I’ve just finished my day in Atlanta and am beginning a commute to Tokyo.
Every year, I describe my top 10 impressions from HIMSS. Here’s my summary of the event for 2010
I’ve just finished my day in Atlanta and am beginning a commute to Tokyo.
Every year, I describe my top 10 impressions from HIMSS. Here’s my summary of the event for 2010
1. Meaningful Use is everywhere. Vendors are promising EHRs, modules, appliances, and services to help clinicians achieve it. I had dinner on Monday night in a small Indian vegetarian restaurant. Sitting next to me were 3 engineers from Bangalore who were arguing about the details of Meaningful Use in between bites of vegetable curry. I could not escape Meaningful Use anywhere!
2. Certification is everywhere. It’s particularly ironic that many vendors claimed their systems were certified, even though the certification NPRM was just released today, making compliance with the new certification process in time for HIMSS impossible.
3. Cloud computing, Software as a Service and ASP models are popular tactics to accelerate EHR rollouts. There are still lingering concerns about how to ensure privacy in a cloud environment.
4. Several firms such as Intersystems, Axolotol, and Medicity are offering HIE platforms that include many of the standards noted in the IFR. The marketplace for HIE products is just emerging and it’s hard to predict who will become the market leader.
5. The Continuity of Care Document is gaining traction. I found many vendors supporting CCD exports from their EHRs. A company called M*Modal , has developed natural language processing technology that captures dictated content in its original context (ontology-driven rules) as a CDA document.
6. Consultants abound. It’s clear that Regional Extension Centers and Health Information Exchanges will require expertise and staffing from professional firms. They all had large booths at HIMSS.
7. 30,000 people attended, including 10,000 I did not recognize (just kidding). It’s clear to me that many IT professionals, even those with limited healthcare domain expertise, attended HIMSS to better understand how they could participate in the euphoria of HITECH stimulus dollars.
8. Self service kiosks for patient identification and self-registration are now mainstream. Just as we print our airline boarding passes, we can now use credit cards or biometrics to check into ambulatory care appointments and automatically settle all co-pay balances.
9. Image exchange in the cloud is being offered by several vendors. As I mentioned in Monday’s blog, Symantec announced an appliance for small clinician offices that cloud enables all imaging modalities using a facebook-like social networking invitation to share/view images.
10. PHRs and patient engagement are becoming more mainstream. Google and Microsoft continue to innovate in the non-tethered PHR marketplace.
I left HIMSS with a feeling of hope. Our industry is vibrant, clinicians are engaged, our goals are clear, and resources are becoming available.
I’ll be commuting over the next 24 hours, but when I land, I’ll publish my analysis of the Certification NPRM.
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On this “overhead” question, I compare it to the use of computer workstations in offices. Throughout the 70s and especially 80s, offices became computerized. But because the systems were relatively primitive, network effects were limited, workflows had not been fully adapted to take advantage of what computers could do, etc., there were few or no productivity gains attributable to computer use in the economy as a whole. It wasn’t until the 90s that these gains started to emerge. At least as I read it, this delayed productivity boost was a big reason for the Clinton boom years.
We’re at the equivalent of about 1980 when it comes to the use of electronic tools in medicine. Don’t expect productivity gains right away, and don’t condemn these systems simply because they aren’t showing gains now. Sure, cloud-computing and modular open-source systems may be far more efficient than the legacy systems that currently dominate. But even the lean and mean systems are a long way from being able to make a significant improvement to quality and efficiency for 90% of physicians. We all know network effects are important. We all know HIE is critical. We all know workflows and software need to be mutually redesigned to optimize outcomes. All that requires lots of investment, and lots of experience in the real world with imperfect systems.
Try to imagine how productive the automotive or even food service industries would be today if we couldn’t use computers and workers had to write everything down on paper….or just decided things weren’t worth keeping track of. I’m not sure if you’re just trying to be provocative, Tom, but if you really are that down on technology in Medicine I think you wildly overestimate the benefits of a “low overhead” approach.
But Wendell, you have missed mine — if docs don’t buy c**p that doesn’t add value, $30B will not flow through to vendors and there will be no increased overhead on doctors’ income statements. If they get out of third-party reimbursement schemes, who can force this on them?
t
Tom Leith: You miss my point. MD as HELL means more overhead without compensating value added from that addition to overhead.
My response is based on Mr. Halamka’s comments, the number of current and potential vendors angling for a piece of tax-payer funds, etc. and a good knowledge of how vendors of most information technology products and services work.
The allocation of $30 billion plus to healthcare information technology will likely flow through to vendors adding to the overhead costs of medical service providers without doing all that much to improve the quality of service or reducing other costs of the service providers.
That is why I agree with MD as HELL on the likely outcome.
On the other increases in overhead due to the acquisition and implementation of information technology can (1) be relatively cheap if done right and (2) can lead to both significant improvement in quality of service and to significant reduction in other costs, if done right.
What on earth do you mean, Wendell? Of course MD is correct. Overhead is any expense not directly attributable to any particular unit of production. It would be easy for him to reduce his overhead to almost nothing — the model the cash-only, “officeless” solo practitioners use. He could do house calls on public transport (or hitchhike), travelling with his license, telephone, and Rx pad. $125 to show up for 15 minutes, and $5 a minute after that. He can weigh patients on their own bathroom scales or just ask them “How much do you weigh, and has it changed recently?” If he thinks he needs labs, he can write up an order with a 23-cent pen on the Rx pad, give it to the patient and say “call me when you get this done and I’ll come back and talk it over with you”. If he’s a cardiologist, he can have the patient walk up and down basement stairs — who needs the overhead of a treadmill? Bruce Protocol, Shmoose Protocol! He can say “Now be sure to remember and write down everything I told you, I don’t keep detailed records, that’s just overhead I’d have to charge you for.”
He could probably make a living this way.
By now Peter is screaming. “But what about reducing cost? What about demented old people who can’t remember what they had for breakfast?” To which MD replies “I’ve reduced cost tremendously: no billing staff, no office, no tabletop lab, no insurance company profits, no computers, no bureaucratic hassles, no car for cryin’ out loud. I don’t even have a carbon footprint! I’m a hero. I feel for you that you can’t remember, but it isn’t my problem. Hire a nurse. What do you people WANT?”
Which is the question: What do we want badly enough to pay for?
t
MD as HELL is probably correct in his? assessment, but it does not automatically have to be so. We will see.
Helpful comments from Mr. Halamka in any case.
More overhead.