Thoughts about HIMSS12

The HIMSS12 Conference in Las Vegas last week had the highest attendance ever. Even the large convention facility seemed crowded and at times claustrophobic. Nevertheless, I'd say it was a very successful meeting. I came away with a lot of ideas for future posts. For now I'll just discuss first impressions of what I thought were major themes I identified, as filtered through my one of 35,000 minds that attended this year's meeting.

Data mining was a very hot topic. Secondary use of data will be facilitated through the expected increase in health information exchange. Vendors, government agencies, researchers are looking forward to a 21st century gold rush of clinical data-not only to improve the quality and efficiency of health care but also for anticipated financial gain in some cases. The drive for health data is almost alarmingly commercialized. This recent report, unrelated to HIMSS12, epitomizes what I mean.


Clinical decision support (CDS) also got a lot of play. Clinical decision support systems are ubiquitous for checking for drug-drug interactions and allergy checks and even to promote guideline adherence. Order sets are a good way to implement CDS rules. But the safety and efficacy of CDS are still questioned. The challenge of decision support is to deliver information the clinician or patient needs at the time the information is needed with actionable choices in a manner that harmonizes with workflow. Strides in the development of artificial intelligence to filter data, generate information, and offer timely suggestions should be expected.


In the last paragraph I mentioned patient safety. The intention to deliver safe care is never far from a clinician's thoughts while practicing medicine. In fact, improvement in patient safety is one of the characteristics used to promote EHR adoption. Published reports on the use of EHRs to improve the safe delivery of care however are contradictory. Several speakers mentioned the Institute of Medicine's report published late last year on EHR safety. An article in Health Affairs was also mentioned several times.
I think these publications point the way toward enhanced scrutiny of the safety of HIT systems, better studies of the current state of the industry, and easier, more efficient, and systematic methods of collecting data on the safety risks of EHR technology.


Health information exchange was a popular topic of discussion. ONC representatives and others touted the successes of the Direct Project, NwHIN Exchange and Connect activities, State HIE grant programs, and health information exchange pilots in the Beacon and SHARP communities. There are a lot of stakeholders in this area with different viewpoints and different criteria for success. I don't think many are fully satisfied with the amount of health information exchange taking place today in the U.S. Vendor preparedness, provider acceptance, and infrastructure are barriers to "push" transactions such as Direct. Federal policy, local governance issues, consumer consent issues, vendor readiness, and infrastructure inhibit robust exchange. Progress is being made in incremental steps but much more needs to be accomplished to reach the full potential of HIT. This leads to the next topic-consumer empowerment.


More and more, patients want facile access to their health information. The "Blue Button" initiative of the VA
is leading the way to opening up the flow of data to patients. There should be easy ways to upload information to a personal health record or to a file on a home computer for patients to use to communicate with their multiple physicians and to enhance their ability to participate in promotion of their health. The ONC has made consumer engagement one of its strategic priorities and has developed a new web site to disseminate information to patients and families.
Last but not least, mobile health was a ubiquitous theme. Mobile health applications are being developed to empower providers and patients alike. The use of mobile technology to facilitate the use of patient care devices, both external and implanted, to facilitate patient care was particularly noteworthy. This technology is advancing like a tidal wave. This field offers perhaps the greatest opportunities for innovators today. Issues with FDA regulation of medical devices are a potential risk. Even the definition of a medical device seems to be in flux. We will have to be nimble to keep up with all the developments in this realm of health IT. Here is a good HIMSS resource.I haven't even touched upon the NPRMs released during the week. I will wait for the dust to settle a bit before I offer my thoughts. The coming months should be interesting for health IT participants.