HIMSS08 Online Daily - Thursday Feburary 28, 2008

1. Kolodner predicts `banner year' for ONC
2. Steve Case calls for a consumer-oriented healthcare system
3. New standards rolling out according to schedule, HITSP chair says
4. HIMSS08 posts record numbers
5. Driving accountability in healthcare organizations
6. Doc advises small practices on EHR adoption
7. Siemens counting on personalized medicine
8. Philips to restructure healthcare business
9. ATM in the ER? It could happen
10. Inova Health System goes wireless

 

1. Kolodner predicts `banner year' for ONC

By Diana Manos, Senior Editor

At a Town Hall hosted by the Office of the National Coordinator, Robert Kolodner, MD, said his office would soon release the federal Health IT Strategic Plan.ORLANDO—Robert Kolodner, MD, national coordinator for health information technology, told an audience at HIMSS08 Wednesday that he expects an unprecedented year for healthcare IT advancement.
To kick off what Kolodner called a 'banner year' for the Office of the National Coordinator for Health Information Technology (ONC), "the long-awaited" federal Health IT Strategic Plan will be released in the next few weeks. The plan will detail all combined federal efforts on advancing healthcare IT.

In September, the Nationwide Health Information Network (NHIN) "dial tone" demonstration will be launched, connecting communities, integrated delivery systems and personal health data banks, Kolodner said. Entities will use the NHIN on a peer-to-peer basis as early as 2009. The NHIN will light up in areas all across the country and then spread outward, Kolodner said.

He also predicted STARK exemption laws would dramatically stimulate electronic health record adoption next year, with 50 percent of doctors implementing EHRs by the end of 2009, up from an estimated current 14 percent.

The Department of Health and Human Services will urge private payers to follow suit in its plan to provide incentives to doctors who use certified EHRs. HHS will soon begin recruitment of some 1,200 physician practices to participate in a pilot paying doctors who use EHRs.

State efforts to implement common policies for information exchange will gain momentum his year, Kolodner said. State leaders are responding well to federal efforts to bring them together for a common purpose of overcoming barriers to data exchange.

The American Health Information Community – the advisory panel to HHS on healthcare IT issues – will be given a future in the launch of AHIC 2.0 this year. ONC will recruit more than 18 members for this new iteration of the Community with a strict charge that no one single entity can dominate the process. "All can be there, but none can control it," he said.

With respect to the presidential election and changes it may put on AHIC's progress, Kolodner was not concerned. "Everyone we've talked to with the presidential candidates said they would not view starting over as an option," Kolodner said. "I don't see a big disruption going forward."

ONC may see changes in coming years as old objectives are achieved and new goals are begun. "Don't expect the same type of ONC in the future," Kolodner said. "It has to change; its nature is to change."
As far as his position, Kolodner said he expects to be around. His position was made a career job last year and he will not be replaced when a new administration takes over.

 

2. Steve Case calls for a consumer-oriented healthcare system

By Richard Pizzi, Associate Editor

Steve Case says he wants to revolutionize the healthcare industry. His keynote speech on Wednesday afternoon was very interactive, as he entertained dozens of questions from the crowd.ORLANDO – Steve Case, the former CEO of America Online, described his plan to “revolutionize” the healthcare industry in his Wednesday keynote address to HIMSS08 attendees.

“We need to move consumers from being bystanders in healthcare to active participants,” said Case. “I’m here as an advocate for consumers. If you empower consumers with information, everyone wins.”

In 2005, Case founded Revolution Health, a “consumer-centric” health company offering a free health and medical information site (which was launched on the Web last year). The company also offers a free online personal health record (PHR) to consumers. Case described Revolution Health’s other offerings, which include CarePages, a site allowing people to create Web pages that help family and friends communicate when a loved one is ill.

Case said changes in the U.S. healthcare system – such as higher insurance deductibles and payers offering fewer covered services – augur the dawn of consumer-oriented healthcare. He said companies have to be more attentive to the needs of consumers as they take on more direct responsibility for care.

 “I believe that a healthcare system shaped by market forces and powered by technology will be an improved system,” he said.

According to Case, Revolution Health’s mission is to “disrupt and transform” the healthcare industry by trying to make it more consumer-oriented.

The former AOL Time Warner chairman’s rhetoric echoed the free-market messages delivered earlier this week at HIMSS08 by U.S. Health & Human Services Secretary Michael Leavitt and former Senate Majority Leader Bill Frist.

Case said Revolution Health has become the largest health property on the Internet since its launch.
Despite the “revolutionary” language, Case acknowledged – in response to an audience member’s question – that change in the healthcare industry would not be immediate, given the central role of payers, employers and government regulation. He also admitted that he was concerned with the quality of health information available on the Internet, saying “there’s too much information of uneven quality” and “we’re trying to create a site with properly vetted information.”

 

3. New standards rolling out according to schedule, HITSP chair says

By Diana Manos, Senior Editor

Attendees at the HITSP session listened closely as John Halamka provided a progress report on the standards organization.ORLANDO – Standards development is progressing according to schedule and should build momentum, said John Halamka, MD.

The chairman of the Healthcare Information Technology Standards Panel told attendees at a Wednesday session that HITSP has developed standards with components that can be recycled in developing future use cases.

"We hope eventually that we'll have enough of these components completed that it won't take nine months to develop more use cases," Halamka said.

"The parts are finite and highly reusable," he said. "We can reduce hundreds of standards into a dozen or two to make development much easier."

HITSP reduced 900 possible standards to a few dozen selected standards and will complete its third round of use cases before Department of Health and Human Services Secretary Michael Leavitt leaves office in 2009, Halamka said.

"HITSP has become a trusted convener. We have a future that looks quite bright," Halamka said. "Hopefully the next administration will be healthcare IT-friendly and willing to financially and strategically sustain HITSP."

Over the last year, HITSP has focused on quality as a use case, “probably the hardest thing we worked on," he said. "Quality use case development wasn't about technology, it was more about policy."

This year HITSP is working on use cases for personalized healthcare, consultation and transfer of care, immunizations and response management, public health case reporting, remote monitoring and patient-provider secure messaging.

"All this needs to be wrapped in privacy," Halamka said of standards development.

HITSP's goals beyond use case development will include increasing education, improving vendor implementation, working with the Nationwide Health Information Network trials and further aligning with the Certification Commission for Healthcare Information Technology.

 

4. HIMSS08 posts record numbers

By Jack Beaudoin, Editorial Director

New Jersey Assemblyman Herb Conaway, Commissioner of the Georgia Department of Community Health Dr. Rhonda Medows, and Iowa State CIO and NASCIO President John Gillispie tour the HIMSS Interoperability Showcase.ORLANDO – Just about 28,000 people passed through the doors of the Orange County Convention Center to attend HIMSS08 this week, according to officials with the Healthcare Information and Management Systems Society.

While the tally remains unofficial, once the numbers are confirmed later today the show will have hit a new attendance record.

The number of exhibitors is also likely to set a record, with 905 vendors, universities, associations and other groups taking part in the show. But what may be even more significant than the uptick is the growth – in number and in floorspace – of some general technology companies such as Microsoft and Google. Both those companies made major healthcare announcements in the days leading up to HIMSS08.

"One of the things we've found is that the relationship to patient data is up for grabs," said Paul Keckley, executive director of the Deloitte Center for Health Solutions. "Nontraditional players such as Microsoft and Google recognize that opportunity."

As for the more familiar exhibitors, many remain bullish on healthcare IT investments despite concerns about the general economy. "We think technology is the linchpin for the next advance in healthcare, which is personalized medicine," said James Coffin, vice president and general manager of Dell Computer's Healthcare and Life Sciences division.

Siemens Medical System's Janet Dillione agreed. "The entire premise of personalized medicine is that IT will be critical to push data to the patient desktop," she said.

Of course, the downside of a bigger show is that there's too much to see and do in one week.

"The show is always great but there is never enough time to do everything," said Nicole Follansbee, a medical informaticist with Wyle Laboratories, Inc, of Houston. She suggested that HIMSS include the fee of recorded sessions in the original registration so that attendees could take the show home with them.
HIMSS officials are already looking ahead. They'll have about 13 months to get ready for HIMSS09, which is planned for early April in Chicago. The 2010 HIMSS Annual Conference and Exhibition will be held in Atlanta (when the show returns to its traditional February time frame), while the 2011 edition marks the return of the show to sunny Orlando.

 

5. Driving accountability in healthcare organizations

By Patty Enrado, Contributing Editor

Quint Studer, author of "Results That Last," discussed successful leadership qualities at a standing-room-only Views from the Top session on Wednesday.ORLANDO – The success of any IT project in a healthcare organization relies on knowing how to hold people accountable and how to fire low performers, according to Quint Studer, CEO of The Studer Group.

Studer’s Views from the Top session on Wednesday, “Cultures of Excellence,” offered eight reasons why organizations don’t attain or sustain excellence. But he cited the absence of an objective accountability system and a process to recruit high and middle performers and address low performers as the most critical issues.

Most managers spend an inordinate amount of time dealing with low performers, but Studer recommended that 92 percent of their time be spent retaining 92 percent of their employees who want to be on board and 8 percent of their time be spent dealing with the 8 percent who don’t.

“The outcome is results that last,” he promised.

He objected to the belief that low performers can be saved. “You can’t move the unwilling,” he said.

To retain high performers, he advised managers to praise and thank them for their work, explain why they are important and ask if there is anything they want.

To move middle performers, Studer said managers need to support, coach and let them know that they’re doing a good job and how they can be developed further.

Firing low performers should be preceded by documenting what has been observed, evaluating how you as a manager feels to the low performers, show them what needs to be done, let them know the consequences of the continued performance and following up. “You need to move the performance curve,” he said.

“Culture outperforms strategy every time and culture with strategy is unbeatable,” Studer said.

 

6. Doc advises small practices on EHR adoption

By Richard Pizzi, Associate Editor

EMRs don't have to be expensive, but it could be expensive not to use one, said Jeffrey Brenner, MD. He spoke Wednesday morning at HIMSS08.ORLANDO – Small physician practices don’t need to spend a fortune on an electronic health record system because good, relatively inexpensive products do exist. And, with proper planning, EHR implementation can be fairly painless.

This was the word from Jeffrey Brenner, MD, a primary care physician in Camden, N.J. Brenner spoke on Wednesday morning at HIMSS08, and provided a compelling story of the challenges faced by a solo practitioner in one of America’s poorest cities.

 “Small practices are unique animals, and they will be the last to adopt EHRs,” said Brenner.

Lamenting the shortage of peer-reviewed academic research on EHR adoption, Brenner warned providers not to take the claims of vendors or healthcare IT boosters at face value. He said a physician’s idea of “best practices” in healthcare IT might not be the same as that of a consultant or a large vendor.

 “Technology vendors are infamous for over-promising and under-delivering,” Brenner said. “You have to take a skeptical eye toward many of the claims about EHR adoption outcomes because of the lack of rigor and peer-reviewed data.”

Nevertheless, Brenner said an EHR could be a boon to a small practice.

 “EHR adoption does not automatically result in cost savings, but it often does,” Brenner noted. “Adoption doesn’t automatically result in higher quality care, but it can.”

Brenner has been using an EHR since September 2005, and claims it has changed his life for the better. He spent less than $6,000 for the software, which was critical.

 “Primary care practices can’t afford expensive products,” he said.

When researching EHRs, physicians at small practices should demo the products alone at home, said Brenner. Since ease of use is paramount to small practices, physicians must feel comfortable with the software. Small practices can’t afford to take the financial hit of an EHR system that doesn’t work for them.

 “The dirty secret of EHRs is all the failed implementations,” Brenner said. “I think a vendor has the responsibility of knowing their implementation failure rate and revealing it to potential clients. That isn’t likely to happen, so a practice has to be careful.”

 

7. Siemens counting on personalized medicine

By Jack Beaudoin, Editorial Director

ORLANDO – The third horizon in healthcare is an intensely personalized one, which will require information technology to marry rich data streams from imaging, diagnostic and genomic sources. That's according to Janet Dillione, president of Health Services for Siemens Healthcare, who spoke on the future of healthcare IT at a media presentation on Tuesday.
Dillione said Siemens views the first horizon as “craft medicine.” In this era, “most of the treatment is generic – try this and see if it works,” she said.

The second horizon is one in which IT enables physicians to consistently use evidence and best practices in a standard workflow to improve the quality of care.

It was for this horizon that Siemens built its clinical information systems solution, Soarian, Dillione said, stressing its Service Oriented Architecture.

“It's strategic, in that it provides a platform for other systems such as imaging and diagnostics, to run on,” she said. And that positions it for the third horizon in healthcare – a patient-centric healthcare system that uses personalized medicine through genomics, imaging and diagnostic advances.

“The entire premise of personalized medicine is that IT will be critical to push data to the patient’s desktop,” she said.

When asked how far off Siemens believes the third horizon is, Dillione responded, “Most of the chemistry and biology will take five to 10 years” to develop and test. But she warned IT systems currently have a life expectancy of 12-15 years, so today's investments need to be made with the future in mind.

Failure to advance medicine will have devastating consequences, Dillione said. By 2030, the number of Americans over the age of 65 will double, overwhelming even the most optimistic estimates for the clinician workforce. By 2050, it's estimated that someone will be diagnosed with Alzheimer’s every 33 seconds. Closer to home, she said one of every three of our current children will eventually “fall to cancer” unless the healthcare system changes.

Successful clinical systems in the future will not offer proprietary medical knowledge – those will exist as public domain databases, Dillione asserted, created by academics and researchers – but they will have to provide quick access to data.

"One of the greatest challenges in healthcare will be managing data," she said.

 

8. Philips to restructure healthcare business

By Chip Means, Web Editor

ORLANDO - Royal Philips Electronics will restructure its healthcare informatics division to align its entire portfolio of patient monitoring and clinical information solutions, company officials announced Monday at HIMSS08.

The restructuring aims to strengthen Philips' healthcare strategy and increase information management for providers, officials with the company said. And it will enable the company to better address enterprise-wide concerns, as opposed to simply department-by-department needs.

"We looked at a healthcare and how we structure our business, and we've seen how the CIO is playing a much stronger role in the decision-making process," said Martha Dolan, director of clinical care for Philips. "There's no more selling department by department... [Hospitals] don't do that anymore. Things have to be simplified."

Philips' clinical information solutions and services include patient monitoring, enterprise and clinical management systems, anesthesia IT, women's health IT, and cardiology information systems.

The Amsterdam, Netherlands-based electronics giant recently acquired several healthcare IT companies as it looks to expand its business in the healthcare sector.

"Integrating patient monitoring into healthcare informatics enables us to find synergies between our software competencies and monitoring solutions recently strengthened by the acquisitions of XIMIS, Emergin and VISICU," said Oran Muduroglu, chief executive officer of Healthcare Informatics for Philips Healthcare. "By better managing the flow of data through the continuum of care, healthcare organizations can significantly impact operations and focus more effort on their core business: taking care of patients."

Dolan said the more intelligent medical devices, diagnostic tools and decision support tools are not meant to replace evaluations by clinicians, but rather enable clinicians to spend less time reviewing normal results and more time on the exceptional results.

"Our job is to sit on their shoulders and whisper in their ears," Dolan said. "Technology should filter information to get at what's clinically important."

 

9. ATM in the ER? It could happen

By John Andrews, Contributing Editor

ORLANDO – The health savings account movement could have negative financial implications for healthcare providers to the point where they may have to set up cash stations in the waiting room, consultant Stephen Lazarus told HIMSS08 attendees Tuesday.

Depending on the nature of the HSA plan, especially those with high deductibles, providers may need to implement some type of pre-payment arrangement with HSA patients, said Lazarus, president of the Denver-based Boundary Information Group.

“If you decide to collect for services later, you’ll end up chasing the patient and that’s a problem,” he said. “So collecting upfront makes sense, though hospitals aren’t familiar with the concept. … It’s hard to pay anything onsite.”

HSAs and their counterparts, High Deductible Health Plans (HDHPs), have been growing steadily since they were founded as part of the Medicare Modernization Act in 2003. Governed by the U.S. Treasury instead of Health and Human Services, HSAs are part of the consumer-driven healthcare movement. The number of HSA account holders has ballooned from 1 million in 2005 to 4.5 million in 2007. The Treasury Department figures between 25 million and 45 million will own an HSA by 2010.

“That certainly could happen. HSAs aren’t going away,” Lazarus said.

A key component of the HSA is the involvement of a financial administrator, typically a bank or financial services institution. Consumers are tied to their accounts electronically through specific Web portals managed by the administrator.

There are numerous variables in the types of accounts and options offered, adding complexity to the system. Laura Darst, senior electronic commerce coordinator for the Rochester, Minn.-based Mayo Clinic, said there are six basic configurations for HSAs, ranging from extensive third party involvement to bare bones plans that place the entire financial onus on the consumer.

 

10. Inova Health System goes wireless

ALEXANDRIA, VA – Inova Health System, a not-for-profit healthcare organization in Northern Virginia will be providing Internet access throughout its five hospitals.

Inova will implement Wayport Inc.’s Wi-Fi Internet across it organization providing patients, doctors and staff with wireless access. Users who want to connect for an hour or more will be subject to a nominal fee per hour and unlimited usage will be offered by paid membership plans.

For the public’s usage, Inova will install the Wayport CyberCenter Express, or public PC units, to provide access to the Internet. Wayport made the announcement at HIMSS08.

“Inova Health System shows great innovation in their approach of leveraging technology to enhance patient care as well as improve the patient and guest experience,” said Kevin McKeand, vice president and general manager, Wayport healthcare. “They will offer a first rate experience for patients, visitors, physicians and staff by ensuring that each user is well supported, that the network is secure and reliable and that all services are consistently maintained over time.”

 “We are excited to offer wireless Internet services to enhance our patients’ and guests’ experience,” said Geoff Brown, chief information officer, Inova Health System. “With Wayport’s network experience and management we are able to offer a modern convenience with highly reliable service and support.”

Hospital guests will be privy to the same robust network as the hospitals and will maintain HIPAA compliance and internal security. Wayport will be providing the hospitals with 24x7x365 support in connecting to the wireless network.