The annual extravaganza that is the Healthcare Information and Management Systems Society meeting was back in New Orleans this year, and judging by the attendance, the move paid off. Some 25,000 attendees and nearly 900 vendor firms were lured to a city still reeling from disaster.
Of course, the event took place well away from the devastated Lakeview and 9th Ward neighborhoods. The welcome environs of the convention center and the cluster of refurbished downtown hotels around it looked almost unchanged from previous events. People around downtownthe restaurant and convention hall workers, the police and store clerks we encounteredwere just going about their business.
There was sadness in the air, but also resolution. It was as if the whole town had lost a loved one, but the band in the funeral procession had marched and played its dirges, and theyd all come back from the cemetery playing Dixieland. And then, deciding it could either lie down and die or go on, New Orleans decided to go on.
It will never be the same, said Stephanie Mills, chief medical information officer at Our Lady of the Lake Regional Medical Center in Baton Rouge, La. But the physician informaticist, who was a presenter at a symposium at HIMSS, also said she is working to create a regional health information organization to link New Orleans hospitals with those in Baton Rouge, something better than what either city had before the storm.
Sunday evening, HIMSS President and CEO Stephen Lieber addressed the annual senior executive reception at the classic Audubon Tea Room, which survived Katrinas onslaught.
Lieber acknowledged it had been a controversial call whether the HIMSS show could or should come back to New Orleans, but two trips to the city for due diligence convinced him it was the right thing. (HIMSS was last in the Crescent City in 2001.)
What I saw from the very beginning is the spirit in this city, a spirit that said, We can overcome this, Lieber said.
The turnout for the event was comparable to last years meeting in San Diego, and there were even more vendors. Were looking at a conference that is comparable and, on top of that, weve done something for the city thats incredible, Lieber said. It was not only the right business decision; it was the right moral decision to come to New Orleans.
Beam him up
Microsoft Corp. Chief Executive Officer Steve Ballmer paced the flight deck of the Starship Enterprise Monday morning as the keynote speaker at the opening of the Healthcare Information and Management Systems Society meeting in New Orleans.
Ballmer wasnt beamed up to the Ernest N. Morial Convention Center stage, which had been dressed with colored lights and other props to look like a Star Trek set.
A comedian, dressed as Capt. Kirk, precluded Ballmers use of the transporter shtick when, during the audience warm-up, he called out, Beam me aboard, Scottie, and a short length of a two-by-four flew out of the darkness and bounced at his feet.
But Ballmer brought his own sci-fi show in the form of a futuristic video of advanced healthcare IT applications, part of an explosion of information and an explosion of tools for consumers.
In one video vignette, a patient thumbed a flat-panel screen the size of a credit card, scrolling through several screen changes until the image of an insurance benefits card appeared on its surface. The patient placed the card against a blank wall at her healthcare providers office and a registration template lit up, capturing her demographic and insurance information and confirming her appointment. At home, she set a prescription bottle on a table top and the table lit up and became a screen, displaying text large enough for a sight-impaired patient to read the drugs name and dosage information without her glasses.
Think about a home that evolves electronically to support healthcare needs, Ballmer said. Your TV, your smart watch, your video gamethose will all be places where you can receive alerts to take action to help you with your healthcare.
Healthcare is the single-largest industry in the world, and yet we dont see quite the same level of standardization in the healthcare industry that we do in the manufacturing industry, he said. The needs of the providers simply have not been met.
Making sense of the information, not just storing and retrieving it, will be the challenge of the future, one that healthcare software developers must meet.
All the information is going to be collected, the question is how can the software bring it all together and allow for providers and their patients to collaborate together on an outcome. The notion that every provider, hospital and health plan will be able to fund their own R&D in these areas will increasingly be a thing of the past, Ballmer said.
Its up to the information technology industry to step up to its role to build the tools to advance healthcare to the next level.
RHIOs everywhere and nowhere
Its been said ones reach should exceed ones grasp, which explains why there's been so much talk about regional health information organizations, or RHIOs, as nearly everyone in proximity of the Healthcare Information Management and Systems Society meeting knew to call them (by day two of the show, a majority of the members of the Morial Center custodial staff, nearly half of New Orleans cab drivers and 13.5% of licensed Mississippi River excursion boat pilots did as well).
And while there have been far more sightings of Bigfoot than verified reports of live, operating RHIOs, many at HIMSSparticularly among the ranks of HIMSS presentersbelieved theyll live to see the latter.
As a physician informaticist, Our Lady of the Lakes Mills is a woman of science but she is not precluded from being a believer of things yet unseen. Mills has been working on developing RHIOs in both Baton Rouge and New Orleans. As if that werent visionary enough, Mills told us that she hopes to one day link those two RHIOs together and expand data exchange coverage across the entire state. So far, however, while planning is being funded by HHS as part of the Hurricane Katrina recovery effort, RHIOs in both cities remain RHIOs in theory, not RHIOs in fact.
Dick Gibson is another physician informaticist. He is chief medical information officer, regional information services, at Providence Health & Services in the Pacific Northwest. And even though Gibson lives in the land of Sasquatch, during a panel discussion in New Orleans, he injected some sobering findings of his RHIO study group into the discussion.
Gibson is helping plan a RHIO in Oregon, which is being sponsored by Providence and several other large healthcare systems and payers that have thus far plunked down $540,000 in two rounds of development funding.
As he sees it, here are some of the problems:
Money. It is extraordinarily expensive, Gibson said, with eight to 10 participating hospitals expected to pony up $17 million over five years, or an estimated $10 per patient, versus the projected benefits of $2.5 million a year in cost savings.
Privacy. Plans call for using a centralized record locator service, and payers want access to the clinical data. Im worried the public wont allow it.
Doctors. RHIO planners are calling for a Web-based viewer that will enable clinicians to look up patient records generated at another hospital. It is hard enough to get physicians to use IT systems within their own hospital, Gibson said, and will be harder still to get them to look up and retrieve records from another system, even if it only means toggling from one screen to another. Im worried its too great of a load for too little of a benefit. The interoperability will be a big leap forward for emergency room physicians and for disease management purposes, Gibson said, but for rank-and-file physicians seeing most patients, the utility will be marginal.
I cant predict the future, Gibson said, but he added that what he sees looming is a perfect vacuum of difficulties that could suck the life out of the effort. A final report on the RHIO plan is due June 5.
Bada boom, bada bing
While last year the conference featured a big-name comedian offering a laymans observations on health IT, this years program had some IT experts trying their hand at comedy.
In 2006, Saturday Night Live alumnus Dana Carvey closed the conference by admitting that he knew nothing about electronic medical records, but this years Riffing on the Issues program, hosted by HIMSS Analytics President and Chief Executive Officer Dave Garets, generated laughs by poking fun at an industry that may sometimes take itself a bit too seriously.
This is going to be a little strange, Garets said at the beginning. If you can't take a joke, this would be a good time to leave.
Joined onstage by John Glaser, Partners HealthCare System vice president and CIO, Garets ran down the topics that would be covered: Defending the Capital Budget with the indecipherable diagram ploy, The Art of Stalling, The Art of Patronizing, We Dont Need No Stinkin Benchmarks, as well as luncheon tips for CIOs and CIO dressing for success recommendations.
Lunch with Big Brother
At a media luncheon hosted by McKesson Corp., we were seated at a table with Pam Pure, president of McKesson Provider Technologies, whos known to help settle the fears of some who feel her company is out to conquer the world. She cant be behind a plan to take over the world, we thought ... shes too nice.
In an introduction, it was mentioned that Pure was named by a local magazine as one of the top 25 most powerful businesswomen in Atlanta, and Pure started her formal presentation with stories that helped promote a soccer mom personaonly the sport played by her three sons is basketball.
She began by saying that by watching her sons basketball games, she learned theres a difference between being big and being better.
When I go to work, I dont have to worry about being big, Pure said, adding thatwith recent acquisitionssome type of McKesson technology is now present in 90% of all retail pharmacies, 50% of all hospitals and 20% of all physician offices.
McKesson is also looking at expanding in the revenue-cycle outsourcing market, and its recent partnerships with Toshiba, Intel, Red Hat and AllScripts Healthcare Solutions (which was just finalized at HIMSS) will drive interactive connectivity throughout the land and push more hospitals toward further automation, she said.
Pure noted how there are 550,000 physicians in the United States, with 430,000 in independent practice, and about 120,000 employed by a hospital or healthcare systemincluding 15,000 primary-care doctors and 105,000 hospital-based specialists.
The IT industry has to provide solutions specifically made for each of those three groups, Pure said, adding that McKesson is ready to fulfill their needs in software, business management, connectivity and supplies.
They all need supplies," Pure said. Coincidentally, McKesson is No. 1 in physician supplies.
In the nine months since its acquisition and expansion of RelayHealth, which is now a brand name for McKesson products, the corporation has had a hand in 8.5 million prescriptions, 1 billion financial transactions and 1 million patient records, Pure said.
Pure continued to list her company's recent initiatives: new wireless devices for nurses, online medication reconciliation programs, and beefed up clinical analytical reporting tools that can provide the data that the Joint Commission, the Institute for Healthcare Improvement and others are asking for and that most EMR systems are still unable to capture.
In an interview after her talk, Pure admitted that the analytical tools were something of an add-on.
I wish I could say it was our own brilliant design, Pure said. But it was driven by customers complaining, I spent $6 million for this system and I cant get my JCAHO reports. I want those reports, and I'm not going to pay one dollar for them. So we got them for them.
Robert Kolodner, interim national coordinator for health information technology, surprised many in the audience when he told the HIMSS crowd that consumers should have significant control over who has access to their healthcare information.
Privacy is not just a federal issue, Kolodner said, adding how a successful privacy and security strategy has to be resilient in order to address emerging technology.
But this strategy would involve allowing individuals to decide whom they trust to gather and store their personal information, Kolodner said, as well as allowing them to decide if they want their information to automatically flow to their primary-care physician and personal health record; if they want to prevent the flow of information to certain providers or payers; and if they want to block all flow of their personal information.
Kolodner also discussed allowing consumers to be able to make corrections to their medical record.
Privacy advocate Deborah Peel said she likes what she hears so far in Kolodner's statement. I think really, if he does what he says, well be the first to applaud, said Peel, the founder of the Austin, Texas-based Patient Privacy Rights Foundation and who, like Kolodner, is a psychiatrist. We at Privacy Rights believe that people will demand these protections from Congress and theyre going to get them. Were only in this mess because the public didnt know the kind of power the insurance lobby and other healthcare entities had to twist the regulatory process within HHS.
The general's return
Colin Powell, the former secretary of state and chairman of the Joints Chief of Staff, also spoke at the event, praising HIMSS for holding its conference in New Orleans and helping with the city's rebuilding efforts. It marked his return 11 years after his first speech to the group.
Powell mentioned his own information technology credentials and told more than 4,000 attendees that he is now involved in some Silicon Valley IT ventures. He acknowledged there are concerns about privacy and security in information systems of all kinds.
Powells main topic, however, was leadership, and he talked about how leaders giving their troops all the tools they need to get their jobs done. As secretary of state, Powell said he spent $350 million to achieve the goal of getting a computer on every desk in every U.S. embassy in every country.
True leaders, he said, dont have to motivate followers; they inspire people to be self-motivated. He told the story of how, early in his military career, he was told that you will know if youre a good leader if people follow youif only out of curiosity.
Powell also inspired several laughs with self-effacing humor, behind-the-scenes descriptions of high-level diplomatic meetings, and a wicked impersonation of President Bush talking about Russian President Vladimir Putin: Colin, Ive looked into his eyes, and Ive seen his soul. To which Powell said he replied: OK, youre the boss, but Ive looked into his eyes and I still see some KGB.