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March 1-4, 2010 | Atlanta, GA | Sponsored by McKesson
HIMSS10 brings together thousands of health care leaders, information technology experts and vendors to tackle pressing issues around health care IT. H&HN Executive Editor Alden Solovy and Senior Editor Matthew Weinstock will provide highlights and insights in their blogs Sunday through Thursday. All comments are welcome and may be posted to the blog. Comments may be edited for clarity or length. Click here to return to the H&HN blog homepage. |
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Uncle Sam and HIT in a Nutshell
by Alden Solovy @ 11:57AM
Of all the things said at this week's HIMSS conference, the single best comment to sum up the event may have come from Eric Saff, svp, CIO and chief security officer of John Muir Health, Walnut Creek, Calif.
"The whole government is betting on this," Saff said. "The entire health care system is going to be realigned financially. This is the tool that's being used to achieve quality and reform at the local level."
Can we get it done? Privately, CIOs are telling me that the vastness of the regulations and the sheer numbers of hospitals that aren't ready to take meaningful steps toward meaningful use may be impossible obstacles to surmount under the current CMS and ONC conception of the tasks at hand. Stay tuned. From Hospitals & Health Networks, we'll keep you posted.
And so…Whew. Another long week of HIMSS comes to an end. I already have arranged my first dinner for HIMSS 2011 in Orlando and I can't wait to get back to my own home, to my favorite coffee mug and to the stack of unopened mail.
Safe journeys home. And safe journeys toward meaningful use of HIT. See you in Orlando...
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- "What's the 'enough number?' " one vendor asked. In other words, what's the number of lives a technology can save that's enough to justify purchasing and using it? Provocative question. In other words, is there an 'HLROI'—a human life return on investment calculation?
- The coolest giveaway in the exhibit hall: Pleo, a robotic baby dinosaur by Innvo Labs.
- Some local and state HIE initiatives are making bigger than needed investments in technology, infrastructure and people, said Deborah Gash, vp and CIO at Saint Luke's Health System, Kansas City, Mo. Her advice: software as a service model for HIEs.
- The best photo opportunity on the show floor: Make a donation to TeamFox—the Michael J. Fox Foundation for Parkinson's Research—and get your photo taken with a replica of the supercharged DeLorean from "Back to the Future."
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HIMSS10 Equals HIMSS 6
by Matthew Weinstock @ 8:00AM
Well, another HIMSS has come and gone. This is my sixth HIMSS. I won't even begin to speculate how many vendors I've met with or how many sessions on CPOE deployment I've attended over the years. And, I certainly have no idea how many times I heard someone utter the phrase "meaningful use" this week. Let's just say I'm looking forward to hearing my kids ask repetitively to watch another episode of "Dinosaur Train" (an excellent PBS show about the adventures of the Pteranodon family, including Buddy, their adopted T Rex). "Daddy, can we? Please? Please? Please? Just one more. Please?"
I have some closing thoughts about this year's conference:
- Hospital officials need to realize that they, not software vendors, are responsible for achieving meaningful use. Sure, vendors can provide certified EHRs, but hospitals have to put them to use and meet the quality requirements and ensure clinician use of CPOE.
- Dueling theaters. In years past, many companies tried novel ways of getting attendees to stop at their booths—cars, magicians, models, musicians, fresh-baked cookies. Those things are still around, but in fewer numbers. Now, its education sessions. Countless booths had mini-theaters set up where company officials or customers testified about a product's brilliance.
- Vendor and hospital officials support the government's push for health IT adoption but fear that the proposed rules set the bar way too high. Many hospital officials are coming to the realization that the stick phase (with its penalties) is far more dramatic than the carrot phase (with its incentives).
- Very little attention was paid to the shift to ICD-10 coding rules. That changeover will come in 2013 and it will require a herculean effort by hospital IT departments.
I hope you enjoyed our reports. Be sure to check back in with us for up-to-the-minute reports from the American Hospital Association's annual meeting in April.
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Meaningful Use Analogies #7 and #8
by Alden Solovy @ 8:57AM
From a vendor who did not want to be identified…
The enormity of the nation's health care IT task, the executive said, is like taking a Third World country completely wireless. In other words, it's like going from zero technology and infrastructure to a complex network…and doing it at breakneck speed. The workload, she said, is amazing.
And this: Providing physicians with electronic medical records is like suddenly giving people who've never seen television DirectTV with 400 channels. They're not going to know how to handle the onslaught of information and opportunities.
Brutal comparisons. It's no wonder the vendor didn't want to be named.
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3 Million Users
by Matthew Weinstock @ 7:00AM
My senior year of college I had a final on the very last day of exam week and the very last time slot. My friends were out celebrating while I was writing an essay on the Soviet Union or Chaucer or something like that. Flash forward 20 years: My last day at HIMSS10 and I scheduled a meeting during the closing half-hour on the final day of the exhibit.
While attendees were walking the floor grabbing as many trinkets as their tote bags would hold to bring home to the kids, I sat down for a chat with Jan Oldenburg, senior practice leader of Internet services at Kaiser Permanente. Kaiser wasn't hawking a product; the health care provider had a booth to promote its vision of a digital world. Oldenburg and I mainly talked about Kaiser's personal health record, My Health. Kaiser members can schedule appointments, order prescription refills, view lab results and engage in secure e-mail conversations with physicians. Patients can also access health information to better manage their conditions.
More than 3 million of Kaiser's 8.6 million members have registered on My Health. Last year, 60 percent of them visited the site five or more times; 40 percent went back 11 or more times. This year, Kaiser plans to study how My Health impacts health outcomes, Oldenburg said.
Of course, you are probably saying, "Well, Kaiser is Kaiser. It has a captive patient population through its health plan and employs all of its docs, so of course it is going to have success rolling this out." Oldenburg acknowledges that, but says others can follow suit. It's about empowering patients, she said.
"You need to start with things that will catch the patient's attention, like viewing actual lab tests and the ability to e-mail physicians," she said.
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Little Card, Big Plan The Military Health System has found an ingenious way to talk about its 10 goals for information management and information technology: Put 'em on a business card. OK, they're using roughly 8-point type, but this little card summarizes a big plan called the "10 for 10," as follows: |
- Evolve architecture and processes.
- Improve the electronic health record.
- Implement a governance structure.
- Enhance business intelligence that makes information visible.
- Advance the MHS personalized health agenda.
- Advance IT interoperability.
- Maximize value of IM/IT by creating a cooperative relationship.
- Innovate information technologies.
- Improve human capital management of right people for the right job.
- Distribute IM/IT solutions.
An MHS spokeswoman said MHS had three goals for participating in HIMSS: to reach out to the military participants in the conference, to provide transparency of military IT efforts and lessons learned to the entire health care community and to encourage vendors to bid on the MHS contracts.
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CMS Wants You!
by Alden Solovy @ 2:24PM
In the most remote corner of exhibit hall "C"—as far as one could walk and still be in the exposition—the Centers for Medicare & Medicaid Services staffed a tabletop information booth. With CMS' center-stage role in the future of health care information technology, they're the E.F. Hutton of HIT: When they talk, everyone listens. Why do they even need a booth? And why are they in the exhibit hall equivalent of the Arctic Circle?
It turns out that CMS wants to hire you. Along with the glitzier booths from recruiting and staffing firms, CMS is out pounding the pavement for HIT talent. As you'll read in this month's H&HN cover story, that may be tough. Finding IT talent may be the challenge that trumps all the other issues facing HIT leadership.
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Welcome to the Relationship Age
by Matthew Weinstock @ 2:00PM
The rules of staff recruitment are changing. So says Dan DeMaioNewton, director of strategy and business development for Monster Worldwide.
"The Information Age is ending and on top of this age sits the Relationship Age. We are entering a new stage where we are looking at relationships, and relationships matter," he said during a session on recruiting IT staff. He noted that younger employees—and prospective employees—are hooked on social networking sites such as Facebook and Twitter. They're using those sites and others to research companies and they're looking at more than the annual report. They want feedback on what it is actually like to work there. Just as you can dig up almost anything on an applicant, they can now dig up anything on you.
"In the Relationship Age, authenticity and integrity are critical," he said.
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March 3, 2010 Great HIMSS blogging! This truly is the relationship age. Networking has always been important, however previously, you’re network could only grow as much as what you had time for. Now, with the Internet and social media Websites, you can network with hundreds of people in a very short amount of time. As a healthcare leader, you can use these networking opportunities as a means to recruit, stay informed and even advance your own career. —Christine Ricci |
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A lot of work is being done from coast to coast ... and now the hard-knock lessons and the keys to success can be shared by leaders across the country. CHIME is launching CIO State Net. The project already has at least one CIO coordinator from every state and DC committed to the effort and some states have several volunteer participants already on board.
With State Net, hospital leaders inside each state can now track and participate in local and statewide efforts. All CIOs will have access to the site. All you've got to do is sign up.
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Watch Out Apolo, Here Comes David
by Matthew Weinstock @ 11:15AM
OK, so I doubt anyone really thinks that David Blumenthal could beat Apolo Ohno in a speed skating race. Ohno holds a record eight Olympic medals. But does anyone think that Ohno could guide an industry that accounts for 17 percent of GDP through one of the biggest technological and cultural changes of all time?
If you've made it this far into my blog entry you are certainly wondering about the point of that reference. I know my editor Bill Santamour is. Well, why don't I let Dr. Blumenthal tell you: "I sometimes see us as speed skating or doing the downhill slalom. We have to move very fast, but we can't miss a turn."
That's how the nation's highest-ranking health tech official described the task at hand for the Office of the National Coordinator for Health IT during a keynote address this morning.
Blumenthal addressed a packed house for roughly 30 minutes. It's the second time I've heard him speak, to go along with the few times I've been on the phone during press calls. A Harvard-educated internist and Kennedy School of Government graduate, he has a very deliberate manner of speaking. His delivery is fairly monotone, and he clearly chooses his words carefully and rarely deviates from script.
So, he didn't break news this morning; that happened yesterday with ONC's release of the proposed rule on certification of health IT. Today's address—his first appearance either as a speaker or attendee at the HIMSS conference—was much more like a state of the union address. He detailed the government's accomplishments during the past year: three regulations (all in various stages) related to meaningful use, creation of regional learning centers, training grants, helping states with health information exchanges, and more. He spoke to the tremendous work that lies ahead as well. Figuring out how meaningful use and the related rules will evolve over time, developing a roadmap for the National Health Information Network, continuing to evolve privacy and security standards.
Throughout his remarks, Blumenthal returned to the theme he's made the hallmark of his tenure at ONC: The goal is to improve the efficiency, quality and safety of patient care; it is not simply about installing technology. He acknowledged that in his own clinical life, it took a while to come to that realization. When his hospital, Massachusetts General, launched an EHR, it "was not a match made in heaven," he said. "I liked paper. I liked my Dictaphone ... I didn't see the need for change."
But he noticed younger colleagues adopting the technology and he didn't want to get left behind. Then, he said, it started making him a better doctor. "I came to the understanding that information is the life blood of medicine and IT is the circulatory system."
Blumenthal closed by telling the audience that they can either start adopting health IT now with the assistance that Congress made available, or do it later with far less help.
In conversations I had walking out of the ballroom and riding the escalator to the next round of education sessions, most people were positive about Blumenthal's remarks. They supported his goal and passion for the potential of HIT. But, and it is a big BUT, there was overwhelming concern that the proposed rules set the bar far too high and that it will indeed take an Apolo Ohno-like performance to achieve meaningful use.
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Meaningful Use Analogy #6
by Alden Solovy @ 8:08AM
Here's another one from Russ Branzell, vp of IS and CIO of Poudre Valley Health System, Fort Collins, Colo. "This is a marathon," he said of the efforts by hospitals to use information technology to improve processes and the quality of care while achieving meaningful use. "Some folks need to go buy shoes and start training. Some of us are in the last mile and are about to hit the wall."
My commentary: either way, it sounds like it's gonna hurt.
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March 3, 2010 But just like any marathon, a steady pace will win the race.....you just have the balance the intake along the way. Too much at one time can be harmful, yet too little will put you behind the game and then it is a constant game of catch-up. —Christine Ricci |
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Three Men With Shovels
by Alden Solovy @ 9:58PM
One more HIMSS flashback to go with my reflections from past years:
New Orleans, 2007. HIMSS was the first major convention to return to the Crescent City after Hurricane Katrina. Eric Yablonka, CIO at the University of Chicago Hospitals and Clinics, thought that we could make a difference for that battered city. Working through CHIME, he organized a pre-event Habitat for Humanity Day and a swat team of nearly 100 people landed in the 7th Ward the Saturday before the CIO Forum. Some folks worked on houses, others were assigned to clear debris and dig post holes, including Eric (the tall guy), Keith Fraidenburg of CHIME (in sunglasses and arguably the hippest man in health care) and me (the other guy). Keith worked in spite of suffering massive back pain. It was a great day of work and camaraderie. This is one of my favorite photos of all time. We call it "Three Men With Shovels."
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March 3, 2010 That photo is still prominently displayed in my office today! Our work that day, while difficult and trying at times, was some of the most meaningful labor in my life. I'm glad to have shared the experience with so many caring friends who came together to help those in need. —Keith Fraidenburg |
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Congratulations to Two Friends
by Alden Solovy @ 6:38PM
Pam McNutt and Rick Schooler have been named fellows in CHIME, the College of Healthcare Information Management Executives.
McNutt is svp and CIO for Methodist Health System in Dallas. McNutt's experience in the field of health care information technology spans nearly 30 years. She's an active member of CHIME and just recently completed her term on the board of trustees. She is a member of the CHIME Advocacy Leadership Team and Policy Steering Committee. She's also chairing the Most Wired Advisory Board. (Have you started your Most Wired Survey yet?)
Schooler is svp and CIO for Orlando Health in Florida. He's been an active part of CHIME since joining in 1994. He was a member of the CHIME board of trustees from 2006 to 2008 and also served as board chair. In 2008, Schooler earned CHIME's Innovator of the Year Award for his leadership in employing IT to shorten the patient discharge process.
Congrats, my friends. Now, back to work...
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Stop the Presses! ONC Certification Proposal Unveiled
by Matthew Weinstock @ 2:15PM
What's that? Actual deadline news at HIMSS? Woo hoo! I feel like I'm back in my youth rushing to meet a deadline with my boss breathing down my neck. So here it is: the Office of the National Coordinator for Health Information Technology just announced that the proposed rule for certifying EHRs is now posted on the Web.
You'll recall that ONC in January published its interim final rule on certification; the proposal unveiled today addresses how EHRs and EHR modules move through the process. ONC policy analyst Steve Posnack did a quick 15-minute overview of the proposal, so we'll be a bit light on detail here. Read the 184-page proposal for more. And we'll have more info in blog posts and articles to come.
ONC proposes that any entity wanting to test and certify EHRs must be accredited by ONC. Further, there would be two phases: temporary certification and permanent certification. The temporary phase would allow EHRs to be certified in time for hospitals and physicians to start applying for 2011 stimulus funds, which coincides with the federal fiscal year beginning this Oct. 1 (Stage 1 of the meaningful use reg). The permanent phase would be in place for Stage 2 and 3 of the meaningful use reg.
For the temporary phase, an entity could be accredited to both certify and test EHRs. Interestingly, separate accreditation would be required for testing and certification once the permanent phase kicks in. In other words, an organization could apply to both test and certify EHRs, but it would need to be accredited separately for the two functions. ONC proposes that the National Institute of Standards and Technology accredit testing entities, which that agency already does for other government programs.
The proposal would require that certification bodies be able to test products at their own offices. But they would also have to offer a secondary method, such as testing EHRs remotely. Posnack said ONC is particularly interested in remote testing—for instance, for EHRs that have already been deployed in a doctor's office.
The proposal allows for certification of complete EHRs or of modules that, when acting together, function like a complete EHR.
The proposed rule affords two comment periods: 30 days for the temporary phase and 60 days for the permanent phase.
Because of my demanding boss and looming deadline, I left the town hall before the Q&As could get into full swing, so I couldn't pick up much early reaction to the proposal. One person sitting near me, though, wondered why ONC would split apart testing and certification in the permanent program. I spoke with vendors on the exhibit floor who said the separation may provide checks and balances. I guess we'll get the answers to that in the days and weeks ahead. Look for more coverage and reaction to the proposal here tomorrow.
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CIOs Speak, Blumenthal Listens
by Matthew Weinstock @ 2PM
Close to 100 CIOs braved a cold rain this morning (don't get me started on the weather wimps in Atlanta, where schools were canceled in anticipation of less than 2 inches of snow) to have a heart-to-heart with David Blumenthal, M.D.
The national coordinator for health IT is in town to deliver tomorrow's keynote address. He held a series of closed-door meetings today with providers and vendors.
Now, I'm not a fan of using anonymous sources. Let's face it, I'm not Woodward or Bernstein and this certainly isn't Watergate, but since reporters weren't allowed in—or notified—of the sessions, I have to rely on people who were there to fill in the blanks. Several CIOs I talked to—anonymously, of course—were happy to have the chance to express their concerns about the proposed meaningful use rule. They said the session was respectful, although not overly insightful, as Blumenthal mainly listened. He did not leak any details about what a final rule will look like.
Overall, the CIOs support the government's IT agenda. They recognize that deploying health IT is the right thing to do to improve patient care. But they also told Blumenthal and his staff that the proposed rule is too rigid. They expressed concern about the tight timelines. And several framed it as a patient safety issue, according to one CIO. For instance, a hospital exec from Kansas said her facility will not apply for ARRA funds. Her hospital has a long-term strategic plan and trying to accelerate IT adoption, she told Blumenthal, could shortchange patient safety.
Another CIO expressed concern about cramming in meaningful use requirements at the same time hospitals are transitioning to ICD-10 coding rules. According to a source who was in the room, the CIO wondered why there hasn't been more attention paid to ICD-10 at this conference.
At the other end, the CIO from a critical access hospital in Nebraska was widely applauded after she explained how her hospital became 100 percent digital. She said that if a small rural hospital in Nebraska can do it, anyone can, according to multiple sources.
At the end, Blumenthal thanked everyone for their insight and encouraged them to file official comments on the rule by the middle of this month. Tomorrow morning it will be his turn to talk and everyone else's turn to listen. Be sure to check our site; we'll have full coverage of his speech.
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Turning Competitors into Collaborators
by Alden Solovy 11:44AM
"We're reaching out to our archrivals historically with the idea that there's a better way to provide care," Eric Saff told a press conference this morning. The svp, CIO and chief security officer of John Muir Health, Walnut Creek, Calif., said that "It's a new world. Never in my life would I have thought I would see the day when John Muir and UCSF were using the same [IT] system, not to mention Hill Physicians."
So how do competitors turn into collaborators?
When talking to other hospital executives about the benefits of aligning IT across organizations, "I make it personal," Saff said. His father passed away as the result of a medical error when Saff was 9 years old. And his mother has faced seven medical errors. "I find out who their family is and make it personal, highly personal."
Every one of us needs a safe and effective health care system. Your mom. Your dad. Your kids. You. These are the tools, Saff tells them.
Now let's get to work.
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Certification and the IT Vendor
by Alden Solovy 10:25AM
Here's a huge cloud hanging over EHR adoption and achieving meaningful use: getting a process for certifying EHRs that providers have already set up. "If ONC and CMS don't get a certification process in place, we won't get anywhere," said Bill Spooner, vp and CIO at Sharp HealthCare in San Diego. The proposed rules came out today but won't be final until last spring or summer. "They have to quit changing the specs," he said.
And this puts vendors in something of a pickle ... updating software quickly to specifications that aren't final when there will certainly be a rush to upgrade products to newly certified versions under the specter of meaningful use regulations.
"To their credit, the vendors are trying," said Russ Branzell, vp of IS and CIO of Poudre Valley Health System, Fort Collins, Colo. "The big vendors are making guesses" at what the final certification criteria will look like. That will speed up the process, but as a result "there will be a lot of rework," he predicted.
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What About Patient Adoption?
by Alden Solovy @ 9:17AM
Physician adoption of IT. Nurse adoption of IT. Those two topics have been the focus of keynotes, breakouts, podcasts, webinars and entire meetings for years. With the national push for personal health records, who's talking about patient adoption strategies?
Deborah Gash, vp and CIO at Saint Luke's Health System, Kansas City, Mo., has a strategy for patient adoption: Ask the docs to get it done.
"When physicians ask patients to get online, the patient adopts," she said. "That's a trusted relationship." In turn, that often trumps potential concerns about privacy.
Boomers are the largest group of holdouts, Gash says. "Our geriatric patients are using this. And the younger generation is all about social networking. It's my age group that's the hardest to convince."
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IT's About Quality
by Matthew Weinstock @ 7:30AM
CMS is serious about this quality stuff. And agency officials want you to be serious about it too.
HITECH is not just about having or using an electronic health record, it's about how IT can impact quality, Michael Rapp, M.D., director of the quality measures and health assessment group at CMS, told a capacity-filled room during a session yesterday afternoon.
Even before ARRA (there's that acronym again), CMS was gaining interest in how it—meaning you—could extract quality data from EHRs. The agency started working with ONC in 2008 to explore ways of doing that. CMS honed in on three Hospital Quality Alliance measures: stroke, ED throughput and venous thromboembolism—blood clots, in English. There are several goals, said Rapp: standardize where the information goes in the record, automate things so EHRs can quickly extract the relevant data and reduce the burden on clinicians.
But the ultimate goal, he said, is to collect data that can be used to drive quality improvement. As it stands now, it can take up to 11 months for data that is manually gathered to make its way onto Hospital Compare. EHRs could make that more real-time.
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Reflections on HIMSS Past
by Alden Solovy @ 9:17PM
This is one long event for the regular attendee. For the board and staff of HIMSS, as well as organizations like CHIME and vendor groups that attach other meetings to this event, it's relentless. In my 10-plus years coming to this event, I've spent conservatively half a year of my life planning for, attending and following up from this conference.
That's nothing. Some attendees have literally spent years engaged in this meeting. With that much time involved, there are lots of stories large and small. Here are some of mine:
- HIMSS was in Dallas and overlapped with my uncle's 70th birthday. In the middle of the show I flew back to Chicago for his party and returned to HIMSS the next morning.
- One year I left my suit bag at home. Upon arriving in San Diego, I went to Nordstrom and said, "If you can tailor and deliver one pair of slacks and a sport coat to my hotel by 6 p.m., I'll buy two pairs of slacks, a sport coat and a suit ... and I'll need the rest tailored and delivered to my hotel by tomorrow night at 6 p.m." I'm wearing that blue blazer here this week.
- In Orlando, I played basketball on the Magic's court at a vendor party. It is not my best sport, but I made a lay-up. I am now officially retired from basketball.
- At one HIMSS—I think my first and I can't remember where—a vendor had Richard Simmons as a booth attraction, snapping Polaroid photos of the offbeat fitness guru with attendees. I'm not certain why, but I posed for a photo of me and Richard holding up a copy of Hospitals & Health Networks. I still have the photo. And no, you can't see it.
- Last year, the day before the HIMSS/CHIME CFO Forum, Ami passed away. Obviously I didn't make it to the event, but—in spite of the tragedy—my daughters and I learned just how caring a hospital can be.
And from this year's HIMSS: On Saturday night hip hop artist Jay-Z brought his BP3 Tour to a sold-out Philips Arena concert near the convention center. I only saw a few disorderlies in the Omni elevators after the show. Two of my friends had rooms next to late-night partiers who were, eventually, evicted from the hotel.
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The HIMSS Bazaar
by Matthew Weinstock @ 7:30PM
Well, it's not quite the same as the wedding dress extravaganza at Filene's Basement, but the exhibit floor opened today at HIMSS 2010. By most accounts, traffic was pretty good, at least in one of the halls of this mammoth conference center. I was only able to wander through Hall B, which houses booths 4100-9199; I'll try to get to Hall C and booths 100-3600 tomorrow.
I'm always amazed by the size and scope of some of the booths at conferences like HIMSS. Many dwarf my modest Chicago bungalow. Certainly the flat-screen monitors are more impressive than the 10-year-old tube TV we have in the basement.
It's not always easy to spot a trend from walking the floor for a couple of hours, but I was struck by the emphasis on handheld devices. I walked by dozens of booths—both device and software manufacturers—displaying smartphones and other handhelds. Maybe Sprint's Dan Hesse (see yesterday's blog post below) was onto something when he predicted tremendous growth for wireless in health care.
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Meaningful Use Analogies #4 and #5
by Alden Solovy @ 5:45PM
Here's a conversation between two CIOs overheard in the Omni...
One CIO says: ARRA funding and the meaningful use regulations are like a kid asking for a pony. "I wanna pony. I wanna pony. I wanna pony," the child says. Lo and behold, the youth is given what appears to be an amazing gift. Suddenly the youngster is complaining. "I don't want this. Get rid of it. Take it away. Yuk." The child wanted a pony, but Uncle Sam gave him a goat.
The other CIO says: Telling a physician to install an EMR for the stimulus money is like telling someone to have a child for the tax deduction."
It's a tough crowd here at HIMSS.
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They Aren't Communists
by Matthew Weinstock @ 3:00PM
Loran Hauck, M.D., said the physicians at Adventist Health System were less than enthusiastic about adopting evidence-based medicine back in the late 1990s. They referred to it as cookbook medicine, socialism, even communism.
But Adventist officials pushed ahead anyway. At the time, everything was still on paper, said Hauck, senior vice president and chief medical officer of the large Catholic health system. They started with order sets for pneumonia and improved care dramatically—lower mortality rates, shorter lengths of stay, lower rates of respiratory failure that required mechanical ventilation—and saved $6 million a year.
Flash forward several years and Adventist has built clinical decision support into its electronic medical record. It is building evidence-based protocols for 120 admission diagnoses or surgical procedures that will amount to more than 400 order sets. Hauck says the information will be pushed to physicians, rather than forcing docs to try to pull the information from a database.
Interestingly, Adventist also has a view on computer screens that lets docs know which and how many patients they have that fall under Hospital Quality Alliance measures.
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You're Hiring
by Matthew Weinstock @ 12:15PM
In case you didn't know it, your hospital is planning a major uptick in hiring IT staff, and you can thank the seemingly ubiquitous ARRA. That's one of the findings from HIMSS' annual survey, which was officially released this morning. Nearly 70 percent of respondents said they planned to increase hiring in 2010, compared with 42 percent last year. Whether the bodies are there to fill the positions is another issue, which you can read about in our February cover story.
Survey respondents also predicted a major boost to IT operating budgets—with 72 percent projecting an influx of capital. Of that, 49 percent said meaningful use is the driver. Here are some other notable results:
- 41% said meeting meaningful use criteria is their top IT priority.
- 38% said governmental issues will have the most impact on health care, followed by financial considerations at 23%.
- 41% said they have no plans to participate in a health information exchange, down from 52% last year.
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All About the Gs
by Matthew Weinstock @ 11:30AM
Dan Hesse, CEO of Sprint Nextel Corp ,was the first executive from a wireless company to give a keynote address at HIMSS. Can you guess what he talked about?
If you were blindfolded and ushered into the main ballroom for the morning keynote you would have sworn that this was either a Sprint annual meeting or, at the very least, a CTIA-The Wireless Association conference. Hesse spoke at length about how wireless technology, in particular 4G networks, can be used to transform health care. Imagine pills with tiny computer chips in them that can transmit data back to your doctor—"Yes, Matthew swallowed me today. I'm busy at work in here. By the way, did you know he had catfish for dinner?" Hesse seemed most optimistic about 4G networks. They can hasten the transition to home monitoring, especially for chronic diseases. Physicians will be able to view images with Blue Ray-like quality on 4G smartphones, and more.
Hesse sees tremendous growth for wireless in health care. It's expected to account for two-thirds of telecom spending over the next three years. A transcript of his speech is online.
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Meaningful Use Analogy #3
by Alden Solovy @ 11:15AM
The meaningful use regulations, as proposed, are like building a house with a blueprint that only covers the foundation of the structure, said Pam McNutt, quickly giving credit for the analogy to David Muntz, svp and CIO, Baylor Health System, Dallas. The analogy stems from the fact that the regulations for the "out years" will include additional quality measures and criteria not yet identified by CMS. "You have a plan for the foundation, but how can you build a house without knowing what it's supposed to look like?"
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It's Up to You
by Matthew Weinstock @ 11:00AM
Did you see that amazing full moon last night? It was spectacular. Thankfully (or sadly?), I got another peak at it this morning as I left my hotel for a the-sun-isn't-even-up-yet breakfast meeting. I was good though; I shied away from the sausage and biscuit sandwich, opting instead for yogurt, granola and fresh fruit. Hey, I can't afford to fall into a food comma at 7:30.
I made it to the conference just in time to hear HIMSS Chairman Barry Chaiken, M.D., give his opening remarks, although I was relegated to the overflow room with the big TV screen. Chaiken was blunt: "It is you who will transform health care. It's your job to act now upon the message in your inbox and to place your contribution to a transformed American health care system in your outbox in due time."
Chaiken recited the stats that are too well known by our readers: 17 percent of GDP, poor mortality rankings, too few docs washing their hands, etc.... With health care and health IT in the national spotlight, he challenged the IT leaders in the room—both vendors and providers—to seize the moment.
"Today, in 2010, we must begin to change health care…by creating health care IT solutions that are so compelling, so irresistible, that people just want to use them. We cannot rely on incentive programs or executive orders. We must create demand. We must create electronic systems so appealing that they make physicians want to leave their paper medical records behind. We must create clinical decision support systems that make it routine for physicians to check their internal knowledge with data and evidence. We must offer workflow solutions that improve the efficiency of using health IT. We must make physicians want, yes, demand the enormous power that IT brings to the practice of medicine."
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What About ICD-10?
by Alden Solovy @ 9:55AM
"There's going to be a conflict between I-10 and meaningful use," Bill Spooner said at a small group meeting. Resources and staff for information technology projects will be stressed to the limit by these two initiatives, he said. Implementing I-10 is "going to be one of those last-minute crunches" Spooner predicted.
The challenge will be resources and resolving it won't be pretty. "This will literally be a breaking point for some organizations," said Russ Branzell, vp of IS and CIO of Poudre Valley Health System, Fort Collins, Colo. He said some hospitals, already behind the HIT curve, will need to make choices between success with meaningful use and success with I-10.
Pam McNutt senior vp and CIO of Methodist Health System, Dallas, put it this way: "We have a shortfall of people who are trained in clinical informatics. There is a tremendous amount of work to be done. Where are we going to find the people?"
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Meaningful Use Analogy #2
by Alden Solovy @ 11:05PM
Achieving meaningful use is like taking a bunch of novices on their first expedition, much like Alison Levine taking local women into the Rwenzori Mountains for the first time. Pam McNutt senior vp and CIO of Methodist Health System, Dallas, drew the parallel between the path to HIT and today's closing keynoter at an end-of-night unwinding session with some CHIME staff. She said hospitals that haven't begun the journey to meaningful use are going to need training and a good guide.
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Hot Sauce and Hot Seat
by Alden Solovy @ 9:45PM
Here's something you may not know about Barry Chaiken, M.D., chairman of HIMSS. He used to carry Cholula Hot Sauce with him whenever he traveled.
TSA rules put an end to that practice, but Barry still has a taste for "the flavorful fire," both in his passion for heath care IT and the way he goes after life with gusto. He's an athlete, entrepreneur and a wine connoisseur. (Psst....he owns his own winery.) Barry hosted this evening's HIMSS board and chair reception.
He's a great guy. Here's one example: Barry has biked in the PanMass Challenge supporting the Dana Farber Cancer Center for the past 25 years. His rides are in memory of his father, Raymond. Several years ago, when my friend Larry died of brain cancer, Barry taped laminated photos of Larry and his Dad to his bike for the ride. He also created a racing jersey including my friend Larry's name on the chest and Raymond on the sleeve. In total, Barry's raised more than $100,000 for Dana Farber and plans to raise more to on his 26th ride this summer.
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Going for the Gold
by Matthew Weinstock @ 7:00PM
Apparently the good folks at HIMSS forgot to check the Olympic schedule for Sunday. That's the only rationale I can come up with for scheduling a policy briefing for the exact moment that the puck dropped in the gold medal hockey game between Canada and the United States. That or the staff from HIMSS' D.C. office were just bitter that no Washington Capitals—but four Chicago Blackhawks—were involved in the game. So, despite the fact that my hotel room lacks a DVR—this is 2010, right?—I hopped on the Atlanta subway and trekked from Midtown to the Georgia World Congress Center.
The briefing featured a couple of state government officials, including Rhonda Medows, M.D., head of the Georgia Department of Community Health. The department has a $12 billion budget and impacts the health care of more than 2.3 million Georgians. It oversees everything from Medicaid and public health to health facility regulation. Medows is pushing the department to work with all state stakeholders to build a health information exchange. She hopes to launch a pilot in June with 30 primary care practices and, potentially, hospitals and other providers.
Medows painted an interesting picture of how a large state agency is pushing the envelope on health IT. One thing that should make providers take notice: She views the federal requirements for meaningful use as a baseline. Medows fully expects to push Georgia beyond the final CMS rule. In particular, she referenced building up the state's public health capacity through such things as disease registries. That would require providers to input more information through a health information exchange. She also suggested that the state will look for ways to include long-term care facilities in the process. They were not included in ARRA and are not eligible for incentive payments for EHRs. Medows thinks other state officials will similarly view the federal rules as the floor, not the ceiling.
Following the briefing, I'm now actually looking forward to the next three days of education sessions and meetings. HIMSS can be draining, but hearing Medows talk reminded me that there are smart people out there looking for creative ways to use IT to improve health care.
Thankfully, the briefing ended in time for me to get to a sports pub to see the third period and overtime of a great hockey game. A silver medal is nice, but I won't be visiting any Canadian companies on the exhibit floor for awhile!
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To Bring Others Up the Mountain
by Alden Solovy @ 4:10PM
"Do I have what it takes to lead a team of women to the top of the mountain?" That's what Alison Levine asked herself when she was tagged to be the captain of the first American women's team to climb Everest. Levine—a former Wall Street investment banker turned adventurer and entrepreneur—gave the closing keynote at the day-long CIO Forum, traditionally an inspirational call to action.
For all the work she put into leading the attempt on Everest—the group was forced to turn back near the summit—for all the publicity and danger, for all the introspection and teamwork, by my reckoning the true answer to her question came thousands of miles away, in a remote war-torn part of Africa between Congo and Uganda.
Working with authorities, Levine challenged the prevailing culture, organizing the first group of local women to climb in the Rwenzori Mountains. Tradition held women as subordinate. They did not go into the mountains. And yet, Levine achieved a groundbreaking result: enabling the first local female mountaineers and a new source of economic wherewithal for women, who now serve as porters and guides in the mountains.
Interesting parallels and contrasts: with an experienced climb team she nearly made it to the top of Everest; with a strong willed, strong-hearted, inexperienced group of trekkers, she changed the status quo on a mountain…and took the first local woman to the top of it.
So what does it take? Levine answers: asking questions, tough questions, important questions, questions that provide information, questions that challenge the status quo. A belief in yourself. A belief in others. For more on her adventures and businesses, check out Daredevil Strategies.
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Workforce Challenge
by Alden Solovy @ 1:35PM
Information technology in health care is struggling with staffing shortages. That’s the focus of the current Hospitals & Health Networks cover story. To solve all of the shortages facing health care, managers need to understand how the workforce is changing, said keynoter Marilyn Moats Kennedy.
“The most important thing to success in maintaining a workforce is understanding what will motivate them,” she said, noting that there are three times as many workers 55 to 70 years old as there are 18- to 24-years-old. “If you can’t keep people employed three years past the time they plan to retire, then you’re gonna be there alone.”
One strategy she recommended is to keep in contact with retirees in order to capture them back when they get bored with their new lives. Another strategy is based on understanding that young employees will not make a life commitment to a career. Instead, get two- to five-year commitments from new employees in return for teaching them explicit skills that they need no matter where they take their career.
“You’re not going to get a disproportionate share of a shrinking employment pool,” she said. “It’s about just-in-time hiring.”
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Slide No. 6
by Alden Solovy @ 10:45AM
After nearly a quarter-million people viewed his slides “American Healthcare: A Four-Napkin Explanation,” Dan Roam got invited to spend seven minutes on FOX News explaining the health care reform debate to the American public. Someone in the Obama administration saw the report. He was invited to the White House. Roam gave the opening keynote at today’s CIO Forum.
It’s a testament to the complexity of health care that his “four-napkin” explanation takes 51 slides. Slide No. 6 may be the simplest and most eloquent description of the problem, as seen from the perspective of the public. Slide No. 32 is an interesting generalized summary of the positions and proposals being offered in Washington.
Unfortunately, some of the conclusions in the slide deck are inaccurate, particularly in the relative assessment of the impact of reform on different sectors of the health care field. Still, it’s a compelling presentation.
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CIO of the Year: IT as Reliable as John Deere
by Alden Solovy @ 9:20AM
Bill Spooner has a 53-year-old John Deere tractor that “we bought when I was a kid and still runs.” He calls it his pride and joy. But don’t mistake this mild-mannered CHIME CIO of the Year as a pushover. No way. He’s also driven a NASCAR vehicle in the Richard Petty Driving School and has flown in a mock dogfight over the Pacific in a jet trainer operated by Air Combat of Fullerton, Calif.
This combination of respect for what works and a passion for technology and innovation has helped Bill lead Sharp HealthCare in San Diego, Calif., to become one of only five organizations named Most Wired by Hospitals & Health Networks for all 11 years of the survey.
Bill was recognized for his accomplishments today. He’ll officially receive the 2009 John E. Gall Jr. CIO of the Year award at a celebration on Tuesday. Read about his accomplishments in the press release announcing the award.
“I’ve learned a lot from my colleagues at CHIME,” Bill said from the podium.
What’s most remarkable about Bill is his unwavering dedication to health care and to service, values he’s carried into his life and into his family. Thank you, Bill. And thanks to your son Garrett. Garrett is career Army and brought home a Bronze Star from Iraq. Bill’s pretty darn proud of that, too.
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Meaningful Use Analogy #1
by Alden Solovy @ 8:45AM
According to Russ Branzell, the meaningful use regulations—as proposed—are like specific written directions from point A to point B. Branzell is vp of IS and CIO of Poudre Valley Health System, Fort Collins, Colo. “These are directions,” he said about the proposed regs at a morning press briefing, “but it should be a map.” In other words, tell us where we need to go as health care providers, give us the destination, but don’t assume that all hospitals should be on the same route to get there.
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Unintended Consequences
by Alden Solovy @ 7:30AM
“Fundamentally we want to do this,” Pam McNutt told a morning press briefing focused primarily on understanding the challenges hospitals face in meeting the proposed meaningful use regulations under the current timetable. The challenge is getting it done, said the senior vp and CIO of Methodist Health System, Dallas. “When you look at the details, the question comes up, ‘How are we going to get this done?’ ”
That’s why both CHIME and the American Hospital Association are advocating a more flexible approach to achieving meaningful use, she said. The idea is to allow hospitals to adopt and implement all the necessary technology and processes, within established deadlines, but also in the context of their own strategic plans.
The current proposed regulations are “a very proscriptive mean to get to an end point,” McNutt said, adding that there’s “a disconnect” between the proposal and her hospital’s strategic plan.
There may be unintended consequences. Chuck Christian, director of IS and CIO, Good Samaritan Hospital, Vincennes, Ind., put it this way: “There’ll be a rush to install applications…badly…and we’ll have negative impact on care. If it is just a rush to install, we’re just going to make a lot of mistakes.”
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Dedication and Laughter
by Alden Solovy @ 11:15PM
In a ballroom in the Omni Hotel here in Atlanta, the semi-annual who’s who of health care information technology gathered to catch up on old times, new challenges and thoughts about where health care is headed. The HIMSS CHIME CIO Forum reception is one of the highlights of the event. The passion for health care information technology is obvious, but it’s grounded in the deepest concern for the quality of the health care system as a whole and the well being of individual patients.
Funny thing…this is not unique among health care executives. The same conversations, perhaps with a different twist, take place at receptions at the annual AHA Annual Membership Meeting, the AHA/Health Forum Leadership Summit, the American Organization of Nurse Executives, you name it.
There’s something energizing about hearing health care leaders talk enthusiastically about the opportunities and challenges faced in the effort to provide quality, safety, effectiveness and patient-centric care. From the HIT vendors to the CIOs, it’s a great group of people.
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Counting Meaningful Uses
by Alden Solovy @ 11:45AM
In the coming five days I personally expect to hear, read, write or say the word “meaningful” at least 300 times. (For the math, see below.) After all, I’ll be in Atlanta at HIMSS, the annual health care information technology extravaganza that’s become an odd mixture of merchandise mart, major keynote addresses, homespun educational breakouts, job-specific interest group meetings and CIO old home week. It’s an event that’s both necessary and annoying. I love it.
Hospitals & Health Networks will keep you posted on everything meaningful from the event—as well as our own insights and spin on the happenings—with a daily blog written by Matthew Weinstock, senior editor at Hospitals & Health Networks, and me.
My favorite day will be Sunday. No question about it. Here’s why. I’ll be at the annual CIO Forum presented by CHIME and HIMSS. First, it’s the event’s big gathering of CIOs, many of whom are friends of H&HN and our Most Wired Survey. Second, the program looks wonderful. I’m particularly interested in a panel of three clinicians headlining a town hall conversation on meaningful use.
Then there’s keynoter Alison Levine, team captain of the first American women’s expedition to Everest. She’ll talk about leadership, teamwork, determination and tenacity. I just want to hear her mountaineering stories. To get warmed up, you can read stories of my attempts to summit Mount Rainier and Mount Shasta.
Finally, the folks at CHIME plan to give our Most Wired Survey a major plug at the event. So I will too: Please make sure your organization takes the 2010 Most Wired Survey. With a team of CHIME CIOs, we’ve created a whole new benchmarking tool for 2010.
Matthew and I will be there, reporting for you from beginning to end. And if you think my estimate is overblown, here’s the meaningful math: 5 days x 10 hours of work/day x 6 “meaningful uses”/hour = 300. That’s just for me. It doesn’t count Matthew.
For the record, there are seven uses of the word “meaningful” (counting this one) in this blog post alone. Maybe 300 is too low.
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