HIMSS18 – A Cacophony, Not Yet a Symphony

My post before HIMSS talked about how jazzed (not jaded) I was to be attending my 20th HIMSS conference. Now that HIMSS18 is in the bag – what did I learn?

ML and AI

On Monday I presented the results of our AI survey at the Machine Learning & AI for Healthcare preconference event at the Wynn. Although there were a few hundred seats, the event sold out weeks in advance. A number of folks I knew who planned to buy a ticket at the door were shut out. So that’s a lesson – when it comes to attending hot topics, don’t procrastinate!

Keynote speaker Lynda Chin from the University of Texas compared using of AI to having a paralegal on your team – it’s someone intelligent that could pull resources together to help you make better decisions. She summed it up simply: “Machines serving humans, not humans serving machines.”

Many other speakers came from large health systems and spoke to important use cases:

  • Kaiser Permanente: Colorectal cancer detection 1-2 years earlier with AI.
  • UPMC: Game-changing pediatric readmissions prediction.
  • Duke Institute for Health Innovation: Implementation of AI with thousands of input features.
  • Stanford Health Care: Working with “small” vs “big” data.
  • Brigham & Women’s: Costs of short-time cancellations vs no-shows.

It’s become a given that these leaders and their vendors use AI and use it well. My favorite from the above examples was Srinivasan Suresh, CMIO at Children’s Hospital of Pittsburgh of UPMC. His slide highlighted that, although he had no impressive AI or ML credentials, he was still able to use these kinds of tools successfully to predict pediatric readmissions due to seizures, asthma, and pneumonia, which led to more effective interventions.

HIMSS and health IT may be more of a cacophony than a symphony, but I’m glad to be in the orchestra.

Keynotes

AI and the cloud were key themes this year and have become mainstream topics. For our views on Eric Schmidt’s keynote about data, analytics, and AI, see our earlier HIMSS18 recap blog.

Glad I had teammates that made it into Seema Verma’s CMS keynote the next day – her announcement about patient data access, open APIs, and Blue Button 2.0 was welcome. You may recall the previous year, given the change of administration, there was little that CMS or ONC could say about anything. Although we’re seeing some progress, it doesn’t seem substantial enough to move the needle on value-based care.

Natural Language Processing (NLP)

A big part of my week was meeting with NLP vendors. Chilmark Research is close to releasing our major report on this topic, and it was great to get insights from more than a dozen vendors. Some of the smaller ones are highly focused on specific use cases (Health Fidelity and Talix on risk stratification; Clinithink on matching patients to clinical trials). 3M and its partnership with Alphabet’s Verily are a powerful combination on determining the “dominoes” of costs and care. Also of note: M*Modal’s virtual provider assistant and use of ambient devices, as well as Nuance’s partnership with Epic to add more conversational AI functionality. We are seeing voice assistant success paving the way to virtual scribes – those that can “whisper” in the physician’s ear will be most valuable to ensure that decision support is not bypassed by passive systems.

Interoperability

As John Moore posted in his earlier HIMSS18 recap, it’s sad (well, infuriating) that we still have to address interoperability. I attended two events held by the Strategic Health Information Exchange Collaborative (SHIEC), which has been successful in providing a rallying point for 60 HIEs and 40 vendors to share knowledge and provide comments to ONC regarding TEFCA and data exchange. But it only represents a fraction of the hundreds of private and public HIEs in the country, so there is still a long road ahead. A payer committee was a welcome sign that convergence was part of their agenda.

Sensors

At the opposite end of the interoperability spectrum, I attended a session by Houston Methodist on body sensors, where the distances are measured in inches and the signals are often so weak that temperature or motion (such as a kicking baby) are enough to throw them off. Sensor network fusion is the frontier – the more information you can capture from more places with more context, the better. For example, one of Methodist’s use cases was rapidly predicting a patient fall.

I also met with Somatix, a small vendor with a big idea we’ve been hearing about for years – using data from wearables to track more routine activities of daily living (some of which, like smoking, are harmful). The vendor is attempting to take this to the next level with more accurate gesture detection and predictive analytics so appropriate (and even real-time) interventions can be made using specific apps. As Brian Eastwood recently posted, we’re still waiting for wearables to provide insight. I didn’t sport a wearable at HIMSS18 (I broke two and lost another in 2017), but I’m on the lookout for a good, waterproof one.

Image Interpretation

Another key area of focus for us is the use of AI to interpret digital medical images. An impressive talk by University of Virginia and the National Institute of Health included use of speech recognition (using Carestream and Epic) to embed hyperlinks of AI-recognized areas of interest into reports for the EHR. The two-year effort showed productivity improvements of 3x over unassisted analysis and reporting.

A presentation by Entlitic claimed AI-enabled “superhuman” techniques able to detect lung cancer two years sooner than existing approaches. Their solution made it easy to compare an existing case to similar cases where timelines of data showed disease progressions. The company has 65 radiologists that label their training data, claiming only 1 in 4 that apply for the job pass their test. We’ll dive into detail about these kinds of advances in our Digital Medical Imaging Report scheduled for Q4’18.

Image Exchange

I spent time with Ambra, a major provider of image exchange solutions (others include Nuance and lifeIMAGE). Aside from the challenge of the size of medical images, it always surprises me how difficult it is to move them around and make them available despite good standards (DICOM). It was only recently that Epic, for example, addressed image exchange, and it’s not part of many HIEs. I’m glad to see we’re moving beyond the vendor neural archiving discussion and toward a focus on the cloud and useful exchange of images in clinician workflow.

Receptions

I also attended half a dozen receptions during the week. The biggest was sponsored by a large consulting firm. It was an evening of fun, but it reminded me of what was right and wrong about our industry and a conference in Las Vegas – who’s really paying that bill? My last reception was with BetterDoctor, which specializes in the quality of provider directory data. It always seemed ironic to me that the most regulated profession in the world has such a problem with accurate information (retirement, credentialing, locations, and so on).

My Ears Hurt

To rework my “I’m Jazzed” comment from the top with a music metaphor, HIMSS is more like a blaring of thousands of different instruments with each of the “sections” competing to be louder than the other – and the sounds of Vegas don’t help. There are many great musicians and an increasing number of duets (e.g., partnerships, ACOs), but we’re still playing off too many different pages. Adding to the problem is the conductor (the government) changing every few years.

It may be more of a cacophony than a symphony, but I’m glad to be in the orchestra. I hope you are, too.

Stay up to the minute.

Did You Know?

HIMSS18 – A Bipolar Experience

HIMSS18 Review 3 of 4

A decade of attending the annual HIMSS conference and I leave both excited and depressed. Excited and enthused by meeting so many people who are dedicating their lives to affect positive change by improving healthcare delivery through IT. Depressed as yet again I find a lack of real leadership and vision among many who repeat the years’ worn phrases of interoperability, patient-centered care, reducing physician burden, and the like.

“Oh please, can’t we just get on with it,” I scream to myself.

In keeping with the bipolar theme that is HIMSS, following are my takeaways, in an up-down fashion.

Up: Anthem goes public on its deal with Epic r/e HealthyPlanet. This partnership is an exciting step in enabling provider-payer convergence wherein Anthem will embed IP (risk, prior authorization, claims adjudication, etc.) into HealthyPlanet and take HealthyPlanet to market with wrap-around services.

Down: Head-in-the-sand vendors who are entrenched in FFS model. These vendors told me point blank that the market will revert back to FFS, that value based care is DOA. Gotta wonder what they’re smoking.

Up: Telehealth going mainstream. Saw loads of examples/demos of telehealth with direct or near-direct integration to the EHR. Been hearing about the coming of telehealth since I started this company in 2007. I believe we are finally there.

Down: Almost zero discussions on managing the costs of care/cost containment. There was some discussion on reducing clinical variability – but beyond that, HIMSS was devoid of any deep conversations on this critical variable in the value equation.

Up: Clear demonstrable, scalable use cases for AI. I was particularly impressed with the work 3M has done with Verily, leveraging Deep Mind technology for specific measures. Though just released, 3M has already landed 17 provider clients and 2 payers.

Down: The preponderance of AI vendors with little sense of scaling their solution. Many of the AI vendors I talked to have ongoing projects with “Big Brand” healthcare systems. That’s great – but disturbingly, few have taken the next step to address how they plan to scale their solution within an organization for widespread adoption and use.

Up: New solutions leveraging FHIR to insert actionable insights directly into clinical workflows. This is near nirvana for me, as it gets beyond the Herculean task of interoperability writ-large and tackles those points where significant friction and opportunity exists.

Down: One policy pundit after another talks yet again about the need for interoperability. Frankly, this is no longer a technical issue. Interoperability is a policy issue and really does not belong at an event such as HIMSS – where we should be talking about the future, not rehashing the past ad nauseum.

Clearly, a lot of work lays ahead for us in the health IT arena, which provides us all meaningful work going forward. And frankly, we are in but the top of the third inning – there is so much to do, it really is an amazing time to be in the healthcare IT market.

Thankfully, we are at last moving beyond the prescriptive use of IT via meaningful use, transitioning to meaningful insights from the data we are collecting and placing into clinical workflows. There is a near unfathomable opportunity to begin leveraging clinical, genomic, and other data sets that will lead us to dramatic improvements in care delivery – improvements that are likely beyond our comprehension at this time.

Despite some of my downer moments at HIMSS18, I could not be more excited for what the future holds for us as an industry – and, personally, in how even I and my care team will leverage new insights to more effectively and efficiently manage my own condition.

HIMSS18: Care Management and Engagement

HIMSS18 Review 2 of 4

By Matt Guldin and Brian Eastwood

Having returned and (mostly) recovered from HIMSS18 in Las Vegas, the Chilmark Research team wanted to share our thoughts on what we saw in presentations and heard in conversations. This post includes our analysis and insights on Care Management and Engagement; additional posts will consider Analytics/AI and Interoperability as well as Population Health Management and Convergence.

Overall, we were pleased to see progress on telehealth, as well as a broader understanding that healthcare organizations (HCOs) will get patient engagement right only when they assemble a comprehensive collaborative health record (CHR). On the other hand, we were disappointed in slow progress toward addressing two prominent public health issues — the opioid crisis and behavioral health — as we didn’t see many large-scale use cases for engagement in general or episodic payments in particular.

There certainly was an increased awareness and discussion of integrating behavioral health into primary care and care coordination at HIMSS18. However, this shift is still in its very early stages.

Care Management Themes

Lack of focus on the opioid crisis: Last week, the CDC released a Vital Signs report that showed a 30% increase in emergency department visits due to suspected opioid overdoses from July 2016 to September 2017. Despite this continued public health crisis, there was a general lack of targeted solutions or marketing focused on this topic at HIMSS18.

Instead of vendors helping providers to help address this problem at the point of care or service, though, there is a “top-down” approach at the state level emphasizing tighter prescription regulations, inventory control, and tracking. There were some specific examples we did find though. One vendor, Venebio, has created a predictive analytics solution to identify and predict the specific overdose risk over the next 12 months for a particular patient; Venebio is selling to state Medicaid agencies, payers, and providers. Collective Medical, through their EDIE report, is helping to provide a list of current medications for ER patients which facilitates identifying drug-seeking patients.

Integrating behavioral health is in its early stages. There certainly was an increased awareness and discussion of integrating behavioral health into primary care and care coordination, including several educational sessions on the topic. However, this shift is still in its very early stages. To be determined: What types of models by the work best in varied primary care settings; how IT solutions such as telemedicine and digital health might help to address various challenges, including a lack of sufficient behavioral health providers and lengthy behavioral health service queues; and the role of self-support tools, which have high levels of engagement and effectiveness.

Scaling episodic payments remains a huge challenge. While a number of HCOs have already engaged in an episodic payment for a particular procedure or two in a service line (such as cardiology or orthopedics), scaling these efforts across several service lines for an HCO remains a challenge as solutions remain immature and most HCOs are in the early stages of forming post-acute networks. Some of the biggest challenges include the timely notification of when a patient enters into an episode, an inability to track patients across and outside the HCO, and an effective patient engagement strategy that is customizable to meets the needs of a patient in a particular episode.

Engagement Themes

Data matters. If there was a unifying theme to the preconference Patient Engagement & Experience Summit, it was the need to begin patient engagement efforts with a CHR – one combining clinical, claims, consumer, financial, and patient-generated health data to provide a comprehensive view of a patient’s diagnoses, social determinants of health (SDoH), and barriers to receiving care. Record in hand, healthcare organizations (HCOs) can shift away from generic patient outreach – think portal message, email, or even snail mail flier – toward outreach that better meets patients’ individualized needs.

Use cases remain simple. The operative word above is can, as HCOs aren’t yet meeting individualized needs. Many use cases at the preconference summit highlighted a single condition: Asthma, colon cancer, sepsis, substance abuse, outpatient physical therapy, etc. Two factors seem to cause this. The first reflects the adage that you can’t manage or improve what you cannot measure. Since HCOs are measuring readmission rates, HCAPHS scores, and joint replacement bundled payment performance as if their financial lives depended on it (and they do), patient engagement and experience efforts are frequently tied to these metrics.

Behavior change is hard. The second factor is the challenge of personalization. It’s fairly easy to use a CHR to identify what makes a patient unique (thanks to advances in AI and machine learning that colleagues Ken Kleinberg, Brian Edwards, and Brian Murphy covered in a separate HIMSS recap). It’s much harder to align those unique characteristics to specific actions that will improve clinical outcomes. As noted by Dr. Heather Cole-Lewis, Johnson & Johnson’s Director of Behavior Science, such alignment requires context, and today’s engagement solutions have not been designed to handle the complexity that comes with that context. For example, to accomplish a care plan goal of lowering blood pressure to 140/90, Cole-Lewis said, a patient may need to do one (or more) of at least seven things:

  • Start doing something.
  • Stop doing something.
  • Keep doing something.
  • Learn about doing something.
  • Do something once.
  • Do something for a year.
  • Do something forever.

Telehealth is maturing. If there was a bright spot for the engagement domain at HIMSS, it was the level of activity in the telehealth market. (Full disclosure: I wrote my first “telehealth is ready to take off” article in 2013.) Nathaniel Lacktman, chair of the law firm Foley & Lardner’s telehealth industry team, pointed out that the recently passed federal budget includes several extensions of telehealth reimbursement under Medicare, particularly for kidney dialysis, telestroke, and the patient-centered medical home. This should provide HCOs with the impetus to initiate or expand telehealth efforts that have otherwise stalled.

Plus, as John Moore pointed out in his HIMSS18 recap, telehealth vendors are pushing to cover the vast area between low-acuity DTC services and inpatient services through a variety of strategies. These include offering chronic condition management, supporting outpatient care settings, or unifying their inpatient and at-home UX. Stay tuned for Chilmark’s forthcoming report, Telehealth Beyond the Hospital, which will examine these strategies in much greater detail and identify which vendors are best positioned to execute in this market.

Give Us Your Data – Is it Really That Easy?

HIMSS18 Review 1 of 4

By Ken Kleinberg, Brian Murphy, and Brian Edwards

What’s inside the black box of algorithims?

During Eric Schmidt’s opening keynote at HIMSS18, he asserted that, given the state of algorithms today, it’s possible to take any large data set and make strong predictions – and healthcare is no exception. There’s no need for clinical content knowledge, rules, or past experience. His statements were met with plenty of skepticism – less about the capabilities of Alphabet and its algorithms, and more about the realities of gaining access to the right healthcare data sets. This is not trivial.

So who should get data from who? What about patient consent? Who can be trusted? Historically, health systems have done their own analytics and research within the boundaries of their own systems. Vendor analytic solutions were implemented on site. Even this limited scenario presented complex challenges – in particular, just bringing data together to a point where it could be analyzed. Transferability of models was difficult, and costs were not shared. The use of analytics was therefore sparse, mostly limited to research and quality improvement.

Bulk data access will be critical for the industry to move beyond the current artisanal methods of building and maintaining data stores for analytics purposes.

Slowly but surely, the situation is changing. The cloud is becoming much more accepted, with many options possible (private, public, hybrid). Algorithms, enabled by rapidly advancing hardware/computing power, are capable of dealing with much larger and more complex data sets. Data operating system approaches can stream data in a liquid fashion from multiple locations/sources, reducing the need for centralized repositories.

A next step as data becomes more available is to fully utilize it. Advances in natural language processing (NLP) are able to extract/mine useful features from unstructured data such as text, faxes, and reports. Algorithms can increasingly use incomplete, messy, or ill-defined data and “fill in the blanks.” At a certain scale, data quality becomes less of a factor in conducting analytics.

Despite the black-box nature of AI systems, they can still be validated using objective methods, such as how and what they were trained upon, and how they perform in real-world clinical scenarios vs. human performance.

Whose Black Box?

There is also a lot of healthy discussion about how AI systems make decisions. The primary concerns are black-box algorithms and a lack of data transparency. This even reached a point where a major educational institution recently recommended that governments not rely on any AI or algorithmic systems for “high stakes” domains, such as healthcare technology, where the way a system makes a decision cannot be understood in terms of due process, auditing, testing, and accountability standards.

Despite the black-box nature of these AI systems, the fact is that they can still be validated using objective methods, such as how and what they were trained upon, and how they perform in real-world clinical scenarios vs. human performance. As long as they are not used in closed- loop systems, and as long as there is a human expert able to accept or dismiss their recommendations, they provide valuable input (before or after) for difficult cases (such as whether surgery or therapy is the best course of action). They may also serve as a last resort with the proper consent (as with a terminal cancer patient).

So that all is highly promising – but is healthcare ready to hand this data over?

Flat FHIR and Analytics

Percolating below the surface at HIMSS was disquiet about the “bulk data transfer” proposal. This proposed method would make large sets of data (think cohort-level data) more freely available for analytics purposes. It will allow a user or program in one organization to issue a broadcast query to the country at large and receive patient data from other organizations. For example, an ACO quality manager could issue a query to a community and get all of the relevant data for patients in the ACO.

This proposal, also known by the name “Flat FHIR,” is part of the TEFCA discussion (Trusted Exchange Framework and Common Agreement) insofar as such queries are a contemplated use case. But among people who are paying attention to this proposal, there are unanswered questions.

Open-ended queries arriving from anywhere in the healthcare system are not currently part of most HCO’s IT capacity plan:

  • Will organizations end up having to add more compute and network resources to satisfy such queries?
  • Does TEFCA’s requirement to provide non-discriminatory access mean that organizations will not be able to implement reasonable network traffic and quality-of-service controls?
  • If patients have different consent profiles in different organizations, how should a query recipient satisfy the request?
  • Will organizations have to establish revenue share agreements based on pro-rata data contributions?
  • Will the fact that TEFCA puts the onus on the query receiver to reconcile medications, allergies, and problem lists mean that the receiver must verify that its data is current with proximate organizations before satisfying the original query?

Such questions represent the tip of the iceberg. As a practical matter, before the bulk data transfer proposal can ever be a day-to- day reality, many technical, non-technical, and financial questions must be resolved.

Despite these questions, bulk data access will be critical for the industry to move beyond the current artisanal methods of  building and maintaining data stores for analytics purposes. After all, analytics has more to offer than the dashboards and reports that describe the recent past. HIMSS18 was less a venue to air out the challenges associated with making bulk data transfer a reality than it was an opportunity to preview some of the advanced and predictive analytics use cases it could enable.

For those of you who are overwhelmed by looking through the HIMSS18 session schedule (and those of you who have been meaning to look but haven’t gotten to it yet), here’s Chilmark Research’s short list of sessions we expect to be worthwhile, as chosen by our analyst team. It is by no means an exhaustive list, but will hopefully steer our readers to a few quality sessions they may have otherwise overlooked or missed with how many options there are at any given time. We will likely have at least one team member at most of these sessions, so if something piques your interest, feel free to reach out to coordinate meeting at the session to discuss the topic further (email analysts directly or shannon@chilmarkresearch.com for meetings).

We’d love to hear feedback on what sessions you’re excited for – feel free to leave additional suggestions in the comments.

Analytics

From Big Data to Big Knowledge: Optimizing Medication Management

Wednesday, March 7, 1:00pm-2:00pm; Venetian, Palazzo D

CME Credits: AAHAM 1.00; ABPM 1.00; ACPE 1.00; CAHIMS 1.00; CME 1.00; CNE 1.00; CPHIMS 1.00; PDU 1.00

Speakers:

  • David Webster, Associate Director of Pharmacy Operations, University of Rochester Medical Center
  • Maria Schutt, Director, Education and Optimization Services, BD, Medication Management Solutions

Why Attend: The application of analytics to time purchasing of medical supplies – in this case medication – is something we typically don’t cover in our own research, but is a growing consideration in the move to VBC. This session will be of interest to healthcare system CFOs and COOs that are looking to find new ways to streamline business operations and identify opportunities to reduce their unit costs of care delivery.

Creating Value via Analytics and AI-Driven Interactive Radiology Reports

Wednesday, March 7, 4:00-5:00pm; Venetian, Murano 3304

CME Credits: ABPM 1.00; ACHE 1.00; CAHIMS 1.00; CME 1.00; CNE 1.00; CPHIMS 1.00

Speakers:

  • Cree Gaskin, Professor, Vice Chair, ACMIO, University of Virginia Health System
  • Les Folio, Lead CT Radiologist, National Institutes of Health

Why attend: AI will have some of its near-term and largest impacts in radiology (lines at RSNA last year were around the block). This session will show how AI and analytics are bringing together clinicians, technologists, and data scientists to go beyond what any could do alone.

 

Care Management

Embracing Longitudinal Person-Centered Care Plans

Wednesday, March 7, 11:30 to 12:30 a.m., Venetian, Murano 3304

CME Credits: ABPM 1.00; ACHE 1.00; CAHIMS 1.00; CME 1.00; CNE 1.00; CPHIMS 1.00

Speakers:

  • Terry O’Malley, MD, Internist/Geriatrician, Massachusetts General Hospital
  • Evelyn Gallego, CEO and Founder, EMI Advisors, LLC

Why attend: Individualized care plans are increasingly becoming a requirement for a number of state and federal value-based reform programs. This session will provide an overview of that as well as looking at how these various programs are looking at creating a longitudinal care plan across multiple settings of care.

Innovative Use of Technology in the Home to Improve Diagnosis and Care: A Davies Story

Thursday, March 8, 11:30 to 12:30 a.m., Venetian, Murano 3301

CME Credits: ACHE 1.00; ACPE 1.00; CAHIMS 1.00; CME 1.00; CNE 1.00; CPHIMS 1.00

Speakers:

  • Matthew Kull, SVP and CIO, Parkland Health and Hospital System
  • Geneva Jane Castro, BSN, RN, Clinical Nurse Informatics, Case Manager, Lana’i Community Health Center
  • Joseph Humphry, MD Medical Director, Lana’i Community Health Center
  • Joseph Longo, VP of IT Enterprise Technologies, Parkland Health and Hospital System

Why attend: The shift to home-based care is going to be an important part of value-based care especially since CMS’ decision to reimburse providers for remote patient monitoring as of January 1st. This session presents two Davies award winners and how they used home-based IT including remote patient-monitoring to improve the quality of care while reducing costs.

 

Engagement:

Connected Care IRL (In Real Life)

Wednesday, March 7, 8:30 to 9:30 a.m.; Venetian, Palazzo G

CME Credits: CAHIMS 1.00; CME 1.00; CNE 1.00; CPHIMS 1.00

Speakers:

  • Lygeia Ricciardi, President, Clear Voice Consulting, LLC
  • Jen Horonjeff, Founder & CEO, Savvy Cooperative
  • Michael Joseph, Founder & CEO, Prime Dimensions, LLC; Executive Director, empathy.health

Why attend: Healthcare organizations cannot identify actionable strategies and tactics for improving patient engagement without hearing from patients firsthand about their experiences within the system – both good and bad. In this session, two patients will discuss their personal experiences and also share tips to help HCOs raise patients’ voices and even compensate them for sharing their time and expertise.

Designing from the Inside Out: Taking a Strategic Approach

Thursday, March 8, 8:30 to 9:30 a.m., Sands Show Room

CME Credits: ABPM 1.00; ACHE 1.00; CAHIMS 1.00; CME 1.00; CNE 1.00; CPHIMS 1.00; PDU 1.00

Speaker: Iris Berman ,Vice President, Telehealth Services, Northwell Health

Why attend: Effective telehealth implementation requires significant strategic planning; otherwise, solutions are deployed on an ad hoc basis, different business units adopt different strategies and tactics, and scaling a telehealth program becomes increasingly difficult. This session covers the ins and outs of planning for a telehealth program — and then scaling it across a network of hospitals.

 

Interoperability:

HIEs, CommonWell, Carequality Can Work Together: Here’s How

Tuesday, March 7, 4:00pm – 5:00pm; Venetian, Murano 3301

CME Credits: ABPM 1.00; ACHE 1.00; CAHIMS 1.00; CME 1.00; CNE 1.00; CPHIMS 1.00

Speakers:

  • Jon Kansky, President and CEO, Indiana Health Information Exchange
  • Keith Kelley, Vice President, Solution Delivery, Indiana Health Information Exchange

Why attend: IHIE is probably the foremost exchange organization in the U.S. and understands how efforts like CommonWell and Carequality can help move the needle on exchange.

A FHIR-Enabled Ecosystem for Health Information Sharing

Thursday, March 8, 4:00pm – 5:00pm; Venetian, Murano 3301

CME Credits: ABPM 1.00; ACHE 1.00; CAHIMS 1.00; CME 1.00; CNE 1.00; CPHIMS 1.00

Speaker: David Hay, Product Strategist, Orion Health

Why attend: We expect this will provide a good overview of how FHIR will simplify the mechanics of data exchange and reduce the learning curve for developers.

 

Population Health Management

Population Health and Data Foster Success in 23 MIPS ACOs

Tuesday, March 6, 4:00-5:00pm; Venetian, Lando 4204

CME Credits: ABPM 1.00; ACHE 1.00; CAHIMS 1.00; CME 1.00; CNE 1.00; CPHIMS 1.00

Speakers:

  • Tim Putnam, Chief Executive Officer, Margaret Mary Health
  • Lynn Barr, President and CEO, Caravan Health

Why attend: Caravan Health has an unique model for establishing ACOs, as discussed in last March’s Vendors Enabling the ACO Report. Learning from their experiences working with smaller, rural providers to establish cross-state MSSP ACOs will highlight some of the unique problems facing more loosely organized ACOs (opposed to IDN-based ACOs). Furthermore, MIPS is generally pretty confusing to a lot of people in the industry, and this session should help clarify some of that confusion to give ideas on how to adjust strategy for success.

Status of HIT Adoption in LTPAC: Drivers and Policy Options

Wednesday, March 7, 4:30pm – 5:30pm; Sands Hall G, Booth 11955ET

Speakers:

  • Joshua R Vest, Associate Professor, Indiana University
  • Larry Wolf, Chief Transformation Officer, Matrixcare
  • Lorren Pettit, VP, Research, HIMSS North America

Why attend: What happens post-discharge has broad implications for how well providers can do in risk sharing contracts. Hopefully, this will provide some ideas on how these under-technologied providers can participate more fully.

 

Provider-Payer Convergence

Closing the Gap: Risk Insights at Point of Care

Tuesday March 6, 1:00-2:00pm; Venetian, Galileo 901

CME Credits: AAHAM 1.00; ABPM 1.00; ACHE 1.00; AHIMA 1.00; CAHIMS 1.00; CME 1.00; CNE 1.00; CPHIMS 1.00; PDU 1.00

Speakers:

  • Heather Trafton, Vice President, Operations, Steward Health Care Network
  • Catherine Turbett, Director, Practice Performance Improvement, Steward Health Care Network

Why attend: Closing care gaps has been on HCO leaders’ minds for a few years now, but there are still plenty of headaches when it comes to activating physicians to use tools at the point of care. Hear from Boston-based ACO Steward Health what they are doing to solve this problem – the part of the description that hooked us? The use of these data to “ensure appropriate reimbursement to fund [VBC] programs.”

The Payer/Provider Perspective on Interoperability – The DaVinci Project

Wednesday, March 7, 11:30am – 12:30pm; Sands Hall G, Booth 11955ET

Speakers:

  • James Lenel, Business Lead – Health Information Exchange & Innovation, Blue Cross Blue Shield Association
  • Kirk Anderson, Vice President, Chief Technology Officer, Cambia Health Plans and Shared Solutions
  • Mark Gingrich, Chief Information Officer, Surescripts
  • Shafiq Rab, Senior VP and Chief Information Officer, Rush University Medical Center

Why attend: Getting payers and providers to see eye-to-eye on information sharing is not easy. DaVinci is trying to reduce the need for participants to reinvent wheels.

Lessons Learned: Transformation Across Large Healthcare Communities

Wednesday, March 7, 2:30am – 3:30pm; Venetian, Lando 4204

CME Credits: CAHIMS 1.00; CPHIMS 1.00

Speakers:

  • Ashwini Zenooz, Chief Medical Officer, VA Electronic Health Record Modernization (EHRM), Department of Veterans Affairs
  • Brigitte Nettesheim, President, Joint Venture Market Operations, Clinical Services & Joint Venture Markets, Aetna
  • Tricia Nguyen, Chief Executive Officer, Inova Commonwealth Health Network

Why attend: Convergence among healthcare stakeholders has been taking many forms, as covered in our inaugural Convergence conference (session recordings) in October 2017. This session looks at some of the organizations taking lead on implementing these new types of business models, sharing their lessons learned to help others that are entering this revamp cycle.

 

Our Sessions:

The Learning Health System & AI

Monday, March 5, 9:55-10:20am; The Wynn Las Vegas, Lafleur

Speakers:

  • Ken Kleinberg, VP of Research, Chilmark Research
  • Joshua Rubin,Program Officer, Learning Health System Initiatives, University Of Michigan Medical School

Why attend: As AI gains in healthcare, the hype grows as well. This session will discuss survey results of Learning Health System initiatives organizations and their vendors regarding their opinions of where AI will have its greatest effect, how these solutions are being sourced, and to what degree they would allow AI systems to influence their own treatment.

HIMSS Social Media Ambassador Meetup (general link)

Tuesday, March 6, 3:00-3:45 p.m., HIMSS Spot (Level 2, Lobby C)

Speakers: Brian Eastwood, Engagement Analyst, Chilmark Research; 19 other Social Media Ambassadors

Why attend: HIMSS Social Media Ambassadors are selected based on their ability to influence industry discourse, identify emerging technologies, amplify awareness of health IT’s importance, and honor those leading the effort to shift the industry’s IT priorities. Hear from Brian and the 19 other HIMSS18 Social Media Ambassadors about how social media informs and broadens their industry expertise.

The EHR App Store is Open — What is on the Shelf?

Wednesday, March 7, 11:30am-12:30pm; Venetian, Palazzo G

CME Credits:  ACHE 1.00; CAHIMS 1.00; CME 1.00; CNE 1.00; CPHIMS 1.00

Speakers:

  • Ken Kleinberg, VP of Research at Chilmark (Moderator)
  • Janet Campbell, VP, Patient Engagement, Epic
  • Michael Palantoni, Director, Platform Strategy and Operations, athenahealth
  • Tina Joros, GM, Open Business Unit, Allscripts

Why Attend: This session will discuss how EHR vendor developer programs have evolved to include App Stores, how formal they are, what types of data they allow access to, and how they handle oversight, security, and revenue sharing. It will be of interest to a growing number of EHR clients, partners, and even competitors desiring access to the “keys to the kingdom” to offer new and innovative functionality.

 

Other Sessions

How CMS is Leveraging Information and Technology in Medicare and Medicaid

Tuesday, March 6, 8:30-9:30am; Venetian, Palazzo K

CME Credits: ACHE 1.00

Speaker: Seema Verma, Administrator, Centers for Medicare and Medicaid Services

Why attend: Learn how the new administration is using IT to manage CMS offerings and services. Hear first hand from the organization’s top executive what to expect from the nation’s largest payer in the next couple years.

Blockchain Reset – Seeing Through the Hype and Starting Down the Path

Tuesday, March 6, 9:30-10:30am; Sands Hall G Booth 11955ET

Speakers:

  • Corey Todaro, Chief Product Officer and Director of Hashed Labs, Hashed Health
  • David Houlding, Director of Healthcare Privacy & Security, Intel Health & Life Sciences
  • Emily Vaughn, Blockchain Product Director, Change Healthcare
  • Mike Jacobs, Senior Distinguished Engineer – Blockchain Evangelist, Optum
  • Ted Tanner, Co-founder & CTO, PokitDok

Why attend: If you’re curious about blockchain in healthcare, this is the panel for you. Expect a good overview of applications and uses in healthcare today, what’s actually possible, and where this technology could be applied near term for most impact. Definitely bring your tough questions as this session is loaded with experts.

 

Why I’m Not Jaded for My 20th HIMSS Conference

As you read this, you’re likely in HIMSS conference prep mode – arranging meetings, checking for the sessions you want to attend, coordinating with colleagues, perhaps preparing a presentation. It’s all too easy to be overwhelmed and disheartened by far too many choices, far too few responses to requests, and the knowledge that much of what you’re going to see and hear is over-hyped or lacking in details. You’re concerned that when you get home and someone asks you about the major themes, or what’s really new or actionable, you won’t really know.

As I prep for my 20th HIMSS conference, I thought I would provide my perspective, and tell you why, rather than being jaded, I’m stoked.

It’s all there. If you’re trying to justify the big trip and expense, think about how many other trips you’ve made for a hit-or-miss meeting with just one organization. At HIMSS, you’ve got multiple targets to aim for, so you’re highly likely to have a least a few great meetings. Just about every health IT vendor and health system has some presence at HIMSS; some vendors might not have a booth, and most providers won’t, but that still doesn’t stop you from meeting someplace – perhaps at a keynote or session you both find interesting.

It’s face-to-face meetings. While an increasing amount of information can be well-shared on websites and virtual meetings, nothing compares to face-to-face. If you’re new, you’ll meet new people. If you’ve been around, you’ll catch up with those you know (and meet new people). I like to exchange business cards – most people still carry them – and jot a few notes on the back so I can follow up after HIMSS. Although most people are really harried for the first day or two of HIMSS, and many execs leave by then, people are a bit exhausted by the third day. When meeting at the many social events or venues (after all, this is Vegas) or at a vendor’s booth later in the week, after the hype has died down, people are more likely to share a bit more with you.

It’s the innovation. I sometimes feel bad for the hundreds of small companies with the tiny booths tucked away on a lonely aisle. It’s hard to spend more than a few minutes with them with so many medium and larger vendors with solutions you need to see. I like helping them out by providing some perspective on which more established vendors have similar capabilities or could use what they have. I like hearing their ideas. Although many of them won’t make it, and the days of tiny companies growing to unicorns and IPOs are over, partnerships, app stores, and M&A are all alive and well.

For advances such as biomechanics, stem-cell research, genetic engineering, and brain computer interfaces to be implemented, it will require the best of our IT infrastructure and applications to find the right patients and risk-models.

It’s the opportunities. Although it’s easy to believe that decades of medicine practiced the same way will continue, with payers and providers duking it out, we’re on the cusp of major change. With EHRs now in place, interoperability barriers starting to yield, consumer engagement on the rise, and data accumulating like never before to support PHM and care management, we’re able to build on top of and embrace new technologies and business models. Value-based models, ACOs, joint ventures, and provider-payer convergence, although still struggling to gain traction, represent the future. We’re reaching for many major frontiers: Use of ML, AI, and NLP in support of advanced analytics and decision support; greater focus on social determinants of health, especially behavior health; advances in precision medicine, with rapidly lowering costs; and use of blockchain, especially for trusted exchange and contract management.

It’s a reality check. Well, if you’re still jaded, I would ask you to remember driving without GPS, communicating without a smartphone, and purchasing before the internet. Do you remember the days when healthcare conference speakers claimed we were at the tipping point for EHRs? We’re there. We can all take lessons from tech’s “Frightful 5” of Amazon, Google, Microsoft, Facebook and Apple; they have redefined and ruled their space, doing what many didn’t believe possible or valuable. Do you have an Alexa yet? Have you tried Google Translate? Have you tried an activity/sleep tracking wearable? Have you done a virtual visit?

It’s the future. I’m reading The Body Builders, a book by Adam Piore about advances in biomechanics, stem-cell research, genetic engineering, brain computer interfaces, etc. I can’t wait to get to HIMSS to talk about this exciting stuff. For these advances to be implemented, it will require the best of our IT infrastructure and applications to find the right patients and risk-models. I hope I can contribute.

My advice for HIMSS18:

  • Pick your areas of interest, look at the schedule in advance, and reach out to schedule the meetings you want to have.
  • Attend the keynotes and your sessions of interest. Ask the people sitting on either side of you, “What do you think?” Give them a business card.
  • Take notes as you go. While some use a paper notebook, I carry my tablet.
  • Post to social media. Use the #HIMSS18 hashtag as well as one (or more) supplemental hashtags on a number of health IT subtopics. If you’d like, chat with me on Twitter @kkleinberg1.
  • Consider joining a HIMSS community and meeting like-minded folks. Many local chapters hold events throughout the year.
  • Go to some receptions.
  • Leave some room for a bit of exploring.

Yes, HIMSS is a marathon. It’s exhausting, but you can rest up afterwards. Run hard, but don’t beat yourself up for not getting to even a fraction of what you would like to have seen.

And oh yes, as you’re looking to understand the major themes and what is new and actionable, or if you have a great idea or product you want others to know more about, I hope you’ll want to share your thoughts and impressions with our analyst team here at Chilmark.

Keeping Score: Reviewing Our 2017 Predictions

In keeping with a Chilmark Research tradition, once again we step into our “way-back machine” to review our 2017 predictions for the healthcare sector – of course with a health IT flavor.

Our score is far from perfect, but we did quite well with our 2017 predictions: 7 Hits, 2 Misses and 4 Mixed. If this were a batting average, we would be instantly recruited into the majors:

Later this week we’ll publish our 2018 Predictions. Stay tuned.

 

Risk-based contracting for health IT solutions accelerates. MISS

While the rate of participation by providers in value-based payment models increased modestly, and more states adopted value-based payment models, the rate of risk-based contracting for health IT saw little growth in 2017. This is due to several factors: The Trump administration’s adoption of more voluntary approaches to future participation in value-based payment models, including bundles; challenges defining appropriate risk-sharing/pricing models, and legacy PMPM or PMPY licensing models.

HCOs demand clear ROI on their health IT spend. MIXED

Healthcare organizations (HCOs), while becoming more cognizant of the need for health IT to generate a true return on investment (ROI), have not significantly changed their purchasing decisions to reflect this change. This may simply be a function of an EHR hangover, where purchasing decisions are driven by breadth and depth of existing relationships with current vendor(s).  

Progressive HCOs admit – their patient portals suck. MISS

As it turns out, progressive HCOs have been impressed with the portals they’ve built with solutions from their EHR vendors such as Allscripts, Cerner and Epic. But challenges remain: Increasing portal adoption among patients with slow Internet connections and/or a technology learning curve, along with a rising tide of consumer-centric engagement solutions, centered on holistic lifestyle and condition management, which have garnered interest from payers and employers interested in cutting costs while also improving outcomes.

Despite the hype, healthcare Internet of Things (IoT) stays on periphery. HIT

Connected devices remain visible and useful within healthcare facilities, especially to monitor ICU and post-surgical patients, but IoT security concerns have tempered enthusiasm for more widespread deployment. Outside the hospital, device use remains limited to remote patient monitoring (RPM) pilots. For example, the National Institutes of Health will use Fitbit devices in the All of Us precision medicine study, while Stanford Medicine is partnering with Apple for an atrial fibrillation trial.

Artificial intelligence (AI) and machine learning will remain outside the clinic. HIT

This year’s hype with AI and machine learning stretched definitions to the breaking point — even a basic statistical technique is now marketed as machine learning. AI-based diagnostic approaches are still struggling to be useful, even as an aid to clinicians. That being said, academic medical centers increasingly use NLP to mine unstructured text, crowds lined up around the block at RSNA to learn more about image recognition, and progressive HCOs regularly use these advanced analytics techniques to examine areas such as sepsis, length of stay, and readmissions risk.

Consumers find AI avatars as valuable as they are personal. MIXED

Virtual assistants have made some inroads for managing chronic conditions such as cancer and type 2 diabetes, though tools like Cortana, Google Now, and Siri still struggle with mental health and remain better positioned to deliver educational content and other prepackaged information. We see interest in virtual assistants that analyze patient input and recommend interventions. This brings value to the engagement experience, with much faster responses than emails or phone calls to physician offices. As solutions’ data sets grow, so will more personalized interventions and user experiences.

21st Century Cures Act interoperability provisions a dead letter. HIT

This prediction stands. Senate HELP Committee chair Lamar Alexander recently chided Jon White of the ONC for the time it was taking to to finalize rules about what constitutes “information blocking.” Rules may eventually be released but there will be wiggle room for all. In addition the environment for enforcement does not appear to favor patients.

EHR vendors get serious about API programs. HIT

All of the major EHR vendors either initiated or upgraded their API programs. FHIR-based APIs are the centerpieces of these efforts. Integrating the Healthcare Enterprise (IHE) is also busy FHIR-enabling its profiles. Developers today have way more opportunity to access FHIR APIs than they did last year. The one blind spot in these programs is write access to EHR data. Independent software vendors (ISVs) want write APIs, but most large systems and their EHR vendors have demurred.

Precision medicine fails to grow substantially outside of oncology. HIT

Despite an increasing number of vendors and continued investment, the precision medicine space remains challenging. While genetic-specific treatments and drugs are slowly making inroads for certain disease, the broader theme of social determinants of health (SDoH) is gaining more attention and will more dramatically influence population-wide health improvement.

Blockchain moves from hype to traction. MIXED

This has moved from hype to a serious topic of discussion – particularly for security and patient-controlled access to medical records. Traction, in terms of market solutions or installed and scaled applications, remains elusive. The largest healthcare systems experiment with blockchain, but a clear focus on use cases remains illusory.

HCOs continue to expand regionally via M&A. HIT

Through the end of September, 87 hospital and health system transactions occurred, and it is expected that the total for 2017 will slightly exceed last year’s total of 102 completed deals. The biggest moves of 2017 stand to be the Dignity Health-CHI merger, which would create the nation’s 10th largest hospital system – a  monster that may quickly be eclipsed by the rumored Ascension-Providence St. Joseph merger. M&A is clearly moving beyond regional plays. Color-by-numbers barriers to M&A are dropping, with the recently announced CVS-Aetna and UnitedHealth-DaVita deals as prime examples.  

Best-of-Breed PHM and analytics vendors continue to stay one-step ahead. MIXED

From a market share perspective, the EHR vendors and Optum racked up more wins in the last year than the independents. That said, the independents still have products and offerings that can go far deeper than the majors. While they stay ahead on the product front, they fell behind in the market. (The same can be said for care management vendors.)

HIMSS’17 will be far calmer and less frenetic. HIT

We were pleased that HIMSS17 focused less on hype and more on value, with demonstrations of operational use cases for network management, bedside patient engagement, data sharing, and clinical decision support. We also heard many vendors discussing services as an add-on to technology deployments, particularly for at-risk pricing and other value-based care initiatives.

HIMSS’15: NOT on FHIR

EPIC FHIR pic

HIMSS15 was supposed to be an opportunity for HIT vendors to really expand on interoperability with possibilities represented by FHIR and other newish standards. At least that’s what I thought.

Interoperability is an overarching concern across HIT and many are expecting big things from FHIR. Only Epic proclaimed its faith flashily with a stylized HL 7 FHIR logo inside an actual fireplace. But the company gave some people who asked about data integration the bum’s rush while also announcing that they would not be charging — at least for a few years — for data transfers between Epic customers and non-Epic customers with Care Elsewhere. Very confusing. Otherwise, the hyping of FHIR at a poster or display level was way more understated than I expected. Inside meeting rooms on the other hand, FHIR came up in every conversation I had.

These conversations fell into two patterns. The first, and most numerous, followed a familiar script: we are closely monitoring this new technology, recognize its enormous potential, and will evaluate how and when to build solutions based on what makes sense for our customers.

The second set of conversations sounded decidedly less cautious. These vendors expressed strong optimism about the benefits of FHIR as a standard but were essentially vague about product plans. While the interoperability issues facing healthcare are far broader than FHIR, I was still expecting a little more substance than was on display in Chicago, especially concerning all the hype we’ve been hearing about interoperability in recent months.

For those who crave substance, a well-attended session by David McCallie of Cerner and Sam Huff of Intermountain set the tone and made the conference for me. This presentation described one potential way to a more interoperable future. These two interoperability stalwarts position the EHR as the system of record and pluggable lightweight applications as the system of engagement for healthcare. Connecting them and providing the data fuel will be a set of FHIR-based APIs. The youngish crowd in the big hall asked a lot of questions and seemed genuinely ready to seize on this approach as a way to penetrate the walled gardens of our EHR-mediated HIT landscape.

I was pretty focused on FHIR this year because it will be an important element in solving the broader interoperability problem. And on that front – the Friday before HIMSS15, ONC issued a report to Congress on information blocking in healthcare.

Not too surprising due to timing, at HIMSS, no one that I talked to had read it and most seemed unaware of it.

The gist of this report is that information blocking is most definitely a problem. ONC’s most significant findings were that the scope of the problem is not well understood, the causes are a bit more murky than the simple competitive concerns of EHR vendors and large providers. The key takeaway is that business practices, rather than technology, may be the primary cause that information blocking occurs and by inference, the lack of interoperability.

Since HIMSS15, I have had several conversations with both vendors and providers who mention this report, usually in passing, as a way to illustrate how far we have to go in healthcare to making patient data as portable as it needs to be to deliver truly coordinated care. Next year, I am hoping that vendors will be talking in more concrete terms about the ways that they have implemented FHIR-based data access for HCOs.

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