What people at HIMSS were afraid to say

One image of HIMSS that will not escape my mind is the movie Capricorn One—one of OJ’s non-slasher films.  For those who have not seen it, the movie centers on the first manned trip to Mars.  A NASA Mars mission won’t work, and its funding is endangered, so feds decide to fake it just this once. But then they have to keep the secret…

The astronauts are pulled off the ship just before launch by shadowy government types and whisked off to a film studio in the desert.  The space vehicle has a major defect which NASA just daren’t admit. At the studio, over a course of months, the astronauts are forced to act out the journey and the landing to trick the world into believing they have made the trip.

Upon the return trip to Earth, the empty spacecraft unexpectedly burns up due to a faulty heat shield during reentry. The captive astronauts realize that officials can never release them as it would expose the government’s elaborate hoax.

I think much of what I saw at the show was healthcare’s version of Capricorn One.  Nothing deliberately misleading, or meant as a cover-up or a hoax.  Rather more like highlighting a single grain of sand and trying to get others to believe the grain of sand in an entire beach.

The sets for interoperability and HIEs served as the Martian landscape, minus any red dust.  There was a wall behind the stage from where the presentation interoperability was shown.  I was tempted to sneak behind it to see if I could find the Wizard, the one pulling all the nobs and using the smoke and mirrors to such great effect.  It was an attempt to make believers, to make people believe the national healthcare network is coming together, to make us believe it is working today and that it is coming soon to a theater near you.

After all, it must be real; we saw it.  People wearing hats and shirts emblazoned with interoperability were telling us this was so, and they would not lie to you.

The big-wigs, and former big-wigs—kudos to Dr. B. for all his hard work—were at the show for everyone to see, and to add a smidgen of credibility to the message.  They would not say this was going to happen if it were not—Toto, say this ain’t true.

The public relations were perfect, a little too perfect if you asked me.  Everyone was on message.  If you live in Oz and go to bed tonight believing all is right with the world, stop reading now.  If what you wanted from HIMSS was a warm and fuzzy feeling that everything is under control and that someone really has a plan to make everything work you probably loved it.

Here is the truth as this reporter saw it.  This is not for the squeamish, and some of it may be offensive to children under thirteen or C-suiters over forty.  In the general sessions nobody dared speak to the fact that:

  • Most large EHR implementations are failing.
  • Meaningful Use isn’t, and most hospitals will fail to meet it.
  • Hospital productivity is falling faster than are the Cubs chances of winning a pennant.
  • Most hospitals changed their business model to chase the check
  • Most providers will not see a nickel of the ARRA money—the check is not in the mail and it may never be.

The future as they see it is not here, and may never be, at least until someone comes up with a viable plan.  Indeed, CMS and the ONC have altered the future, but it ain’t what it used to be.  People speak to the need to disrupt healthcare.  Disrupt it is exactly what they have done.  The question is what will it cost to undo the disruption once reason reenters the equation?  What then is the future for many hospitals?

  • Hospitals on the whole will lose more much more money due to failing to be ready for ICD-10 than they will ever have seen through the ARRA lottery.
  • It make take years to recover the productivity loses from EHR and the recoup those revenues.
  • Hospitals spending money to design their systems to tie them into the mythical HIE/N-HIN beast will spend millions redesigning them to adapt to the real interconnect solution.
  • The real interconnect solution will be built bottom-up, from patients and their primary care physicians.
  • Standardized EMRs will reside in the cloud and patients will use the next generation of smart devices.  And like it or not, the winners will be Apple, Google, and Microsoft, not the ONC and CMS.  Why?  Because that is who real people go to to buy technology and applications.  A doctor still does not know which EHR to buy or how to make it work.  Give that same doctor a chance to buy a solution on a device like an iPad and the line of customers will circle the block.

And when doctors are not seeing patients they can use the device to listen to Celine Dion.  This goes to show you there are flaws with every idea, even some of mine.


7 thoughts on “What people at HIMSS were afraid to say

  1. Interesting point of view and not without some merit. The thing that most large EHR implementations forget that the point of the whole exercise is to transform care delivery and meaningful use is simply supposed to be an indication (however imperfect) of that transformation. I don’t think most large EHR implementations are failing at all, their misdirection on the details of Meaningful Use instead of their intent to use meaningfully is the failure, and we all, from ONC on down share in that.

    I don’t believe that any hospital goes through the pain and suffering of implementing an EHR simply for ARRA dollars. That’s supposed to sweeten the pot a bit by giving them an economic incentive to do the right thing. Sure, it will be expensive for all concerned to move this forward together, but all businesses have costs and more and more have IT costs. Medicine isn’t just about stethoscopes any more. The message is that you’re going to have to do it, with or without ‘our’ help. What is the ROI for doing the right thing?

    Physicians’ offices are a different question and if we had more decent IHEs, the positive effects of them would provide excellent incentive for adopting EHRs (especially in a capitated environment), unless one is really more interested in over-ordering, duplicate-ordering, and admitting patients into hospitals when it is not really necessary. I think until we get past self-interest our chances of improving the abysmal care we so often give or decreasing its ruinous cost are infinitesimal. The current Congress shows us what happens when self-interest reigns over social interest.

    As to your visions of the future, I agree, disagree, and haven’t a clue, not necessarily in that order.


    • Well said. I am still trying to sort out how much of what I wrote I agree with. What I am convinced of is that much of what is coming out of DC will change, be delayed, or fail and providers ought not lock themselves into said strategy to such an extent that they lose themselves.


  2. Neil very thought provocative. Here are some of mine (I tend to only discuss points that might be different since that is more interesting)

    HEALTH IT DIVIDE – I think what is far more likely to happen is that there will be a divide between providers in small practices and those in ones that are large enough to have an IT dept or be affiliated with a hospital that provides the EHR for them. The largest EHR vendor in the US is privately held Epic claims that 1 in 4 providers will be on their system at the end of their current role out in large health care systems.
    Although I am aware of only one that slowed down (Sutter) I am not aware of anyone removing or rolling it back once implemented. In Seattle every large hospital has or is about to implement and EHR (Cerner and Epic) and many of the large clinic systems (Polyclinic) are buying into local hospitals EHR’s. The laggards are the smaller practices but over 1000 doc’s have signed up via the local REC so I am not sure where you are getting your data or if Seattle is unique?

    TOOLS NOT GOAL – if you fail to change your workflows an EHR is nothing more then an electric pencil but when done right it is a critical component in improving quality and safety although it probably won’t reduce costs to the practice it will to the healthcare system. That is one reason that places like the VA, Kaiser, etc have already gone live – their EHR investment combined with workflow redesign results in costs savings by reducing hospital stays (Group Health study) etc but as an integrated system they are able to capture the savings.

    HEALTH CARE IS A BUSINESS FIRST – people often seem surprised that a business would go after money that is being “given away” or try to maximize their profits. If there isn’t an ROI for an EHR very few will implement it. The missing factor isn’t the capital investment it is how do you capture the shared savings going forward from the existing payers if you do everything right? Full meaningful use.

    ANALYTICS vs CAPTURE – Neither Google nor Microsoft have anything that captures information at the point of care actually. I imagine the model that Microsoft is using is that of a toll booth on the freeway offramp but someone still needs to get the data into the system. Given that 1 in 4 doc’s will have just invested in one non cloud based EHR I doubt they will rip it out anytime soon. The VA has the highest outcomes at the lowest cost of any provider system in the US and they use a constantly updated but 20 year old MUMPS based system. BTW 1 in 3 medical students does some of their training on this system.

    GAMECHANGER – although it could be argued that meaningful use is a government project it is in fact a “payer” project since over 50% of all health care in his country is paid for by the government (state Federal employees, school teachers etc) What has changed is that the vendors are no longer catering to each hospital or doctor but to the people who are paying for the services.

    Any thoughts or feedback? (this is of course just a brief summary and not meant to be comprehensive) http://paper.li/cascadia/ehealth-leaders


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