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.
In short, policy and payment imperatives have increasingly been driving the U.S. healthcare system forward over the past several years, and that broad healthcare system change has forced change at the operational level at hospitals, medical groups, and health systems. And, of course, healthcare IT has been and continues to be, a key facilitator of all this transformation. And that has put healthcare IT leaders—most especially CIOs, CMIOs, and other senior healthcare IT leaders—in patient care organizations—in positions of both extreme importance and tremendous pressure. CIOs, CMIOs, and their senior-level healthcare IT colleagues are in a position to be more influential than ever, among their c-suite colleagues. But they’re also under more pressure than ever to help their executive teams figure out how to leverage data and IT in ways that will help transform those organizations as they go into the new healthcare.
Of course, one of the underlying challenges in all this is that very few senior-level healthcare IT leaders got to where they’ve gotten to, via public policy-related routes. Most CIOs started out as programmers, IT network managers, telecom managers, etc., while most CMIOs started out as clinicians in practice. Translating the nuances of federal healthcare policy mandates and directives into actual operational strategies and tactics is simply not anything that anyone learned how to do in computer science courses or in medical school.
And that gets back to the annual HIMSS Conference—both with regard to educational sessions and vendor exhibits. Things have been shifting strongly now for years, but one very noteworthy element at the annual HIMSS Conference has been what has happened in the past five or six years now, with federal healthcare officials—from the Department of Health and Human Services (HHS), the Centers for Medicare and Medicaid Services (CMS), and the Office of the National Coordinator for health IT (ONC), increasingly using the platform that the annual conference provides, to make major healthcare and healthcare IT policy announcements at the conference. Farzad Mostashari, M.D. was the first National Coordinator to really make use of the HIMSS Conference platform; Dr. Mostashari was (and still is) articulate and charismatic, and saw a real opportunity to get in front of healthcare IT leaders and focus their attention on issues of importance to him. Subsequent federal healthcare officials have followed suit, and in the past few years, conference attendees have come to expect federal healthcare officials to drop major news at HIMSS.
CMS Administrator Seema Verma didn’t disappoint last week, with her major announcement of CMS’s “MyHealthEData” initiative last Tuesday morning. Not only was that announcement important in itself; it also spoke to the triumph of policy and payment developments in the healthcare IT operational landscape in the U.S. Because however the MyHealthEData initiative plays out, Verma has signaled to American healthcare IT leaders that she wants providers to help her to empower patients/healthcare consumers with their data and patient records. And of course, that means dramatically enhanced data exchange and interoperability, among other things.
So the annual HIMSS Conference really has changed dramatically; and really, that transformation has been inevitable, when one looks at the big picture here. Put very bluntly, the purchasers (including the federal, state and private purchasers) and payers of healthcare in the U.S. have been telling providers that healthcare simply costs too much, provides too little value for the money, and lacks transparency and patient-centeredness. And, inevitably, providers and vendors are being pushed more and more directly by the purchasers and payers of healthcare in the U.S., to develop and implement the IT and data tools that can help to transform the U.S. healthcare system, as it explodes from $3.1 trillion and 18 percent of GDP right now, towards $5.631 trillion and 20-plus-percent of GDP in the next several years.
What will be fascinating, will be to see how rapidly the healthcare IT landscape evolves, over the next several years. I can tell you that that landscape will become more policy- and payment-driven than ever before. So it will be fascinating to see what HIMSS19 (in Orlando) is like, because as much as buzzwords and buzz terms like population health, care management, predictive analytics, artificial intelligence, and interoperability dominated conversations at HIMSS18, there’s no question that they will be back again next year.
Put simply, as “here” as we were this year, expect us to be even more “here” next year. And good luck and godspeed to everyone in the intervening year!