I remember a time about 10 to 12 years ago when rumblings emerged about the annual HIMSS Conference. Some people—not a lot, but some—were saying that the annual conference of the largest association of healthcare IT professionals (the Chicago-based Healthcare Information and Management Systems Society) had simply become too big—the crowds were too big, it was becoming too difficult to engage in serious discussions, it was simply becoming a hassle to attend and participate, etc.
There were of course legitimate complaints. Indeed, with regard to the size of the conference, HIMSS 2008 had 29,179 attendees, according to a history of the association and the conference compiled by members of the HIMSS Legacy Workgroup; whereas attendance at this year’s conference, as of Tuesday, March 6, was 42,608—more than 68 percent more people attending. So, clearly, the HIMSS Conference has become gigantic—so much so that only three cities—Las Vegas, Orlando, and Chicago—can now fully accommodate it. Remember that the conference requires a vast constellation of physical spaces of different sizes (all the way from a main ballroom accommodating more than 8,000 attendees, down to several hundred smaller rooms, including classroom-sized rooms for meetings), as well as an immense set of exhibit halls; and enough hotel rooms to accommodate nearly 45,000 people; and airports with sufficient flight to fly all those people in and out essentially at the same time.
In any case, the murmur of grumblings a decade-ish ago was not purely about crude numbers. It was also about the feeling, in some quarters, that HIMSS’ focus had become too diffuse over time. Certainly, back in the 1990s and in the very early 2000s, there was a somewhat diffuse feeling around the HIMSS Conference in general. I remember back in the 1990s, the tenor of the conference, which was quite unfocused compared to these days. Walking the exhibit floor back then, one observed a kind of miscellaneous smorgasbord of vendor offerings, with vendors kind of all over the place in terms of the wares they had for sale, and most systems, particularly electronic health record (EHR) systems very closed and proprietary then (indeed, EHR vendors took pride in the closedness of their systems—really). There was also a lot of vaporware on display then (and that was one of the commonest complaints 10 to 20 years ago).
Well, everything changed in 2009, when the U.S. Congress passed, and President Obama signed into law, the ARRA (American Recovery and Reinvestment Act of 2009), one piece of which was the HITECH (Health Information Technology for Economic and Clinical Health) Act. Yes, Virginia, the HITECH Act changed everything. Certainly, HITECH’s passage changed the trajectory of EHR implementation, turbo-charging the forward advance of EHR adoption in both hospitals and physician practices. Prior to 2009, depending on who’s doing the counting, somewhere around 40 percent of hospitals had fully implemented EHRs (and that’s only the basic implementation, not more advanced clinical information systems development), and no more than 15 percent of physician practices (counting quite liberally) had done so. Fast-forward to 2018, and virtually every Medicare-participating hospital is live on an EHR, as are the vast majority of physician practices. And that changed the entire landscape of healthcare IT.
For one thing, once EHRs had become near-universalized, that opened the door to the adoption of more advanced solutions, including analytics tools and other technologies. The EHR has been foundational for so much of everything else that’s come along in the past decade.
But the impact of HITECH, and of its prescriptive meaningful use program, has been only one piece of this puzzle. The passage in 2010 of the Affordable Care Act (ACA) totally transformed the landscape of U.S. healthcare for the leaders of patient care organizations, and therefore, the operational landscape for healthcare IT leaders. Along with it came the value-based purchasing program under the Medicare program, the mandatory readmissions reduction program also under Medicare, and a mix of mandatory and voluntary bundled-payment programs, and voluntary accountable care organization (ACO) programs, also under Medicare. And every single one of those programs required transformed healthcare IT, including a new generation of data and analytics strategies and tools.