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At the 2015 HIMSS Conference, Time to Think About the Big Picture—the Really Big Picture

April 8, 2015
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Thinking back to HIMSS annual conferences of a quarter century ago, and forward to HIMSS15, what’s clear is the need to keep the big picture around healthcare in mind

As everyone prepares to gather at the vast McCormick Place Convention Center in downtown Chicago for this year’s HIMSS Conference, sponsored by the Chicago-based Healthcare Information & Management Systems Society, it might be worthwhile to contemplate what the conference was like a quarter-century ago, what it is now, and what it might further evolve to become.

Yes, I was there: my first HIMSS Conference was in 1991, and I’ve attended every one since then except for one year, meaning that this will be my 24th HIMSS Conference. In that time, a huge amount has changed, and it’s worth pondering what has changed on a deep level.

Of course, before we look at the more profound changes, it would be worthwhile to mention a few of the more obvious, top-of-mind differences between 1991 and what is expected to happen this year. In 1991, 1,800 people attended the HIMSS Conference, held in San Francisco, whereas over 38,000 attended HIMSS 2014, held in Orlando. HIMSS remains one of the largest annual healthcare conferences in the United States, and is now roughly comparable in size to the RSNA Conference, sponsored by the Radiological Society of North America, and which attracted 52,000 attendees in December 2014. The fact that RSNA is a global conference with a majority of attendees being radiologists from all over the world, makes it a different creature altogether from HIMSS, but it is quite telling that, even as RSNA has shrunk somewhat from its attendance highs of around 65,000 ten years ago, HIMSS continues growing every year.

But such superficial differences are only the tip of the iceberg (though to be honest, attending a conference of 38,000 people really is fundamentally different from attending a conference with 1,800 attendees, even on the most superficial level!). On a fundamental level, the entire policy, industry, clinical, and informatics landscape around the HIMSS Conference has changed and been transformed in the past quarter-century. Back in 1991, I remember a great deal of hype around the concept of “integration engines”/”integration platforms,” designed to try to create some level of interfacing between what at the time were extremely closed electronic health record (EHR) systems. Of course, none of those vendors even exist any longer. But at the time, the near-complete closedness of EHRs and other clinical information systems made the kind of products those companies offered a viable idea at the time.

What’s more, if one were to walk the (much, much smaller) exhibit floor in those days, one would have been aware of a sense of “scatteredness” in terms of the types of focus among vendors, and of an absence of any unifying themes or messages. At a time when hospitals, medical groups, and health systems were just beginning to implement core EHRs, and, let’s face it, at a time when the information technology solutions available generally were quite primitive technologically compared to today, everything on offer was relatively early-state and tentative. There was also a tremendous amount of “vaporware,” as it is often called in healthcare.

On the policy and industry level, it is extremely important to remember that early 1991 was a time when the 1990s version of managed care was just getting rolling. And the entire healthcare system in the U.S. was just beginning to awaken to the massive changes that might be needed going forward. Twenty-four years later, we can look back on the gains and failures of 1990s-style managed care, often referred to as “mother-may-I” managed care, for its intense focus on utilization management and control, and we can see how narrow the vision of managed care during that decade really was, even as the percentage of the U.S. gross domestic product (GDP) spent on healthcare nationwide was soaring—from under 13 percent of GDP in 1991 to 17.4 percent in 2013—and, according to the Medicare program’s actuaries last fall, a staggering 19.3 percent (and $5.158 trillion, compared to $3.056 trillion in 2014) by 2023.

In short, the exploding costs of U.S. healthcare, which have been reflecting the aging of our nation’s population and an explosion in chronic illness, have focused federal policymakers on the financial unsustainability of our healthcare system. Not surprisingly, the Affordable Care Act, passed by Congress and signed into law by President Obama in March 2010, included a broad range of “internal healthcare reform” provisions, including the mandatory avoidable readmissions reduction program and mandatory participation in the value-based purchasing program, that are compelling providers to document performance improvement in a host of areas. What’s more, the passage of the American Recovery and Reinvestment Act in 2009, including the HITECH (Health Information Technology for Economic and Clinical Health) Act, put EHR and clinical information system implementation on the front burner for providers nationwide.

In other words, two great waves of policy change that have rocked the healthcare IT world—the passage of HITECH as part of the ARRA, and the passage of the ACA—as well as other types of legislation affecting the Medicare and Medicaid programs and other federal areas—all of these developments have changed the fundamental landscape of healthcare IT, and thus, what’s talked about—and hawked—at HIMSS.