Reflections of HIMSS XXX

At a pre-conference team dinner with a group of young first-time HIMSS attendees, I alarmingly realized that 2019 was actually my 30th year participating at HIMSS.  

My colleagues asked me to reflect on how the event and health IT have evolved over that time. Below are the reflections I shared based on my selective memories of where we’ve been and how we arrived at where we are today in healthIT.

I welcome comments from other industry long-timers if this rings true to you and what I’m missing! 

1970s to 1980s Themes

• Financial and billing systems to capture charges and maximize fees and collections
• Mainframe computing vs. shared services for data processing

1980s to 1990s Themes

• The financial systems you bought in the 70s, and the hardware-based orientation of the data processing department, fail to address clinical and operational needs of key departments
• Niche systems for pharmacy, radiology, laboratory, surgery, etc. are introduced to yield strong ROI by replacing paper and manual processes
• Mini-computers enable departmental independence from data processing
• Send faxes to another fax machine
• The physician is the center of the care universe

1990s to 2000s Themes

• The departmental clinical systems you bought in the 80s have created fragmented silos of data that led to clinical errors and operational inefficiency from an enterprise perspective
• Order entry and results reporting systems evolve into Electronic Medical Records (EMRs) with the promise of breaking down the silos of data across the hospital and improving patient safety and clinical effectiveness
• Interface “standards” to exchange departmental data with the new EMR, and to exchange data between hospitals with different EMRs.
• Send faxes to another fax machine
• The hospital is the center of the care universe

2000s – 2010s Themes

• The EMRs each hospital bought in the 1990s and 2000s are creating silos of data across the health system (as mergers and acquisitions drive IT complexity)
• Health systems need to standardize on one EMR vendor for the entire enterprise and de-install a lot of what you spent the last 5-10 years to implement; minimize the niche products and eliminate data and workflow complexity by buying everything from that one vendor
• Exponential investment creating new digital health companies in emerging niches to address gaps and needs beyond the EMR
• Cloud and mobile helps minimize past dependence on IT
• Send faxes directly into the EMR
• The patient is the center of the care universe

HIMSS 2019 Themes

• Health system EMRs have created silos of data both for an individual and across a community – this restricts clinically-integrated, value-based care and limits a focus on better health. Plus, those EMRs are too complicated for a physician to fully adopt without stifling their productivity and causing burnout.
• Data must be (1) captured invisibly, (2) shared freely, (3) analyzed, interpreted and understood instantly, (4) simplified to be made relevant and actionable at point of decision, (5) secure but ubiquitously available
• Send HIPAA compliant faxes into the EMR
• The consumer is the center of the care universe

Emerging Themes

• EMRs are foundational, but are wholly insufficient (like expecting to be able to live in a house that has expensive plumbing and wiring, but no furniture, light fixtures or kitchen appliances).
• Focus on the health problems of an individual and / or population in a community.
• The HIMSS Interoperability Pavilion was an oasis in the vast vendor exhibit hall, which truly emphasized this theme, using examples of vendor collaboration on topics including:
• Addressing the opioid crisis
• Mother & infant mortality prevention
• Immunization integration
• School telehealth & social determinants
• Where can we still buy fax machines?

The winners over the past 30 years

• Consultants driving system selections and implementations to “de-risk” decisions
• Vendors who have come and gone by riding sales to address the theme of the day and parlaying that into nice exits (just before their niche declined) to Fortune 500s like GE, McKesson & Siemens (before the weight of all those wet dogs sunk their Health IT battleships)
• HIMSS as the hub for the shopping event for all these IT purchases

The losers over the part 30 years

• Hospitals that have spent massive amounts of money and time on IT that failed its promise, all while healthcare as a whole lagged behind every other industry technologically
• Physicians and nurses whose difficult jobs have been made more so
• The government, employers and individuals who have ultimately paid the increasing bills to get unacceptable health outcomes for the costs incurred

After 30 years of seemingly going in circles, is now the time digital is going to meaningfully impact health? To what extent will the incumbent healthcare stakeholders, including the health systems, solution companies and HIMSS itself, be in control or be the restrictors of that transformation?