Every year, I walk the floor of HIMSS and summarize the broad trends I see in the industry. Here are my 2009 observations
1. The Stimulus - There's energy and optimism at HIMSS this year caused by the prospect of $34 billion dollars of stimulus funding for Healthcare IT. Since the current healthcare IT annual spend is somewhere between $15-25 billion, this could double the entire industry.
2. The Economy - the euphoria of the stimulus is tempered by the challenging economy - downsizing, wage cuts, and the collapse of 401k's are a stark contrast to the hope of new EHR rollouts.
3. Software as a Service - It's clear that all these new EHRs are not going to be hosted in the offices of rural solo practitioners. Web-based software as a service hosting centers for EHRs are being discussed by many companies - software producers, infrastructure providers and consulting companies. Many server, storage and virtualization suppliers are offering new products to support the Cloud Computing infrastructure needed to support Software as a Service hosting.
4. Security - with the prospect of every patient in the country having an interoperable EHR by 2014, there are increasing concerns about protecting confidentiality. Companies are creating new security tools, new consent management systems, and new audit reporting systems.
5. Open Source - Just as Linux has become mainstream in corporate data centers, open source EHR and HIE products are becoming more mainstream. A group of open source vendors met with CCHIT to discuss their role in the EHR ecosystem.
6. PHRs - with more EHRs comes the prospect of more PHRs to share electronic data with patients. Google announced its Medicare data sharing pilot. A really interesting question to be answered is the role of PHRs in the meaningful use of EHRs. Will EHR to PHR data sharing qualify for the interoperability requirements of meaningful use? To be determined.
7. Appliances for HIE - In previous years, folks exchanging data among stakeholders focused on content - shall we use HL7 2.x or 3.x, shall we use LOINC or SNOMED-CT? This year, the focus has been on infrastructure - how do we transport data securely from one stakeholder to another? A few companies are offering integration engines and health information exchange appliances to address this secure transport requirement. HHS released its CONNECT open source Nationwide Health Information Network gateway, built by 20 members of the Federal Health Architecture team.
8. Home Healthcare Care/Telemedicine - Continua Alliance, GE and Intel have all embraced remote monitoring and home care as one strategy to reduce healthcare costs while improving quality.
9. Performance Measurement and Outcomes - Tools for quality warehousing, business intelligence/reporting, and risk adjustment are being offered by many vendors.
10. Decision Support - As more EHRs are rolled out, we'll need decision support rules and services. Several companies offer order sets, knowledgebases, and decision support web services.
A good show with many innovative interoperability products, especially in the interoperability showcase. It was good to catchup with colleagues and vendors - 24,000 of my closest friends!
Tuesday, April 7, 2009
Dispatch from HIMSS
Posted by John Halamka at 3:00 AM
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We need to merge EHR with PHR and create a Virtual Care Plan. In this model, all information exists in order to serve the patient's care plan. The care plan of a healthy person is mainly preventive care. For a person with health conditions, the care plan organizes both personal and medical information in a way that serves the patient. The data sharing occurs virtually and authorized users interact with the care plan according to their role in the care planning. This model allows us to move beyond the territoriality that exists within our current conceptions of EHR/PHR>
I admire your steadfast optimism that the technology changes sweeping through IT will be adopted by Health Care reasonably soon. In my observations and participation in Health Care IT I find it moves much more slowly than the industry. It was slow to the Internet, still is slow to Web 2.0 and unless we all do Microsoft Azure in the clouds, it will be slow there as well.
Doubling spending while asking for projects on ready to go sounds like a feeding frenzy of the business as usual folks.
I hope I am wrong.
I agree with Kate about the 'integrated PHR'. I am just finishing my thesis from Northwestern Medical Informatics program and did a demonstration of my project at HIMSS. It's a data exchange from NextGen EHR to the HealthString PHR via CCR/PDF-Healthcare. We are conducting a research study including patients with chronic conditions to see how the sharing of data and a pre-populated PHR (with meds, allergies, problems to start off) can help to improve care coordination, relationship with physician, and will eventually look at clinical outcomes. Phase 2 will be the patient sending data back via CCR/PDF to the physician to store in the EHR before their visit. You could do the same with embedding the CCD in the PDF and can also add attachments within the PDF (ECG, hosp D/C summary, etc.) It's been quite tricky but very interesting project with LOTS to learn still... so far so good though. Love the move to educating and engagine our patients in their health! :-)
Storing healthcare data in the cloud is clearly a challenge if the many advantages of cloud computing are to be realised. This topic was addressed recently at our "Out of the Slipstream" conference in Phoenix: see http://www.slideshare.net/george.james/securing-the-cloud
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