|A view at the floor|
Here are my top ten hot topics from this year’s HIMSS meeting, which was held Feb. 19-23 in Orlando this year. Before I comment, one should note that I look at this meeting with an imaging background and interoperability interest, so I probably missed many things outside my scope of interest. Second, I was a little bit turned off by this year’s slogan “Where brightest Minds inspire action.” I have to admit that it did its job because as soon as I arrived at the airport I made a picture of myself with this poster to post on social media, but after the fact I thought, “what about those even smarter physicians, or, even better, shouldn’t it be all about the patient?” In any case, it was a nice marketing scheme and definitely did its work.
So, what about my top 10 hot topics of this year?
- Cognitive computing is the solution to all problems in healthcare (or maybe not?) – Virginia “Ginni” Rometty (IBM CEO) said in her keynote speech, “We’re at a moment where we can change large pieces of healthcare and we are at a point where cognitive computing could usher in a new golden age in healthcare.” Note that cognitive computing is defined as “the simulation of human thought processes in a computer using techniques such as AI, machine learning, and neural networks. So, is our solution to our healthcare issues to replace physicians with computers? Maybe not quite yet, it can be used to guide precision medicine, such as tailored drug and therapy treatment for cancer, and yes it can also be used to create better outcomes using data mining to indicate more effective treatments. But I believe we have some major issues to deal with first, such as, having information about patients in different data silos that is still incompatible, hard to extract and exchange, and lastly, semantically very differently encoded. And then, assuming we do eventually get all that data at our fingertips, replacing the thought process from an experienced physician is somewhat more complex than being able to win a chess or jeopardy game (which is what Watson is known for). So, in my opinion, Watson may not be a solution for a while.
- Clinical Document Architecture (CDA) is not (quite) dead but
“in hospice.” – This is
a quote from Keith Boone, an interoperability expert and guru who wrote a blog
about this particular subject 2 years ago. CDA is the document standard that
was defined as part of HL7 version 3 and was supposedly to become the norm for
exchanging documents out of, and in between EMR’s. For example, a physician can
access a CDA encoded discharge record from a patient and import it into his or
her own EHR by requesting the CDA from the hospital. There are several
different templates defined as part of the CDA definition, such as care record summaries,
clinical notes, and several others. The expectation is that CDA is going to be
replaced by Fast Healthcare
Interoperability Resources (FHIR) (see below) in the next 2 or 3
Use case demo with FHIR
- FHIR year-three is still in its teens. – If you have teenagers you know what
One of the several presentations
on FHIR at the HL7 booth
- Imaging is still an IT stepchild. – As with any stepchild, imaging does not get the attention it deserves and is under appreciated and underserved at this meeting. The HIMSS program committee does not seem to realize that the CIO’s who visit HIMSS will never set foot in any of the imaging trade shows, so in order to bridge the gap between IT and imaging, it is essential that there be education and exposure to the complexities of storing, archiving, managing and exchanging patient images. It is not the vendors fault, if you wanted to learn about the new enterprise image solutions using VNA technology, all of the major (and minor) players were present. But the lack of educational sessions on this topic was discouraging.
- The HIMSS Interoperability Showcase is growing up. – As of the second day, there were
One of the many use-cases shown
- IHE Connectathon is maturing. – The IHE connectathon took place in
Connectathon in Cleveland
- Enterprise-wide Image exchange is still a challenge. – The Joint SIIM/HIMSS workgroup on enterprise imaging gave their report at the meeting detailing the result, which produced several white papers that are available for free on their website and covers all aspects including the governance, image ownership, encounter-based imaging issues and viewing. The problem is not only how to manage and exchange these images, but also how to acquire them in a consistent manner, especially from the non-DICOM “ologies.” Taking a picture on a smartphone to be uploaded into the patient EMR is not trivial as it requires consistent and unique metadata to be generated, which sometimes can be done from order information, but often there is no order available. There are a couple of follow up working groups established that basically try to take these white papers a step further and educate users about the issues and resources. In addition, there is a working group that is evaluating the Digital Imaging Adoption Model (DIAM), as defined and used by the European HIMSS division, to see how it can be made applicable for the US.
- It is very hard (if not impossible) to get physicians to give up their pagers. – There are still about 1.5 million pagers! around in the US, which are almost exclusively used by healthcare practitioners. There are several reasons for this, most of them are related to habits as there is no reason that, with using the appropriate secure messaging software, one can’t use a smart phone. If a physician would use a smart phone it is possible to link directly to the EMR, look up on-line resources as needed and even pull up an image, all of which is not possible with a pager. Dr. Sean Spina from Island Health in Canada did an experiment with his pharmacy staff and found that when using the smartphones, the average response times for messages was reduced from five-and-half to three minutes and the time for high priority calls were reduced from 19 to 5 minutes. However, it really requires a top-down enforcement as one vendor commented that if they sold let’s say 1000 licenses for their messaging, after one year they found that at most 200 would be using it, the remainder would still be hooked on their pagers.
- Patient engagement through messaging is critical – Another important type of secure messaging that is evolving and also critical for outcomes is messaging of patients. There is a high percentage of patients that do not take critical medications, so simple follow-up texts has been proven to make a major difference, even potentially impacting readmission rates in the hospital.
- The last observation is that gadgets and
happy hour rule at these types of
My favorite give-away:
This was another good trade show, it had record attendance because the “who-is-who” in healthcare IT was there and there were some pretty good talks even though it was often hard to spot them in the myriad of presentations. As one of my vendor-colleagues commented, “your customers expect you to be at HIMSS, whether you like it or not.” One common complaint was that the trade show was very elongated, i.e. to get from one side to the other was more than half a mile and it took me at least 10 minutes walking at a brisk pace to get from one place to the next, but I heard few complaints about the content. HIMSS18 will be in Vegas again, a favorite location for many, including myself. Looking forward to it!