Reflections from the Big Easy

I was away at annual the HIMSS health IT trade show in New Orleans last week, and was struck by just how similar some of the themes being discussed in the Big Easy were to those being discussed by the English NHS.

Everybody was talking about interoperability and the need to make data liquid between different healthcare providers; avoiding lock-in within any one system.

The suggestion is that the US is inadvertently creating islands of unconnected digital health data. This was something that national health IT coordinator Dr Farzad Mostashari described as the tendency to data ‘hoarding’.

His presentation outlined some of the steps that will be taken to address the issue. So, interoperability is the focus of the next stage of ‘meaningful use’.

This is the big programme of incentives that is driving the spread of electronic medical records across the US, following President Barack Obama’s American Recovery and Reinvestment Act of 2009, which put a big focus on healthcare IT to reduce costs and improve quality.

Linking up systems and exchanging information between them looks to be the priority for the next couple of years, after four years in which the dash to simply get EMRs in place has been the focus.

There was also some interesting research out from Black Book Consulting at HIMSS, suggesting that a lot of family doctors are unhappy with the EMR they put in to meet stage one of the meaningful use requirements. The research suggests that a number are now looking to change.

Alliances and non-alliances

On the vendor side of the event, the surprise story of the show was the news of the creation of the CommonWell Health Alliance, an interoperability alliance between four of the largest EMR suppliers, including McKesson and Cerner, but no Epic.

On the acquisition front, another member, Allscripts, announced its purchase of interoperability and portals specialist, dBMotion, for $235m.

But the biggest ongoing vendor story in the US EMR market is the rise and rise of Epic, which increasingly dominates the larger hospital market.

It may be the Marmite of health IT; it may not be cheap; but the company’s claim never to have lost a customer is pretty astonishing, as is the roll call of clients.

Many read the CommonWell Health Alliance as an attempt by competitors to counter the rise of EPIC – although the alliance itself says it is all about using interoperability to improve quality and reduce costs, including the costs of compliance.

In an interview with EHI, Leslie Karls, head of UK business for Epic, said that it would stick to its proven methodology as it develops in the UK, which means only working with hospitals ready to commit the executive leadership and resource required.

Karls was also at pains to stress that latest research from HIMSS Analytics clearly shows it is only at the higher levels of integrated electronic patient records that business and clinical benefits really get delivered. “There are no short cuts,” she told EHI.

With the Department of Health and its successor organisations apparently gearing up to have another push on EPRs in England, its interesting to get a perspective on what happens once record systems have gone in.

A recurring theme heard over the week at HIMSS was that getting an EMR or EPR live is just getting to the starting point. The real job comes in getting the clinical and business benefits from changing processes, redesigning care and reviewing performance.

Dr Martin Harris, chief information officer of the Cleveland Clinic, told EHI that an EMR is “a good start.”

Getting smart with data

A lot of vendors at HIMSS were pushing analytics and the smart use of data to make use of the vast piles of data being generated by the US healthcare system.

Healthcare providers need to use this data effectively to deliver a better patient experience, based on understanding how and when they want services, said Warner Thomas, chief executive of Louisiana’s biggest healthcare provider, Ochsner Health System.

He added that many industries already did this, with retailers such as Amazon and Walmart leading the way.

The need to provide patients with access to services through the channels they want to use was also the message of Dr Kate Christensen, medical director, internet services at Kaiser Permanente.

More than 4m Kaiser members use its My Health Manager online services, almost two-thirds of the total. She told EHI that members love being able to view test results, book appointments, order prescription refills and email their physician.

Interestingly though, Dr Christensen said that Kaiser no longer thinks internet services save money by reducing office visits. Instead, it thinks they lead to better patient retention and more activated patients, more likely to better manage their health.

Another striking figure quoted by Dr Christensen is that more than 22% of patient visits to MyHealth Manager are now mobile, a figure that she says has exploded over the past year.

The new NHS Commissioning Board, is, of course, fully signed up to the patient information revolution, and is committed to delivering on the government’s target of giving patients access to their GP records by 2015.

Asked what lessons she’d offer anyone starting down the route of online services for patients, Dr Christensen advised being generous and trusting patients with the data they are given.

She also stressed that connecting the personal health record to a fully functional EMR – a tethered record – is essential. In Kaiser’s case the EMR is from, you guessed it, Epic.

Not lonely in the cloud

Another big theme at HIMSS 2013 was cloud-based services. A lot of vendors from those involved in imaging, to EMRs, to analytics and everything in between, were showing their cloud offerings.

Probably the key company to watch is Athenahealth – yet another member of the CommonWell Health Alliance – which aims to disrupt the entire market by being a purely cloud based firm that dispenses with traditional licensing in favor of charging by use.

Led by larger than life CEO Jonathan Bush, a member of the US political dynasty, the company has begun to pick up awards, is gaining momentum, and has just bought veteran mobile health specialist eProcrates.

Policy and more policy

The aspect through which US healthcare looks most like UK healthcare is the sheer amount of change and policy initiatives that it is trying to cope with.

It is only two years since the hugely contentious Affordable Care Act was passed, unleashing dramatic changes in the organisation and delivery of US healthcare. Policy change was identified by CIOs as the single biggest barrier they face in the annual HIMSS leadership survey.

One of the most important policy changes is the shift to population health management and accountable care organisations; which pay a fixed fee for providing healthcare for a given population.

This represents a big move from traditional fee-for-service payment models; and is part of the attempted shift to new payment models to contain runaway healthcare costs.

Just how big that challenge that is was set out by star speaker and former-president Bill Clinton, who said the US healthcare system was broken.

It is spending roughly one trillion dollars more a year as a percentage of GDP than leading European healthcare systems.

Clinton said the soaring costs of healthcare – which is now gobbling up 2.5 trillion dollars a year – were hobbling the US economy and one of the main reasons that average household incomes hadn’t increased in a decade.

Clinton said health IT had a vital role to play both in integrating the system and empowering citizens to take better care of their own health.

He added that this was something he had needed to do himself; he switched to a vegan diet after cardiac problems, because he wanted to live to become a grandfather.

“We need to think about role of information technology in enabling people to take better care of themselves, have a better impact on the healthcare market, and to know what the heck is going on,” he said.

Although it’s been 12 years since President William Jefferson Clinton was in office, he retains his power to wow a crowd, even on health IT.

It’s difficult to imagine any British politician with the similar charisma on the topic, but then deputy prime minister, Nick Clegg, didn’t invent the Internet.