Looking for a big connection at HIMSS 2012
The lounging tourists in the gondola gazed in awe at the passing Renaissance architecture, while their gondolier sang ‘O Sole Mio’ silhouetted against an azure blue sky. The Venetian canal looked just as blue, and affluent diners at the waterside trattoria made the scene idyllic. But delightful as it seemed, the canal did not lead anywhere, the buildings were mere facades, and the blue sky only a painted ceiling.
Welcome to the Venetian-Palazzo-Sands Casino and Expo Center in Las Vegas, host to HIMSS 2012. More than 36,500 attendees and in excess of 1100 exhibitors made it a truly overwhelming experience. More than 200 education sessions in 20 parallel streams presented delegates with a near impossible dilemma of choosing which ones to attend.
In addition, there were a similar number of ‘learning events’ such as symposia, workshops, poster displays, roundtable meetings, synergy and e-sessions, specialty activities, networking and virtual sessions, the communities of profession meetings, the HIMSS Interoperability Showcase, the social media and knowledge centres, and the Intelligent Hospital Pavilion — a bewildering array of choice. On top of this, one’s senses were then assaulted by a parallel universe of the exhibition’s 1100-plus healthcare vendors and service providers.
Then there were the invitations to evening meetings, drinks receptions, informal and hosted dinners. The whole experience is best summed up by a delegate’s overhead remark around 8.00 am on day one: “Let the madness begin!”
From the start, the trend towards more and more deployments of eHealth into the community was evident. In her opening remarks, HIMSS chair Charlene Underwood foresaw a continuing and increasing growth in the demand for home care, which will be influenced by a parallel trend in demand for eHealth, telehealth and mobile health services. At the same time, Ms Underwood said, payers and funders, both private and government, will increasingly only pay for services that are evidenced on patient health outcomes.
In his keynote opening address, Twitter co-founder Biz Stone spoke of how Twitter will assist in driving remote communications, sharing and empathy between patients, and better link healthcare providers and consumers. Mr Stone believes the power of Twitter’s open, real-time information network will enable better analysis of sentiment and trends in people’s thinking. Although Twitter is still in a revolutionary stage, in time it should help to bring a greater personal responsibility to an individual’s healthcare, he said.
From Involution Studios of Arlington, Massachusetts, and with his rich experience in designing Apple software, Juhan Sonin predicted that the impact of mobile phones and devices such as the iPhone and the iPad will have a huge impact on healthcare. The revolution in design of the user interface, using touch screen technology in mobile personal devices, is closely associated with two trends, he said. Healthcare information is rapidly becoming all digital, and through EHRs and other applications, personal healthcare information is being made available on mobile devices to health consumers.
In a world containing seven billion people, where there are 5.5 billion mobile phones and a surging uptake of personal mobile devices, healthcare is being brought to the patient anywhere and anytime. A migration has begun from the traditional episodic-based healthcare to continuous care.
Mobile health, or mHealth, is aligned with the need to move more healthcare to the community, and preventative health. Health software systems must be re-engineered for the new mobile technology, and the challenge is to bring health data to the consumer, where the population is increasingly experienced in using mobile devices. Following that is the need to use mobile technology with personal EHRs and new software applications to make faster and more accurate healthcare decisions.
The HIMSS Social Media Centre was an even larger drawcard than last year, providing education sessions, panel discussions with leading clinicians and healthcare IT bloggers, social media specialists, Internet kiosks, an attendees’ lounge, and large screens featuring conference highlights via Twitter. To visit the Social Media Centre was to see not only the conference learning and networking, but even how healthcare communications worldwide have jumped into instant and new dimensions.
Just one panel discussion at the centre, involving clinicians who participate in social media, provides a small taste of the challenging questions and thoughts:
- Hospitals and their management do not have social media policies, and do not yet understand social media
- What are the consequences for medical advice using social media being inappropriate, and the risk of legal action?
- Social media is not suitable for direct doctor-patient consultation, more for moderated advice and generic education
- Social media is extending networks of like-minded communities, and is a mimic of real life
If social media is indeed a mimic of real life, then perhaps within it there is a potential to enhance healthcare for everyone, anywhere and any time.
IBM's Watson, a natural language processing technology, made a big splash in the US when it beat all human contestants on the TV game show Jeopardy. Now, the ‘Dr Watson’ initiative, a collaboration between Nuance Communications, WellPoint and IBM, heralds a transformation in medicine and healthcare which will bring a cultural shift for clinicians.
No longer will there be a dependency on the knowledge in a doctor’s head, Nuance’s Dr Nick van Terheyden claimed. Dr Watson’s approach will introduce an accelerating move to computer-aided diagnosis and treatment, which will bring fundamental change over time to the philosophies and regimens of education and training in nursing and medical schools.
Dr Watson combines the power of a super computer with the artificial intelligence of an evidence-based medical decision support system. A ‘Deep Q&A’ approach is used, which analyses, interprets and understands not only structured and unstructured data, but also natural language questions. Dr Watson can sift through a staggering 200 million pages in just three seconds.
However, as no clinical trials have been conducted, Dr Watson’s immense potential remains an untested hypothesis. Questions surrounding easy clinical access, commercial feasibility and cost at the point-of-care also remain for the future.
Under the US government’s $24 billion program for ‘meaningful use’ of electronic medical records, more than $3 billion had been paid out by the end of 2011 to healthcare providers for compliance in stage 1 of the program.
Farzad Mostashari, the US federal national coordinator for health IT, spoke of how, with the increasing introduction of EMRs and EHRs, the sharing of information becomes transformational. Primary care physicians are beginning to realise that health records do not belong to them but to the patients, he said. As more and more patients ask complex questions about their condition, they surely have a right to access their EHR.
The meaningful use program includes objectives such as the improvement of quality, efficiency and patient outcomes in healthcare. As an indication of the program’s scope and reach, 130,000 primary care providers are involved, and 90 per cent of pharmacies are now able to receive ePrescriptions.
In a presentation on adverse medical events reporting and the progress of US patient safety organisations, Stephen Earle, a project consultant at LifeSpan and HIMSS fellow, reported that only 14 per cent of adverse events in healthcare are reported. “How can we learn from our mistakes, if we won’t share our experiences?” he asked.
The To Err is Human report, published by the US Institute of Medicine in 1999, made a huge impact when it found that there were approximately 98,000 preventable deaths estimated to be occurring in the country’s healthcare system each year. It seems that was but the tip of the iceberg, with the report’s authors now believing that estimate was understated by a factor of 10. Supporting their view is that of all the autopsies performed in the US, which are a very small fraction of all deaths, five per cent of those autopsies reveal a fatal diagnostic error.
“The single greatest impediment to the reduction of errors is that we punish people for making mistakes,” Mr Earle said. He argued that people fear the ‘whistleblower’ syndrome and are resistant to reporting adverse events. The culture must change to focus on improving the process.
It is estimated that a person’s health and life expectancy is derived on average by only 20 per cent from hereditary genes. In his book Blue Zones, a National Geographic study of a number of communities around the world with the highest life expectancies, Dan Buettner spoke of common factors which had been identified as contributory to people’s health and longevity.
The essence of these factors relate to well-recognised lifestyle practices such as regular low-intensity exercise, work and a purpose in life, reducing stress, not retiring completely and always doing some form of work, eating wisely by favouring a plant-based diet including beans and nuts, maintaining relationships with family and loved ones, and connecting with a community.
Mr Buettner’s message emphasised that the future for healthcare must be based more and more in the community, and be focused on monitoring and preventative measures in self care by the consumer.
HIMSS 2012 was an energising marketplace of practitioners’ learnings, vendors’ promises, new ideas and displays of innovative software, wrapped up by future forecasts for healthcare information systems management and technology. The bottom-line question is, where should you bet your money?
One theme does seem to predominate. The surging growth of mobile personal devices and social media in mHealth looks to be unstoppable. It must surely carry healthcare faster into the community and drive health prevention technologies into the hands of the individual. Not surprisingly, the significant role played by mHealth at HIMSS 2012 will move on to the fourth HIMSS mHealth Summit in Washington later this year.
Existing healthcare systems face an imminent future of re-engineering or replacement to integrate with the needs and technology of mHealth. Health ICT must build the connections to smartphones, iPhones, iPads, tablets and the like. How is it to be done? Which technology, which vendor product, what software design, and which device? What healthcare processes must change? Who will pay?
Somewhere at HIMSS 2012 were the answers to those questions, among sellers and buyers who will be winners and drive the future. But beware: sometimes blue sky is just a painted ceiling. Like the gamblers in the Venetian Casino, all you can do is roll the dice and make your call. The roulette wheel is spinning, so make your selections carefully.
About the author
Director, JEMS Consulting
Bryn Evans is a management consultant, with many years’ experience as a CIO in healthcare, and as chief executive of a clinical software supplier. He writes extensively across a range of categories and genres, notably in the areas of management, information technology, sport, travel, history and fiction.
Posted in Australian eHealth