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Amid the Swirl of Vendor Hype, Thinking about the Bigger—and Historical—Picture

March 5, 2013
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Making sense of the vendor offerings at HIMSS13 requires a sense of historical perspective—and a very comfy pair of walking shoes

One of the things that I inevitably find once I’ve returned home from any HIMSS Conference (and alert readers might recall my mentioning that this year is my twenty-second) is that is nearly impossible to convey to those who have never participated in a convention like the HIMSS Conference how tremendously intense the atmosphere is (usually in a good way, but still intense). Simply saying things like, “Yes, they had over 1,000 vendors this year, and the biggest vendors once again had ‘booths’ that were each a half a city block long.” Even sharing photos with them doesn’t quite convey the intensity.

And I’ve come to realize that one of the reasons that the intensity of HIMSS is difficult to convey is that it’s not purely physical, though honestly, 35,000 people tromping here and there across several days in a gigantic convention center (indeed, the Ernest N. Morial Convention Center covers nearly 11 square city blocks and encompasses over 3 million square feet of space—hmm, doesn’t it make one more tired just reading those facts?) is in itself a bit fatiguing to be a part of.

But as we all tromp back and forth across the exhibit hall, with its record 1,214 vendor exhibits this year (and that doesn’t even include specialized areas such as the interoperability showcase), it’s important to keep a few things in mind, and to put the hyper-sensory-overload elements of the show side of the HIMSS Conference into historical context.

So what has changed over the 22 years since I first started coming to HIMSS? Several things.

First, the entire landscape of healthcare IT has changed considerably since the first time I came to HIMSS, in 1991. To begin with, the technology then, compared to now, was positively primitive. Electronic health records (EHRs) were incredibly proprietary, closed, and most importantly, technologically limited then, compared to now. Even the very best vendor solutions then were, when compared to the current solutions available now, rudimentary and limited in their technological capabilities.

Second, the entire landscape of healthcare policy and reimbursement has changed dramatically over the past 22 years. Given the demographics-driven healthcare cost tsunami that the United States (along with, really, all the advanced industrialized nations) is facing, with the costs of the Medicare program alone expected to double within the next decade, there is simply no question that healthcare information technology is being developed in a remarkably different context from two decades ago. Put another way, in contrast to the tremendous lack of policy clarity back in 1991 when I first started attending HIMSS, today, clarity is the one thing that we in healthcare absolutely have. Healthcare in this country costs too much, the purchasers and payers of healthcare can no longer afford the cost, and they’re demanding that providers move towards what we at the magazine have been calling the new healthcare—a healthcare system that provides dramatically improved care quality, patient safety, operational efficiency, cost-effectiveness, accountability, and transparency.

Third, given the vastly improved information technology available and the tremendously clear policy landscape, healthcare IT vendors are developing far more sophisticated, targeted, and, really, smart, solutions, for the needs at hand. We now know that population health, accountable care, chronic disease management, and continuous clinical and operational performance improvement are going to be clear meta-goals for healthcare going into the middle of the second decade of the 21st century in the U.S. And any vendor strategies and solutions that help providers and health plans to move towards those meta-goals will in some way find adoption, while those that are functionally frivolous or redundant are going to shrivel on the vine of industry acceptance.

In that regard, I found the announcement on the part of six major electronic health record (EHR) vendors on Monday that they were launching something called the CommonWell Health Alliance, a collaborative effort to promote and work towards seamless interoperability, to be very heartening. Clearly, interoperability remains one of the great barriers to the full leveraging of information technology for operational and patient care improvements in healthcare to date. And, in historical context, that announcement was quite remarkable, considering that 20 years ago something like “CommonWell” not only would have been technologically unfeasible, but virtually impossible from a business/strategic standpoint as well.

Now, don’t get me wrong: I remain concerned about the proliferation of applications, considering the challenges of interoperability, core network infrastructure support, and IT governance that face CIOs, CMIOs, and other healthcare IT leaders right now. And I seriously wonder how some solutions can truly be integrated into clinician workflow, given the enormous challenges facing healthcare leaders looking to develop the accountable care structures absolutely needed to build the new healthcare.

But as I tromp across the city blocks full of exhibit hall space at HIMSS13, I am constantly reminded of the positive changes that have taken place in the past two decades, and at the (at least partial) evaporation of the vaporware that seemed to be everywhere 22 years ago. Practical tools for a practical time: HIMSS 2013 is clearly a world removed from HIMSS 1991.