Halamka's Dispatch from HIMSS

John D. HalamkaEvery year I walk the HIMSS floor and speak at HIMSS events with the hope that I can distill the conference sensory overload into a few key themes. 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.

In the next 24 months we’ll see an accelerating evolution of fee for service into alternative payment models fueled by MACRA and MIPS. 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.

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 of 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”

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.  A few idea/products to watch

• Surescripts National Record Locator Service - a master patient index which provides pointers to the medical records of patients at every site of care.
• Commonwell - a collaboration of vendors also providing master patient index services.
• DirectTrust - creates a scalable way for trading partners to establish trust relationships without requiring bilateral participation agreements with every participant. i.e. without DirectTrust 20 trading partners would require 20x20 (400)  agreements. DirectTrust also supports a national provider directory.
• FHIR-based application program interfaces (APIs) - with APIs, provider to provider and patient-provider data exchanges are simpler to engineer and support.   Just about every EHR vendor has agreed to support FHIR APIs this year.
• Cloud-hosted services - the era of locally hosted licensed software is ending and being replaced by agile services that can be turned on and off with minimal capital investment.   As healthcare gets bigger through merger and acquisitions it will become increasingly important for affiliated organization to leverage a common pool of cloud hosted services.

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.   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

It’s time to replace compliance (fear of failure/sanction) with determination (joy of success) to make healthcare better. Although some of the innovations sound like they could increase risk (cloud/mobile/apps), in fact they are likely to reduce risk by leveraging the experience of a larger number of people outside any given institution.  

I left HIMSS this year with great optimism. Vendors, technologies, and incentives are aligned for positive change.   2016 will be a great year.