HIMSS15: The Patient Takes Center Stage

Back in 2012 I wrote a blog post called SXSW: Woodstock for Geeks, which became the opening chapter of Tech Tonics, the book I wrote with David Shaywitz. In this piece, I pointed out the marked differences between SXSW vs. HIMSS, both of which I had recently experienced.   I said that HIMSS was best described as “a festival of old-school techno weenies recognizable in the wild by their big company expense accounts and the blue and gray suits that barely cover their pocket protectors.” In contrast, I experienced SXSW as an event that “would blanche at the thought of being called a conference. SXSW is more of a happening.  Rather than suits (the costume is old jeans and rock and roll t-shirts), the primary thing that comes in blue is hair.” My conclusion of the 2012 piece was this:

“In a perfect world, the ideal HIT gathering would be somewhere psychologically between HIMSS and SXSW:  fewer gray suits, less purple hair, more next generation technology, more business models that work.   If we could do a little cross breeding between species here, we just might make it work. Or we could accidentally end up with the Monster from Young Frankenstein.  Wait a minute, my God it’s brilliant! He might actually be perfect!  The Monster had both a gray suit AND a green head.  If he knows how to code, we have a winner.  Oh, sweet mystery of life at last I’ve found you!”

It seems I need to write a new book opening.

I have just returned from HIMSS 2015 where I found that this hypothetical hybrid Monster has come to life, much to my surprise. In three short years, HIMSS has gone from an event where electronic medical records (EMRs) took center stage to one where the focus was very much on the patient/consumer, a voice that was entirely missing in the HIMSS of 2012. And I even saw a guy with blue hair wandering about.

The change that has come over HIMSS was really noticeable.   First of all, HIMSS 2015 had over 42,000 attendees, a big increase vs. the 37,000 of 2012. That’s quite a jump, and one that is amplified by the investment attention being paid to health IT these days. Back in 2012 I reported that the prior year saw about $600 Million of venture investment in health IT; in 2014, the latest year for which we now have statistics, over $4 Billion, with a “B” was invested in health IT. And of that $4 billion, the bulk was in the deals one would more readily call “digital health, “ a term that was barely in vogue back in 2012. Back then we were still arguing about whether to call it mHealth or mobile health or connected health or whatever, but regardless of the name, today’s health IT means far more than it used to, sweeping in products that are intended to serve everyone in the healthcare world: patients, payers, providers, retailers, you name it. There is even a robust pet health category which, mercifully, was not a leading theme of HIMSS15 but was present in a big way at the newest entrant to this healthcare IT/digital health conference fray: CES 2015.   FitBark anyone?

As I padded around the 2.5 million square feet of HIMSS at Chicago’s McCormick Place this year—and the throbbing in my own feet would suggest I touched each and every one of those square feet—I was particularly struck by how much of the agenda was focused on what the EMR companies are doing wrong (in 2012, by contrast, the EMR companies’ agendas dominated). The primary focus of this energy has become how fed up everyone is with poor interoperability and lack of transparency—in other words: why can’t I, as a patient, get my own damn data whenever I want it? Former head of the Office of the National Coordinator of Health IT in the Department of Health and Human Services, Dr. Farzad Mostashari, was at HIMSS pounding the podium and calling for patients to rise up in a “Day of Action” where at least 1 million people requested their own patient data simultaneously.

This attitude belied a big contrast to 2012 where the biggest draw on the show floor was Epic’s booth; it included a full-blown sports bar complete with beer tap. In contrast, the big exhibit floor draw at this year’s event was Walgreen’s Connected Patient Gallery, chock-a-block with digital health offerings focused on improving the patient’s experience of the health system in terms of convenience, personalization and mobile technology.   Wait, there’s those patients again!  In fact, it was gratifying to see HISTalk sponsoring the presence of a number of patients/patient advocates at HIMSS, as well as the advancing army of Regina Holliday’s Walking Gallery jackets representing meaningful patient stories.

It’s worth noting that the world was still hoping that health systems would adopt EMRs back in 2012, taking advantage of newly created financial incentives to do so. Now, three years later, that mission is largely accomplished, but we left out that pesky middle part…the part about how these systems had to help, not further encumber, the patient experience. One of the more notable stories I read reported on the vast number of information errors contained within the EMR. Garbage in, garbage out, as they say. I suppose if the data itself is bad, the lack of interoperability is a blessing.

To many, Meaningful Use for EMRs has been well, meaningless and useless, stopping far short of enabling the use of data to actually improve care outcomes. Fortunately, many of the young companies present at HIMSS are taking a swipe at that problem, figuring out ways to co-mingle disparate data sets and overlay a palette of analytics and tools against the data coat of many colors in order to find one shade that blends. The goal of these efforts might actually be to turn the mountains of data into something a doctor can use to make a patient better or something a consumer can use to make better choices when purchasing within the healthcare system. Let’s hope that’s the case, as never have so many tried to do so much with so little actual information.

The front and center presence of so many young companies was another difference from the HIMSS of old, and particularly young companies focused on how patients can fare better in a rapidly changing healthcare system. Digital health upstarts, including many consumer-facing entities, were noticeably present as if they had made a wrong turn at Austin and ended up at McCormick Place. I had the pleasure of managing and emceeing the HX360 Innovation Challenge which featured digital health companies that are explicitly seeking to improve the experience for patients who must come into contact with the health system. The four finalists who presented at the live event were WiserCare, Ginger.io, Wellframe and ClockwiseMD (WiserCare and Ginger.io were declared the winners). These are four startups with cool ideas and energetic leaders that would still have looked very out of place at HIMSS 2012. But this year they were just four of the many young upstarts looking to tell a new story about how health IT can actually make a difference for patients and consumers. There were hundreds of others there in their newfound hipster t-shirts and logo wear standing in stark contrast to the army of suits still ever-present.   One of my funniest moments at HIMSS occurred as I stepped on stage to moderate a panel of four senior hospital-based venture fund leaders, all of whom showed up in identical blue blazers. It prompted me to introduce our group as Gladys Knight and the Pips.

And it’s not just the upstart startups that make HIMSS look new, it’s also the big companies coming from outside healthcare to act as game-changers. While Apple and Google were noticeably not present despite their active role in disrupting the healthcare old guard, companies like CVS and Walgreens and IBM/Watson and Samsung and Box were visible and relatively new to the party, or at least far more visible than several years back when McKesson and Epic and Allscripts and Cerner were the center of the HIMSS universe. Not that these companies aren’t still omnipresent–they are—but there was a sense that they are no longer setting the agenda for health IT as they once did, particularly as patient experience becomes more and more the focus of attention.

The half day Patient Engagement Forum was a  (nearly) new concept, featuring talks from people like Jane Sarasohn-Kahn and Jack Barrette and about patient-generated data, social networking, peer-to-peer and crowd-sourced health information, among other newfangled ideas, such as putting the consumer at the center. All of these topics would be expected at SXSW but are now, mercifully, becoming mainstream at HIMSS. One of the sessions featured the results of a patient engagement survey which highlighted one of the key problems in improving outcome: doctors, technologists and patients all view patient engagement differently, pointing their fingers at each other as key to making it better and having different views about the importance of high tech vs. high touch in the overall experience.

If we are ever going to move this ball forward, patients, providers and chief information officers are going to have to go into the woods and do some sort of Outward Bound program together, or at least get onto the same playing field.   The “real” consumer-focused businesses, like Apple and Samsung and Walgreens and CVS, are far more accustomed to thinking about the patient as center of the customer universe and that is why they may be halfway through the lunch of some of the old health IT stalwarts.

In a study released by HIMSS at the conference (26^th Annual HIMSS Leadership Survey of health IT professionals), “72% of respondents said that consumer and patient considerations — such as patient engagement, satisfaction and care quality — would be the business issue that would most effect their organization over the next two years. Indeed, 87% of respondents said that patient satisfaction would be the top business priority at their organization over the next 12 months.”

There is, in my opinion, no way in the world that the healthcare vendors of today can become the most trusted consumer brands of tomorrow solely through advancements in technology. There is going to have to be a swing back towards humanity if those HIMSS survey business requirements are going to be met. Patient-centered design, patient-reported data, personalization are all great technological inputs, but if patients aren’t treated like people when they show up at the doctor’s office, none of it really matters. The go-to-guy of the moment on this topic is Dr. Atul Gawande, famed physician author of the recent book Being Mortal. I read an interview he did with another famed physician author, Dr. Robert Wachter today, and to me it perfectly highlights this topic. Said Gawande:

“The very first place we’ve gone is to non-technology innovations. Such as, what are the 19 critical things that have to happen when the patient comes in an operating room and goes under anesthesia? When the incision is made? Before the incision is made? Before the patient leaves the room? It’s like that early phase of the aviation world, when it was just a basic set of checklists. In all of the cases, the most fundamental, most valuable, most critical innovations have nothing to do with technology. They have to do with asking some very simple, very basic questions that we never ask. Asking people who are near the end of life what their goals are. Or making sure that clinicians wash their hands.”

One of my favorite companies that participated in the HX360 Innovation Challenge was one that might be deemed pretty old school, in that most of their effort is delivered by people, not on cell phones or tablets. The company, Empathetics, trains medical professionals in using empathy and interpersonal skills to improve patient experience and thus improve health system efficiency and clinical outcome.   It may be kind of old school in its delivery, but it’s pretty new school to apply research in the neurobiology and physiology of empathy to create better outcomes for patients and the hospital’s bottom line. This kind of training should be a priority of all those delivering care to patients.

During the HX360 portion of HIMSS I sat in on a session where chief innovation and medical officers of major health systems talked about initiatives they were undertaking to do exactly this kind of thing: re-engage with patients as people through more responsive, empathetic behaviors. The attendees were riveted to the speakers’, their peers, descriptions of successful initiatives at increasing the trusted human-to-human relationship between hospitals and their patients. On example that drew much attention was one where a patient complained about how the nurse call button by the bed was the last thing to be cleaned in the room but the one thing the patient often touched; the nurse took notice and worked with the hospital housekeeping staff to change the room cleaning protocol to respond to this simple patient need to feel their interests were at the center of the hospital process.

Perhaps this kind of interaction points to why SXSW is such an interesting venue for conversation about healthcare experiences—you can’t help but notice the individuality of humans walking around Austin striving to be different, be noticed, be heard, be themselves, and be accepted for it. This is precisely what patients want, albeit they don’t seek to achieve it through piercings and tattoos. Rather, they seek to achieve it through being listened to in their time of need and being cared for as individuals despite the great equalizers of technology and time management. It is gratifying to see the rest of the healthcare system starting to sit up and pay attention at HIMSS and elsewhere. There is no doubt a long road ahead, but at least we have started our engines.