to water,"causing continuous bleeding that was stopped only after 41 hours of coagulant therapy, the twins in obvious pain during this ordeal.

Quaid avoided indicting hospitals in general, praising Cedar Sinai for subsequently making large investments in patient safety technology and lauding HIMSS attendees for developing these technologies. He said the near-fatal medication mistakes were the result of two vials of heparin looking very much alike, but these mix-ups were just one type of error in a chain of many.

He made the point that IT well knows: that human errors will happen, and keep happening, if systems aren't re-engineered to prevent them, illustrating the lag in healthcare with a video clip of a jet engine attempting to power a Wright Brothers-era aircraft. Building on this metaphor Quaid noted that airplane travel is currently significantly safer than walking, while the yearly hospital mortality rate in the U.S., as a result of preventable errors, is equivalent to "one major airline crash every day, every year." And he said that these deaths, as the result of "infections and other events, are the third-leading cause of death in the U.S."

Recounting the personal pain his family experienced provided emotional backing for his message to attendees: to push for the same type of systems analysis for change seen in the aircraft industry in order to reduce hospital mortality."

"Where do we go from here?" he asked. His answer: "System solutions to safeguard against predictable human performance errors. We have to make bar coding and electronic records common in all hospitals in this country"

Quaid's keynote presentation take-away message to the huge, standing-room-only ballroom crowd was: "Set standards to bring interoperability and security to this amazing revolution in healthcare. You understand the synergies . . . and you will lead us to a better and brighter future, to keep families like mine safe."

Interoperability, interoperability, interoperability

With Quaid underlining the need, interoperability was clearly the main focus of HIMSS09, and given a persistent beat similar to that of real estate's mantra of "location, location, location." Interoperability of HIT systems is of course one of the primary hurdles for the sector, given the explosion of companies developing these systems and the random mishmash of initial development.

While broad interoperability is much easier said than done — and an HIT concept hanging around for a long time – it actually may be nearing realization, at least as demonstrated by the conference's Interoperability Showcase. Further, it is developing with ease, in another fashion, among informed patients, via the Internet, as described by one conference presenter.

The BB&T reporter joined the "Medical Device Interoperability" showcase demonstration (appropriately, he thought), which involved three kiosk set-ups – an OR, an ICU and a recovery area – each festooned with a monitors gathering data from a very sick "virtual" patient, this information then flowing into an EHR to provide a collaborative record of how this patient was doing.

The demonstration was provided by Interoperability Healthcare Exchange, a non-profit group promoting a seamless e-approach between devices for improved speed and better patient care. An IHE presenter said that the showcase was designed not to show the quality of the individual devices being used, but rather the quality of the conversation amongst them.

However, the phalanx of monitors at each station mostly reminded BB&T of a NASA command HQ – and wondering how much all of this would cost, and how many hospitals actually will be able to make all of this technology available to patients?

Interoperability – among patients

Clay Shirky, author and adjunct professor at New York University's telecommunications program, described the ease with which individual patients are transforming the basic healthcare model via the Internet and spontaneous "social" communities.

Though he didn't call this interoperability, that is what he described: individuals linking up with one another to build a critical mass of medical expertise, impossible before with the telephone or other traditional modes of communication. Following are three examples he gave of the ways in which individuals have been able to link up with many others to impact healthcare:

• A doctor issuing a letter concerning problems with the Durom Hip Implant made by Zimmer (Warsaw, Indiana), the letter picked up and disseminated on Facebook and forcing, with this broad distribution, a quick recall;

• Individuals with the same disease becoming fairly expert at the therapeutic options available, providing specific advice to one another, as well as support, concerning the pros and cons of the various treatment choices;

• Wikipedia offering a growing amount of specialized information concerning healthcare, and doing so with an efficiency and rapidity – quickly corrected if in error not seen on professional online medical sites.

Overall, Shirky said the Internet has worked to put large pressure on the traditional model of communications, a model, he said, that tries to emphasize "building trust." But he argued that this cannot be done artificially. Rather, he said that information flows "where trust has already been built" and thus explains the communication that is developing over the Internet, among individuals who come to develop trustworthy relationships and are reshaping the basic models for disseminating healthcare knowledge.

An EHR case study

Another continuing interoperable focus of HIMSS is the need to develop a comprehensive electronic health record (EHR) for the nation, often been compared to ATM banking – "If banks can do it, why can't healthcare?"

But a presentation titled "Achieving the EHR's Promise: Columbia University's Academic Physician Partnership," detailed why recording health information isn't quite like spitting out an account balance, especially in grown-like-Topsy U.S. healthcare. The multiple difficulties for Columbia Doctors (New York), were described by Richard Levine, MD, president/chairman of this pieces/parts accumulation of clinical and educational practices.

Columbia Doctors is comprised of about 1,200 physicians, 150 practice groups, 40 different cites, 500,000 annual patient office visits, a teaching hospital serving two campuses – Columbia and Cornell – and an overall structure he called "very specialized, very siloed."

He termed the IT legacy situation of this conglomerate "a m lange of disparate parts," which the organization in late 2007 decided to tie together with a single EHR. Peter Stetson, MD, Columbia's chief medical information officer, cited various initial barriers, including the costs of implementing tablet-style computers, entrenched loyalty to existing IT systems and the general difficulty of changing physician behaviors.

He described the competition to choose a vendor, starting with about a dozen firms, paring it down to two, holding a competition – resulting in the winning selection of Allscripts (Chicago) – and the ongoing process of installing, refining, identifying departmental "champions," and meeting regularly, overall a process that one of his PowerPoints described succinctly as "HARD."

Stetson said that the EHR still being implemented – branded as CROWN, for Clinical Records Online Web Network, powered by Allscripts – is breaking down the organization's non-interoperable silos and eventually used in the organization's research efforts. He told BB&T that broad interoperability would be the key to linking privately developed EHRs to any national EHR, if that should eventually transpire – though tending to doubt such a development.

Greenspan the Dismal

Against the general optimism of HIMSS09 was a fairly gloomy assessment of the future of U.S. healthcare by Alan Greenspan, his dismal demeanor underlining the general view of economics as the Dismal Science.

Sometimes reading, head bowed toward notes apparently difficult to decipher, Greenspan predicted that, well, hopefully, things will get better for U.S. and world economies. But he followed these prognostications with the acknowledgment that, while the decline in various economic metrics seems to be slowing somewhat, he couldn't predict when it would become an upturn. And he was not optimistic about the future of U.S. healthcare.

The problem (and no particular big headline-making news for the medical sector): the tidal wave of aging Americans that will require medical care, and – what medical technology providers are probably less willing to acknowledge – what he said would be healthcare's lack of "capacity" to fulfill this need.

And while attendees – packing the cavernous Skyline Ballroom of McCormick Place – were obviously hoping for Big Wisdom concerning healthcare from the biggest figure in world economics over the past 20 years, they received only a couple of tidbits:

• That health information technology will be one of the methods for reducing medical costs.

• That the Obama administration may have to increase co-pay charges on the country's affluent in order to pay for increased healthcare costs.

As a matter of background, Greenspan compared the healthcare of his childhood with modern offerings."Take two aspirin and call me in the morning," he said, was the extent of the "high-tech" medicine that could be offered by physicians when he was growing up, because there "wasn't much that the profession could deliver." And he contrasted this with the blossoming of product offerings, products and services of today, and the growth in healthcare spending to 16% of total GDP.

He said the rate of expansion in healthcare's offerings – so that steel companies are spending more "on healthcare than on steel" – "occurred without any evidence of pressures on the economy." And this lack of pressure he put as the result of the overall economy providing "enough resources for the non-medical requirements of the society."

It is difficult, he said, "to get a sense here of what the limits [of this supply] will be or here it will eventually end up," and he expressed certainly that the U.S. economy "is not going to grow as fast in the years immediately ahead, as it has in years past."

Complicating this is the "baby boom generation . . . [and] moving a very large part of the most productive part of our population from work to retirement over a relatively short timeframe." The result, he said: "a clash, invariably, in the marketplace because resources are not going to be as ample as they have been."

What he proposed as the necessary (and rather unlikely) antidote for averting this clash would be a "surprising acceleration in productivity" to meet the "propensity of newer technologies to enhance the supply of various types of medical products" – a comment hardly pleasant music to high-technology, which often must fend of criticism that it is the source of ballooning healthcare costs.

Greenspan also described a clear difference between the continuing problems of keeping Social Security and Medicare afloat, noting that 20 years ago he had headed a commission to offer solutions for fixing both. "At the very first meeting, we decided that we were not going to try to handle Medicare. We said the demographics are going to be okay for 20 years or more, so we have time."

We knew back then precisely what the timing would be, when the baby boom generation retired, forecastable like other things are not forecastable. "But we've done virtually nothing about it, nobody ants to touch an issue. If you've read the [2006] trustees' report, you find that we are funding – even before the current crisis – less than half of what the entitlement is."

And he said that growth in health spending, about 2% faster than GDP, will inevitably force hard choices and cut-backs. "I haven't the slightest idea what the true current services cost of Medicare . . . I hope that one of the avenues by which we will seriously confront and improve the issue is in healthcare information technology – but there are so many avenues here."

Products, and more products . . .

With 900 exhibitors at HIMSS, a few should be mentioned to represent the kinds of products unveiled by the small-sector players, as well as the large.

• Medsphere Systems (Carlsbad, California) reported the release of open source code for recently developed components of the comprehensive OpenVista EHR. Medsphere's open source release, now available for download at www.medsphere.org, includes the OpenVista Interface Domain (OVID), the OpenVista Clinical Information System (CIS) 1.0RC1, and OpenVista Server 1.5SP1. OpenVista is the commercialized version of the VistA EHR created and developed by the Veterans Administration more than 20 years ago.

• AirStrip Technologies (San Antonio) reported FDA clearance for its AirStrip OB, a mobile medical software application that sends vital waveform data, including fetal heart tracings and maternal contraction patterns, in virtual real time directly from the hospital's labor and delivery unit to the obstetrician's handheld mobile device. The data can be accessed anytime, from anywhere the doctor gets a cell-phone connection.

• Keane (San Francisco) reported launch of Keane Optimum, a one-source solution for healthcare organizations to improve both financial performance and patient care. This software minimizes the expense associated with managing discrete IT solutions to give hospitals a unique level of visibility into their business operations, to improve accounts receivable cycles, reduce medical errors and simplify complex third-party billing.

• Allscripts introduced Allscripts Remote, an iPhone application that provides physicians anytime/anywhere access to and control of Allscripts electronic health records (EHR). With Allscripts Remote, physicians can now safely make the information available on their phones.

Also available for the Apple iPod touch, Allscripts Remote delivers an interactive connection to the Allscripts Enterprise and Professional EHRs. Capabilities include quick access to real-time patient summary information; fast communication to local hospital emergency rooms; ePrescribing to the patient's regular pharmacy; and real-time access to all the information a physician needs to make decisions, including medical history, lab results and medications.

• Ergotron (St. Paul, Minnesota) unveiled its latest StyleView monitor solutions for point-of-care technology, including the VL Enclosure, Vertical Lift, HD Combo and Neo-Flex WideView and Dual WideView WorkSpace Carts. The StyleView VL Enclosure represents Ergotron said this is its most secure wall mount to date, designed to maximize security and maintain patient privacy, including keyed and keyless locking mechanisms. StyleView Vertical Lift is intended for high-traffic areas and patient rooms. The StyleView HD Combo gives healthcare professionals the ability to easily re-position an entire workstation – one can adjust the display, keyboard, mouse and barcode scanner in a single motion.

• OptumHealth (Golden Valley, Minnesota) unveiled eSync, a technology platform that collects and synchronizes health data in order to more proactively engage individuals and care providers with appropriate healthcare opportunities. OptumHealth said it refined eSync in beta testing, applying its processes to health management programs serving 20 million people. "We designed eSync to link to and interoperate with payers' existing systems. Used broadly, eSync technology could significantly improve health system performance across the country."

• Nuance Communications (Burlington, Massachusetts), a supplier of speech solutions, reported results from a new study showing that its Dragon Medical real-time speech recognition software can significantly accelerate the transition to, and use of EHRs. A survey of 1,255 physicians who have adopted Nuance's Dragon Medical software showed that 83% said it improved the quality of their electronic patient notes; 81% said that it significantly reduced transcription spending; 69% said it made their EHR faster and easier to use.

• Versus Technology (Traverse City, Michigan) highlighted efficiency gains, improved communication and workflow optimization as a result of its enterprise real-time locating system (RTLS). Versus said that the system improves workflow, that improvement extending benfits to staff in all departments, from lab technicians and clinical engineering staff to nurses, physicians and the C-suite.

• TeleTracking Technologies demonstrated its new version of Bed Management Suite, designed on its advanced TeleTracking XT platform. Bed Management Suite employs the features and capabilities available with the company's patient flow platform, TeleTracking XT. New features include a scalable, flexible, browser-based system that allows health systems to manage patient flow for one hospital or several, all from this single platform.

TeleTracking also reported a development agreement with Hill-Rom (Batesville, Indiana) to invest in and commercialize patient flow and nurse communication solutions designed to enhance efficiency, improve patient safety and integrate communication within the health care environment. The deal will support investment in integrating Hill-Rom's NaviCare Nurse Call system with TeleTracking's leading Capacity Management Suite powered by TeleTrackingXT to deliver new, integrated value between patient flow technology and nurse communications solutions.

. . . and collaborations aplenty

The conference featured many other announcements of new partnerships.

• The Image and Knowledge Management (IKM) business unit of Siemens Healthcare (Malvern, Pennsylvania) and Harris (Melbourne, Florida) reported joining forces to offer providers critical solutions for picture archiving and communication systems (PACS) for disaster recovery to support business continuity. Siemens' IKM business unit and Harris said the initiative will help make PACS disaster recovery easily attainable and affordable.

• GE Healthcare (Chalfont St. Giles, UK) reported a collaboration with the National Center for Public Health Informatics of the Centers for Disease Control and Prevention (CDC; Atlanta). The project will demonstrate the capability of a public health agency to use electronic medical record (EMR) systems to provide clinicians with timely, patient-specific information at the point of care. The pilot program will explore the feasibility of integrating actionable alerts with GE's Centricity EMR system, based on patient record content, using a standard messaging format.

• Dell (Round Rock, Texas) and Perot Systems (Plano, Texas) reported an alliance to provide integrated global IT solutions that unite their technology and services solutions for virtualized desktop, storage and server solutions for hospitals, health systems and physician practices – virtualized on premises or hosted, either off-site or in secure, private clouds.

• dbMotion (Pittsburgh) and Allscripts (Chicago) said that agreed to create tightly integrated connectivity solutions that allow physician communities to see a more holistic view of their patient's clinical record and to collaborate with providers throughout their community. They said they will develop solutions to present information in a seamless way.

Additionally, dbMotion and the University of Pittsburgh Medical Center (UPMC) reported completion of the initial phase of an extensive interoperability initiative. As a result, they said that the time spent collecting preoperative patient information at one hospital was reduced 82%, while patient readiness for surgery improved 50%, according to UPMC.

• InterSystems (Cambridge, Massachusetts) reported that the Brooklyn Health Information Exchange (BHIX; Brooklyn, New York) has selected the InterSystems HealthShare software platform for multiple information exchange projects focused on electronic health record (EHR) interoperability. The agreement is valued at nearly $3 million for software, support, and services delivered over the next two years.

• The U.S. Department of Health and Human Services, in collaboration with 5AM Solutions (Reston, Virginia), demonstrated a new web-based tool, My Family Health Portrait, that provides a secure first step for patients to use an electronic health record (EHR). This new tool, first released by the Office of the Surgeon General in January, allows patients to track their family health histories, which can be printed or shared electronically with the family members, doctors and EHRs that they choose.