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Why Shouldn’t Dr. Halamka Be Optimistic? And Why Shouldn’t We All Be? Further Thoughts on HIMSS16

March 9, 2016
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Dr. Halamka’s core, realistic optimism in his reflections on HIMSS16 is ultimately irresistible

It was fascinating to come across the blog of John Halamka, M.D., on Wednesday last week, as I was dashing through the Sands Expo Center in Las Vegas. Indeed, just the day before, I had run into Dr. Halamka in the crowded corridors of the convention center, and had a good chat with him about things. I had run into him just before he and Jonathan Bush, the founder and CEO of athenahealth, were to do their co-presentation, sharing their perspectives on data-sharing and other topics.

So when I came across Dr. Halamka’s Wednesday-written blog, entitled “Dispatch from HIMSS,” I was deeply intrigued. And his blog did not disappoint. I would encourage readers to go directly to the blog and read it in its entirety, but a few comments particularly stood out for me.

Surveying this year’s conference and its “buzz,” Dr. Halamka wrote, “In the recent past, big data, interoperability, personalized medicine, population health, and wearables were buzzwords in every booth. This year, the buzzwords were replaced by one overarching concept—providers and vendors must innovate or die.” He cited the advent of the MIPS (Merit-based Incentive Payment System) system, being ushered in by last year’s MACRA (Medicare Access and CHIP Reauthorization Act of 2015) legislation, noting that, in his view, “We will no longer be driven by compliance imperatives (Meaningful Use, HIPAA, Affordable Care Act, and ICD10), but instead will need to improve outcomes in order to survive financially.   No one is completely sure how to do that, but there are enablers.” And he cited several phenomena that he believes will help U.S. healthcare leaders forward, including the Surescripts National Record Locator Service, the CommonWell Health Alliance, DirectTrust, FHIR-based application program interfaces (APIs), and “agile,” cloud-hosted services.

Most pointedly, Dr. Halamka noted that “Providers will be responsible for the care that their patients receive throughout the community—inpatient, outpatient, urgent care, post-acute care and home care all contribute to total medical expense and wellness.  Some of the care may be delivered by people and organizations outside the control of primary care givers.  The only way they can succeed is by aggregating data from payers, providers, and patients/families in an attempt to provide ‘care traffic control.’” And, he noted, “Doing this requires tools for team-based care and communications, functions that may not be provided by the core EHR vendor.   Instead, an ecosystem of apps, services, and connectivity will surround the EHR to enhance usability and workflow.”

No one will disagree that any of these will be challenges; indeed, there is universal agreement that in some ways, CIOs and other healthcare IT leaders are challenged as never before in U.S. healthcare. But here’s the thing: Dr. Halamka ended all this on an upbeat note. As he emphasized, “In the View from the Top keynote I did with Jonathan Bush (the yin to my yang) we left the audience with a call to action. It is possible today to connect the healthcare ecosystem using the enablers listed above,” he said. “We do not need to wait for the perfect standard or the next round of prescriptive regulations. It’s happening now and companies that are early movers in telehealth, connectivity, and care management will out-compete the laggards.” And his very last paragraph was this: “I left HIMSS this year with great optimism.  Vendors, technologies, and incentives are aligned for positive change. 2016 will be a great year.”

I have to say, reading this blog was very validating for me. I also left HIMSS feeling optimism, of rather a similar sort to the kind that Dr. Halamka felt.

To begin with, after 25 HIMSS Conferences, I’ve never seen a more focused, aligned, determined group of industry leaders. There is huge contrast in comparing HIMSS16 to HIMSS Conferences in the mid-1990s, for example. Back then, there was no clear consensus on where healthcare was going, along the dimensions of policy, business evolution, or technology development. As a result, looking back now, there was a sense of tentativeness and even, some years, drifting. There were all sorts of competing narratives, battling theories of change. Sure, the very, very broadest outlines obtained some level of agreement among some observers: healthcare was becoming more expensive, healthcare consumers would eventually become empowered, electronic health records (EHRs) were inevitable.

But look back at, say, 1995, 1996, 1997, and those who were at the HIMSS Conference in those years will recall, as I do, EHR vendors boasting about how closed their core clinical systems were; provider leaders saw filling hospital beds as a core business objective in perpetuity; payers were absolutely seen as the enemy, or at least a profound adversary; and the concept of interoperability was openly scoffed at by many.