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The Return of HIMSS: Is Inertia Enough?

by Chilmark Team | March 25, 2022

Views from the Conference Floor

By: John and the Chilmark Team

In my previous post, I questioned whether HIMSS would rise above its sheer inertia to thwart the ViVE challenge. Sadly, no: inertia keeps HIMSS very much in the game as the best event for provider health IT. But that is about it. HIMSS22 did not branch out to address the healthcare ecosystem, from payers to providers to life sciences and employers. That lack of vision will, over time, lead to HIMSS’s decreasing relevance.

But that is far from saying HIMSS is on the way out. Contrary to rumors, HIMSS22 was very much alive and well, albeit dated and stale. HIMSS today is a conference I can see my father attending. ViVE, on the other hand, an event designed for my son’s demographic. Of the two, I’d rather hang out with my son, as it’s far more fun and engaging.

Regardless, HIMSS remains the premier health IT trade show with its strong vendor focus. It is the place where we, the healthcare Technorati, gather. Therefore, it is a wonderful event for those of us in this industry to meet, share notes and just catch up with one another. As this was my first HIMSS since 2019, it sure was sweet to see so many friends and colleagues all in one place, something I heard echoed by just about everyone I met.

We sent the entire Chilmark Research team down to HIMSS to get the latest read on what is happening in the provider health IT world. Following are our key takeaways:

The workforce issue among all providers is very real. For the next 18 months or more, retention and recruitment of clinical staff is the top priority. This issue will reverberate across the industry and have direct impact on IT adoption and new business models, e.g., value-based care.

Slim margins across provider organizations coupled with workforce challenges are leading most vendors to pursue other market opportunities in payer and life sciences sectors.

Provider pull-back on telehealth is simply a result of poor reimbursement models and change management challenges – basically the risk is not worth the reward in fee-for-service models of care.

AI/ML is hot, but far more smoke than fire from the vendors coupled with very immature deployments by health systems. A chief problem today is that AI/ML tools are being adopted with little thought as to how to evaluate efficacy, understand what bias may be present in the data, or understand the concept of drift in these algorithms.

On to the Show

While HIMSS is a trade show for vendors to show their latest and greatest, it is also an excellent opportunity to meet with a broad cross section of executives from provider organizations. When I would ask these executives what their most pressing issue was, the answer was universal – clinician retention and recruitment. This issue has been building for some time, but two years of a pandemic has pushed it over the edge and into crisis mode.

This issue will reverberate across this sector, but initial impact today can be boiled down to two thematic buckets.

  1. Don’t mess with workflow. Case in point: Many healthcare organizations are pulling back on their nascent value-based care initiatives – which require significant changes in workflow – and returning to tried and true fee-for-service.
  2. Ease the clinician burden. Anything one can do to simplify a clinician’s workload is welcomed. Workflow optimization, robotic process automation (RPA), patient self-service and similar solutions will be sought out.

Big Picture Impressions

With the entire team at #HIMSS22, we all had our unique perspectives and lens to look through. Following are a random collection of these impressions from the Chilmark team.

Without a doubt, most topics were inclusive of multiple gaps in healthcare that COVID has been uncloaking.

SDoH was mentioned repeatedly but saw very little actual progress in integrating community services into the care delivery workflow since the term first started being buzzy around 2018.

Beyond the usual AIML fanfare, the biggest issue was the spotlight on bias and how prevalent it is in many of the models (not always AI) used for everything from risk stratification to clinical decision support.

It was hard to deny feeling swept up in the excitement of an in-person event.

Interoperability was the talk of the town this trip. Everyone was speaking to this in some regard, since data-driven care delivery was such a focus this year and TEFCA just went into effect.

Impressions of Hospital-at-Home – Elena

COVID has been a forcing factor for many changes in how healthcare is delivered. Virtual care models were de rigueur at HIMSS this year. Hospital-at-Home is a subsector of the entire virtual care domain.

Many vendors claim to have complete home care solutions, but note (with a degree of sadness) that there is a wide range of solution packages, ranging from “almost there” to “don’t shoot the piano player, he’s doing the best that he can”. Part of this may simply be the immaturity of the market, as roadblocks to these solutions have been prevalent for years. Primary among them is the obvious struggle with payment models, followed by secondary issues of provider engagement, process change, what is the ideal consumer/patient model, etc. It is unlikely any of these issues will be resolved in the near term, though there are glimmers of hope from those innovative health systems that are pushing the envelope.

Talking with Dina gave me an understanding of how troubling it can be to build a comprehensive ecosystem of home care that is inclusive of medical and non-medical needs of a patient. Meeting with virtual care vendor eVisit showed just how challenging scheduling and provider access can be for remote patients.

From a device centric approach, BioIntelliSense is looking to tackle the market with a very small, compact device that measures a host of vital signs. The device, about the size of 2-3 stacked half-dollar coins, is hospital grade, FDA approved, and can be used to monitor a patient from acute care through the transition to home care monitoring. Current Health, which was recently acquired by Best Buy, had a number of their devices on display that Best Buy will package, deliver and set up in the home – like the Geek Squad for health. Best Buy remains cagey on exactly how they intend to serve this market, e.g., B2C or B2B2C. As with most things in this young market, time will tell.

We also met with Philips to get a sense of their Hospital-at-Home strategy. It appears that Philips is taking a measured, cautionary approach to this market opportunity, likely waiting to see greater maturity. The company did acquire BioTelemetry in 2021, a company focusing on cardiac care. In the near term, Philips will lead with BioTelemetry for its Hospital-at-Home offering.

AIML Remains a Top Buzzword/Acronym – Jody

The biggest issue was the spotlight on bias and how prevalent it is in many of the models (not always AI) used for everything from risk stratification to clinical decision support. The NEJM in July 2020 highlighted the prevalence of racial bias in many contemporary clinical decision support tools. Dr. Tania Martin-Mercado gave an excellent presentation at HIMSS of just the algorithms in 2022 she has come across with substantial race or gender-based bias. The industry clearly has a long way to go to address the problem. In my mind, if we are going to talk about health equity in an algorithmically driven age, this was the issue of the day, if not the year.

Despite the challenges of biases in the data, there is a lot of passion around health equity across many vendors. Some AI vendors have integrated health equity measures into their analytics in a compelling way (Althea.ai). Optum, after a major snafu with one AI model that inadvertently discriminated against African-American patients, has been making the call for AI and health equity along with Mayo Clinic’s platform that John Halamka leads. Arcadia has an impressive amount of experience with bias mitigation that can contribute to health equity as well.

Robotic process automation (RPA) vendors were everywhere and due to those staffing constraints in healthcare, appeared quite busy at HIMSS. We met with a number of RPA vendors including Notable, Akasa, UI Path, GAVS Technologies, and Element Blue. VC favorite, Olive, had a major presence at HIMSS and was the focus of a great deal of discussion, particularly from competitors.

There is a lot of conceptual confusion in the RPA market that requires a closer look to map the territory and apply some definitional attributes to what is AIML-based or not, the use cases addressed, and the need for a modicum of common performance standards. Better understanding of error rates and governance structures for when things go wrong with RPA remain vague or nonexistent.

A Few Breadcrumbs from the Exhibit Floor

It is difficult to cover everything that occurs at a given HIMSS conference, let alone encapsulate all the notes we took during our countless meetings. Below is a curated collection of #HIMSS22 “breadcrumbs” that are notable.

MEDITECH and Google announced an extension of their partnership to layer in Google’s Care Studio to simplify a clinician’s search for pertinent patient data. Is this part of a broader trend at MEDITECH to turn them from a distant innovation follower into a leader?

Interop vendor Lyniate announced the acquisition of MPI vendor NextGate, a very nice strategic tuck-in. Though the question remains: Is this enough to thwart the onslaught of a slew of new interop solutions that seem to be arriving in the market daily?

Epic is blowing the doors off with its Cosmos platform which now has some 140M patients’ longitudinal records representing over 2.2B encounters. Epic could really change the dynamics in the RWD/RWE market for life sciences research and trials recruitment, eliminating the need for your traditional CRO.

Symplr has been highly acquisitive, rolling up solutions left and right to provide a comprehensive suite of solutions that wrap around the EHR. While this strategy does give a health system “one throat to choke,” how they might knit these solutions together with common UI is not for the faint of heart.

Cerner’s booth seemed quite active, but I wonder how many of their discussions were differently phrased versions of “what will happen once the Oracle acquisition goes through?” Not an easy question to answer. I also found it curious that Cerner announced an expansion of their partnership with Nuance, when Oracle stated in their call announcing the acquisition that they have their own voice digital assistant that they intend to take to market with Cerner. Makes me wonder if Oracle’s solution is far from ready for clinicians.

Lastly there is the new, native cloud database darling Snowflake. Towards the end of HIMSS, Snowflake announced its Healthcare & Life Science Data Cloud. This new solution folds in strong data consent and governance capabilities. Snowflake’s “Data Cleanroom” is particularly interesting, allowing two entities and their data stores to share attributes of the data (blind, secure joins) without actually sharing PHI. Believe this company has a lot of runway to work with in this industry and has already gained significant traction.

I’m quite sure I missed a few other notable announcements, but the above is certainly enough to chew on. We, the Chilmark Research team, will continue to track these developments and others going forward. If there is something we truly missed, please let us know in your comment(s) below.

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