HIMSS14 Onward with MU, ICD-10, Interoperability, Patient Engagement & More

More than 38,000 people attended the 2014 Health Information and Management Systems Society annual conference in Orlando, making it the largest the organization has held to date. More than 60,000 Tweets were sent and more than 1,200 vendors exhibited their products and services in the exhibit hall.

Federal mandates

The biggest news of the conference for most attendees was word that, while the compliance dates for Meaningful Use Stage 2 and ICD-10 will not be delayed, some hospitals and providers may be eligible for a hardship exemption for Stage 2.

Centers for Medicare & Medicaid Services (CMS) Administrator Marilynn Tavenner said she has spent the last four years on health IT and, in a nod to healthcare.gov woes, “learned about projects that take more time, cost more money and need more resources. I am sympathetic to that.”

However, the true cost of healthcare can’t be understood until people have access to the system and those who need more assistance are identified so CMS can drive its resources appropriately, she said. The work already completed is starting to yield significant results. National healthcare expenditure is at an all-time low, she noted, and outcomes are improving with fewer adverse events and reduced 30-day hospital readmission rates, among other encouraging trends.

A panel comprised of three former national coordinators of health IT and current coordinator, Karen DeSalvo, MD, MPH, MSc, discussed the decade of health IT activity since the original Office of the National Coordinator for Health IT (ONC) was established.

“Success is not measured by how many billions are spent on health IT,” said Farzad Mostashari, MD, MSc. The app world has spent a total of $8 billion, he said, which is one-fifth of what we spend on health IT in one year and apps “have arguably had a much bigger impact on everyday life and experience.”

DeSalvo said she is interested in seeing how consumer drivers will force providers to adopt health IT in ways that are more accessible. “Patients are going to start to demand this in a way we haven’t experienced before.”

When asked what role government should play in overseeing health IT, DeSalvo said the government has a role, responsibility and opportunity. “We’re accountable to every American in a way no hospital, provider or vendor is.” She noted the need to “correctly set the dial so we’re regulating just enough. We need to protect issues around privacy and security but not have so much regulation that we squash innovation.”

Looking ahead, David Brailer, MD, PhD, predicted that “a defining trend over the next decade is going to be consumer unrest over healthcare.”

An audience member asked the panel how to ensure data exchange is accurate and complete but waiting for that is “absolutely the wrong answer,” said Mostashari. “We get data accurate by sharing. Once you start exposing your data to other people, the quality is exposed. How do you get accuracy? Share it. Some information is better than no information. Just start sharing.”

ONC’s Town Hall meeting offered information on how the office is working to advance the national health IT agenda. The leadership panel announced the new eHealth University, “a one-stop shop to access databases and information providers can use to help them implement ehealth initiatives,” said Robert Tagalicod, director of the CMS’ Office of eHealth Standards and Services. This new offering features modules that include videos, fact sheets, checklists, guides and webinars to help providers use electronic standards and adopt health IT.

Tagalicod specifically referred to Meaningful Use (MU) requirements and the looming ICD-10 implementation date. “We truly know the demands [on providers],” he said. “We will be developing resources throughout the year to help providers meet these milestones.”

This is the year, Tagalicod said, that MU Stage 2 makes healthcare more patient centered. “We encourage providers to give patients access to their health information and provide tools to electronically communicate because that is the key to improving outcomes and care coordination.”

ONC and CMS are working to improve their efficiency much like the rest of healthcare. Kate Goodrich, MD, director of the CMS Quality Measurement and Health Assessment Group, said her team has been doing Lean culture change. One hundred percent of the measures in MU Stage 2 had defects, she acknowledged, so they hope to dramatically improve going forward. “We’ve been trying to develop measurements that are meaningful to patients and providers.”

CMS has a task force working on it and she said the agency is much closer to alignment of quality measures but has much more work to do to align policies and submission of data. “The goal is for providers reporting once and receiving credit for all programs. We are getting closer to that but there is more work to do and we cannot do it ourselves. We need input from all of you to realize the ideal state of reporting once.” 

Keynote speakers

Mark T. Bertolini, chairman, CEO and president of Aetna, advocated for better care for the chronically ill and increased spending on wellness during his keynote address.

The industry engages in $800 billion of wasteful spending per year, he said, citing a 2009 study. “This should be the focus of our efforts, our policy decisions, our solutions, our IT—how to get to this waste. Our systems are not functioning right.”

Tackling the epidemic of chronic disease means offering relevant, simple tools for the chronically ill to enable them to better manage their health, he said. “The system needs to change its focus on individuals so the hospitals and health systems can make them better. They need to be connected to technology.”

The time demands of federal mandates such as ICD-10 and Meaningful Use “drive my innovation push,” said Lyle Berkowitz, MD, associate CMIO of Northwestern Medicine, who opened the Innovation Symposium.

“We don’t have a shortage of physicians, we simply have a shortage of using them efficiently. Rather than making healthcare more efficient, technology is slowing people down,” he said. 

Innovation can be big or small, complex or simple, Berkowitz said. “The important thing is how big an impact it has on the problem you’re facing.”

Innovation requires a different way of thinking, he said. Innovators must learn and build up. They also should fail early, fail often and fail cheaply. In other words, innovators should take risks early on when there is little at risk.  

“Embrace innovative thinking. Explore new processes and tools. Take a safari outside of healthcare and look at what’s being done,” Berkowitz told his audience.

Speaking of other industries, healthcare can learn a lot from the customer-centric philosophy of Amazon, said Ed Park, COO of athenahealth. Amazon architected itself for collaboration from the get go. “What if we put the patient at the center of that kind of collaboration?” Park asked. The idea was unheard of a few years ago but recently, several consortiums and alliances have popped up focused on patient centeredness and interoperability.    

“This is a call for action,” Park said. “You are an enormously influential group. How you spend your money and time will determine whether we will see innovation the same as in Silicon Valley or doomed to another 10 years of stalled progress. Start with the patient at the center of care. They need it, we need it and maybe it will make a difference.”