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Live From HIMSS: Nothing Is Simple

April 4, 2009
by Joe Bormel
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I'm both excited and relieved about HIMSS this year, and it's only Saturday morning. I started with a day full of meetings at HIMSS on Friday. Here are a few, high-level observations:

  • More Passion and Urgency than ever before: This will be a great year to learn about what's going on in the industry. The ARRA-2009, and it's lack of specification on details has brought everyone out. The sense of passion and urgency in everyone's voice, facial expressions, and overall presence is much higher than past years. I can't compete on years with most of the bloggers here, but for me, it's 15.
  • Relax and Learn: HIMSS is an ideal place to learn about the high and low level issues, from every perspective. We're at a strange time now, about 6 weeks after the ARRA-2009 passage, and about 6 weeks before we have the combination of Kathleen and David coming on-board and up-to-speed. It's also about 6 weeks before most of the smartest and best connected people in the industry have released their detailed recommendations on how we should deal with our new horsemen: Meaningful Use, Certification, and Interoperability. Those recommendations will be readily available on the Internet and well-written (and thankfully succinct because they'll have to be.) So, listen, learn, converse, attend meetings, and don't worry too much about taking notes. Your notes will be written for you in the next few weeks!
  • Horsemen: I titled this blog post "Nothing Is Simple." There's no easy, objective way to address them:
    • Meaningful Use - I took my stab at this one yesterday, here. I've solicited and received lots of feedback. I've learned that everyone wants to be very high level, succinct and clear. Doing that and simultaneously being explicit is more than an art. Based on a dozen or more recent examples, my own and others, I think that's impossible. So, grill presenters, after they've attempted to get their message out, to be either a lot more explicit, or a lot more high level. That includes me. This stuff demands it.
    • Certification - not a surprise, but the big challenge will be getting this right from the Three Bears perspective - not too big or too small. The timing of release of this information is going to drive toward re-use. The other interesting and extremely messy aspect of certification is that it overlaps with Quality measurement and reporting thereof. It overlaps with Usability. David Blumenthal has written about his concerns here. And, the overlaps don't stop there. Talk about scope creep!
    • Interoperability and HIE - this is more nuanced than I appreciated. I've previously referenced Wes Rishel's EMPI tutorial. I've studied several IHE integration profiles and have been following the NHIN work. I'm not clear on the meta interoperability, as one connects an edge-system to the NHIN. I watched Rob K and Charles P discuss this; both have spent a lot of their lives on these important issues. I think I heard agreement that it's not broadly understood and perhaps not as developed as the folks presenting it make it seem.
  • Impact on cost of care: My friend, Dr. Michael Stearns, President of e-MDs, was one of the folks I asked about using chronic disease management and use of EHRs. Mike is an industry powerhouse and delightful thinker. When I asked him if he had seen cost impact studies on diabetes, where EHR enablement was a factor, he provided a well organized response that I hope he'll share on my blog post on that topic. He reminded me that in that case, and the use of EHRs in general, will likely have an initial increase in the cost of care, once we're more focused on quality (like adequate screening.) It makes you wonder if the $80 Billion savings projected will be dwarfed, as a result of meaningful use of EHRs.

I hope everyone can relax a bit and enjoy the passion, information, promise and useful conversations that will be coming out of the HIMSS meeting this year. This will not be like previous years (which, although also interesting, didn't have the political and financial stakes of 2009.)

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