Even the exhibit hall was calmer with vendors focused on solving specific problems instead of the latest buzzword

Frankly, I was dreading attending HIMSS this year. I’ve grown tired of the hype, the noise and just how little we have accomplished as an industry in the past few years. We have not contained costs, but have increased clinician burnout. We have made only a modest impact on quality, but the lack of interoperability has hampered care coordination. I had become increasingly cynical every year as we approached the big event, dreading more of the same, which is never a good thing.

Yet at the outset, while waiting to board my flight to Orlando, I started meeting many a compatriot in healthcare IT. This did not stop until I landed back in Boston five days later. Those brief meetings always included a hug, checking in with how each other is doing personally and then proceeding to talk about the industry – in that order. I have worked in a wide range of industries over the course of my career, only in healthcare have I experienced such genuine warmth and caring. These brief encounters renew my spirit pushing that cynicism back for this industry is more than just a business, it is about health, and it is about life.

HIMSS’19 Reflections

For the last eleven HIMSS conferences I have attended, there has always been one buzzword or acronym that virtually all vendors on the exhibit floor would latch onto, whether they could deliver those capabilities or not. There was no such word or acronym this year. The hype, the buzz may be behind us, which is welcomed by this analyst and I’m sure most in attendance.

I also noticed that conversations were less about whiz-bang features. Instead, conversations focused on specific problems that can be solved and value delivered to an organization. The industry is quickly moving beyond being strictly regulatory-driven (albeit CMS’s NPRM dropped Monday at HIMSS goes against that) to a more pragmatic market, which is a healthy sign of a maturing industry.

It was clear this year that the EHR war for buyers is over. Those EHR vendors offering a fairly limited, EHR-centric product with few extensions (e.g. analytics, RCM, PHM, etc.) were eerily quiet. EHR vendors with broad capabilities had their fair share of visitors, but the discussions focused on the extension apps and equally important, how to extract value from those significant EHR investments.

In speaking to one of the largest EHR vendors, they were surprised by the interest in PHM among their clients, which has been tepid in recent years. Clearly, CMS’s recent moves to get provider organizations to get serious and start taking on downside risk are being felt. But this vendor went on to say that most prospects simply want someone to tell them what to do to be successful. For companies like Aledade and Evolent this must sound like mana from heaven.

Some quick outtakes from HIMSS’19

• Acute and ambulatory have been by and large taken care of, yet we still do a very poor job as an industry addressing the “community of health.” Good opportunity for a truly visual, intuitive platform.
• Ada Health, a Berlin-based small company using AI for self-triage is just entering the US market and has landed Sutter Health as its lighthouse customer. Keep an eye on them – they are interesting.
• Significant shift among provider-centric vendors who are now signing large deals with payers. Still plenty of mistrust between providers and payers, but if incentives are aligned – it can work.
• Collective Medical out of Utah has been operating in stealth mode and racked up several payer and provider clients. Compelling value-prop but they will have to move fast as several much larger vendors are looking to do something similar.
• Many a large health IT vendor does a poor job at data aggregation and digestion (normalization) and are seeking partnerships with a number of small innovative companies that focus on this problem.
• Apervita, a company that has been around for several years with a business model I never was fond of has completely changed direction. I like what I saw at HIMSS this year. Their work with NCQA is pretty impressive.

The Wrap

HIMSS this year reflects a maturing market. With any maturing market, conferences like HIMSS begin to lose their luster, despite their own self-promotional hype. But what HIMSS does well is to bring together a broad cross-section of the industry and remains a fabulous place to reconnect and network. Does it need to be three and a half days (plus!), I do not believe so. In five years, HIMSS will still be here, but the high water mark was likely last year (barring any major federal incentives a la HITECH). The tide is going out.

Next week, most of the healthcare IT industry will descend on Orlando to attend HIMSS’19. This is my 12th year attending HIMSS, an event for me that is more about networking and confirming assumptions than actually learning anything new.

For years now, HIMSS and the multitude of vendors exhibiting there have feasted at the trough of federal largesse ($35B plus), via the HITECH Act passed in 2008 to foster adoption of EHRs. The HITECH Act was successful, driving EHR adoption from the low teens to over 90% today. Though some may question the value of that investment, I personally believe that over time (another 7-10 years) we will reap benefits that far exceed that initial investment.

However, now that we’ve reached that level of adoption, the market has plateaued. Sure, there were hopes of a robust EHR replacement market, but that never materialized. Then there was the hope for huge gains (profits) to be made on the shift from volume to value through the sale of PHM solution suites. That didn’t pan out too well either as the fate of the ACA was left in the lurch with a change in administrations. Also, quite frankly, PHM is a complex sell, requiring significant change management that few healthcare organizations were ready to commit to and few vendors had the services to support.

The provider health IT market is going through a significant transition and it’s not going to be pretty. Clearly, the party is over and one has to wonder: Why does HIMSS continue to exist? Why are all these vendors here? Are we on the Titanic, seemingly blind to the economic icebergs that surround us?

But I digress.

What is important is that the EHR has become the central nervous system to provider organizations. Secondly, this market will continue to consolidate rapidly with few independent EHRs surviving the shakeout. Those left standing will attempt a number of different strategies to drive continued growth in a plateauing market.

• Acquire other EHR vendors to gain market share (Allscripts, Cerner, CPSI, Harris)
• All major EHR vendors are pursuing an extension strategy moving from EHR to supporting PHM, RCM, analytics, etc, though their capabilities in these adjacent areas vary wildly.
• Expansion into new markets. Epic is looking to dentistry and insurance. Allscripts, life sciences and payers with Veradigm. Cerner, government and payers. All large acute/ambulatory EHR vendors are actively pursuing overseas markets, with Meditech particularly strong in Canada.

It remains to be seen how successful these strategies will be but rest assured, even if successful, no EHR vendor is completely safe from a future acquisition.

This sets the stage for what to expect at HIMSS’19:

• All vendors will continue to tout the momentum they have in the market as if this market will remain forever on a hockey stick trajectory, but very few can back it up.
• AI/ML will be just as pervasive this year as last, permeating all aspects of health IT, but likely very little demonstrable proof of scale.
• A multitude of disease-specific, chronic management solutions but no vendor with a true portfolio of best-in-class solutions on a single platform. Resmed appears close to enabling such a platform for respiratory ailments.
• More FHIR use cases.
• Plenty of patient-centric this, consumer-centric that but all a head fake as it is really about capturing patient revenue via online bill pay and filling vacant appointment slots.

And what I hope to find at HIMSS’19:

• An AI/ML company that has truly scaled its solution across an enterprise in at least two customer deployments.
• Clear metrics from EHR vendors on the level of adoption and use of FHIR across their client base.
• An engagement solution that is looking beyond the near-term volume/revenue needs of a healthcare organization to how to truly engage patients/consumers in their health e.g. Aetna/Apple’s Attain app.
• How vendors are assisting their customers in achieving demonstrable, defendable ROI from their solutions. Health Catalyst stands out here.

May your trip to HIMSS’19 be a success, however you define it. And if you see us in the halls, do not hesitate to stop and say hello – maybe we’ll have a few quick on-the-fly notes to share.