Letter from HIMSS16

Every year, the US Healthcare Information and Management Systems Society, better known as HIMSS, runs a giant conference and exhibition.

HIMSS16 was the latest of these annual get togethers, with some 50,000 delegates heading for Las Vegas to hear from healthcare leaders, see new products, network, be educated and get lost in the 2.25 million square foot of exhibition space.

As in the last few years, there was a major focus on interoperability, openAPI’s and FHIR standards. This year, however, there was a notable shift away from conversations about which vendors will support these standards.

Instead, the focus was on building apps and solutions on top of electronic patient records, such as those supplied by Cerner, Epic, Allscripts and Athenahealth.

Some of these solutions are coming from established suppliers but many healthcare providers are building their own innovative apps to suit their specific needs, especially around patient engagement.

Talking of patient engagement, experts such as John Halamka, an emergency physician who is also a chief information officer and chair of various health exchange and standards bodies, were focusing on how to bring value to the patient from online access.

Their focus was on actionable rather than informational services, such as appointment booking, medication ordering, wellness programs, interactive care planning and health alerts. They argued these are more valued and encourage return visits more than simply browsing lab reports.

Suppliers such as Epic and Cerner are adopting OpenNotes platform, which notifies patients when their doctor has updated their record and enables them to read everything written about them. This helps engage the patient more in their care and increases thrust through transparency.

The conference floor was brimming with big data analytics solutions. It felt as if population health solutions have matured and there were plenty of healthcare providers showing how they use these solutions to their benefit.

These tended to be focused on meeting known needs, but the next generation platforms will be using predictive analytics to identify the future ‘super utilisers’ of healthcare resources – so that they can be targeted for lifestyle and low intensity medical interventions.

Wearable technology, genomic and metabolic data, massively increased data processing capability and the rise of data science in healthcare is enabling a new breed of medicine based on data driven decision making – precision medicine.

This will enable a better understanding of inter-personal variation, and holds out the prospect of individually tailored therapies, based on data driven clinical decision support. Projects such as My Cancer Genome show how worldwide collaboration is enabling oncologists to target therapy for cancers with specific genomic markers – and getting better outcomes.

One of the best known features of the US healthcare IT scene is meaningful use. This was introduced by the American Recovery and Reinvestment Act of 2009, and has encouraged the spread of EPRs by providing financial incentives for providers to adopt certified systems to deliver specified quality, safety and efficiency benefits.

National social insurance programs such as Medicare are now changing the incentive focus to reward improving healthcare outcomes. These new frameworks are emerging based on the realisation that clinicians were increasingly focused and incentivised on data collection – rather than improving care.

Other broad themes of HIMSS16 included:

• Usability and doctor burnout – as clinicians have increasingly used IT solutions to provide and document care, many feel they have become slaves to them.
  Reasons have included poor usability, overzealous policy initiatives and poor implementations. However, overcoming this is not just about making systems more usable; it’s also about automating data collection and virtualising care pathways out of the doctor’s offices.

  One provider doing interesting work in this area is HealthLoop, a cloud-based platform that enables medical practices to automate monitoring and communication with patients after a consultation and during the recovery process, and that helps doctors to identify patients at risk of decline.
   

• Cybersecurity – several high profile data breaches have highlighted the risk to providers and suppliers alike. The US ‘Cybersecurity Command Centre’ includes prevention, detection and reaction solutions as well as tools for risk assessment [in the UK, the Health and Social Care Information Centre is establishing CareCERT to do something similar for the NHS].
   
• Equality – a HIMSS survey suggests that female health IT workers earn some $25,000 per year less than their male equivalents. HIMSS will be promoting women in Health IT through awards, networking, mentoring and career advancement programs.

If you’ve made it to the end of this, well done! I’m sure you’ll recognise many familiar themes back home. It’s always interesting to see how the issues are common to the UK and how much we can learn from the successes and failures here in the US; as well as how much the Americans are keen to learn from us.

Dr Shaun O’Hanlon is the chief medical officer of Emis Group, a supplier of hospital and GP systems that has launched its own personal health record, working on the Apple HealthKit platform.  He tweets @drshaun