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ATLANTA – Swirling lights, multiple screens with various news outlets reporting on the future of healthcare in the country, and loud acoustics helped kick off the Health Information and Management Systems Society (HIMSS; Chicago) annual conference or HIMSS 10 as it has been dubbed by organizers and participants held here at the Georgia World Congress Center.

The key take away the opening video montage that displayed past comments of President Bush and President Obama on healthcare was that change was just on the horizon. It was a theme that was echoed throughout the day in multiple sessions.

But early yesterday morning, Barry Chaiken, MD, a chairman of HIMSS, kicked off the need for change mantra and wasted very little time spelling out the problems and issues that healthcare faces.

To illustrate his point, Chaiken told the story of the inbox and how it has changed throughout its 40 year-existence. Years ago an inbox was considered as a tray where various papers and documents were placed. Now inboxes have grown and are features on a phone or someone's computer. The paper aspect of the inbox, has almost completely been eliminated, Chaiken said.

“The story of the inbox tells the story of the economy of our country,“ Chaiken said. “The story of the inbox tells of how a manufactured-based-economy transformed to an electronic information-based-economy. But healthcare in many ways remains frozen in time.“

Chaiken added that “in many respects, the U.S. healthcare system still operates like the typical business of 1969; it is still largely paper-based, it ignores information tools that can facilitate evidence-based best practices, and it functions without analytics to qualify and quantify the care we provide. Medical decisions are made according to implicit criteria – hidden internal knowledge – rather than explicit criteria – external knowledge that can be checked, evaluated, and updated. He pointed out that “the Dartmouth Atlas of Healthcare provides documented proof of glaring, unacceptable variations in how healthcare is provided and sheds light on disparities existing across the country. Too many providers are not taking advantage of 21st-century technologies to access 21st century information, choosing instead to provide care the same way it was done 40 years ago.

The healthcare system is plagued with inefficiencies that significantly impact its effectiveness, Chaiken told the audience. According to statistics he cited from the World Health Organization (WHO; Geneva) U.S. Healthcare costs 50% more per capita than in any other country. He added that the only way to stop this is to have a greater adoption and use of healthcare IT solutions.

“While these healthcare challenges are daunting, I believe the solutions to them must and will come from the professionals sitting in this room and from our colleagues across the country and around the world, he said. “Healthcare information technology is the instrument that will transform healthcare and it is we – the informaticists, clinicians, management engineers, senior IT executives, IT specialists and the diverse talents of so many others – who will create the applications, processes and workflows that will improve quality, safety, access and cost-efficiency.“

Chaiken told the audience that they would be at the forefront in developing technologies that would help bring healthcare into the 21st century.

“It's no longer about what others are doing or have done,“ Chaiken said. “It is you who will transform healthcare. It's your job to act now upon the message in your inbox and to place your contribution to a transformed American healthcare system in your outbox in due time.“

Keynote Speaker Dan Hesse CEO of Sprint (Reston, Virginia) said that he couldn't agree more. Hesse, who spoke after Chaiken, said that the coming year was going to bring wireless patient monitoring to the forefront and the adoption of a 4G communications network was going to change the landscape of how medicine is practiced in general.

The term 4G refers to the fourth generation of cellular standards.

“Now what if I had been talking to you about wireless in 1986,“ Hesse asked. He then picked up a huge cell phone from that era to illustrate his point. “You would've laughed me off the stage.“

He then picked up a smart phone, which fit in the palm of his hand.

“The cell phone is the most rapidly adoptive technology on this planet and its presence is growing in healthcare,“ Hesse said.

He pointed out that the inclusion of applications with cell phone is helping this change take place and is transforming healthcare.

“Have you ever accidentally coughed into your cell phone? Well you might want to on purpose because there is now an (application) that can analyze the cough,“ he said.

Hesse also mentioned that there was an application called Flu Radar, which gives helpful tips regarding the disease.

But beyond applications, perhaps the most transformative piece of technology to revolutionize healthcare will come from a physician's increased ability to remotely monitor patients.

Hesse held up a pill and said that in the future, smart chips could be added to the pill and once it was ingested it would give the physician the ability to monitor if a patient is taking their medicine or not, or what kinds of issues the patient would suffer from.

These chips could be added to pretty much anything and provide wireless connectivity,“ Hesse told the audience.

“As the population grows we believe that home healthcare will grow,“ he said. The 4G network will help with that because it will bring in a higher resolution for imaging at greater speeds.“

Hesse said that while much has changed with wireless technology since 1986, even greater changes are coming in the next few years. He urged the audience to seek out innovation and look for even better ways to improve the healthcare industry.

“Healthcare faces what I believe is a once in a lifetime combination,“ Hesse told the audience. “It faces great challenges and great opportunities. Even the best technology company can't seize that opportunity on its own. We need all of you to take part in this.“

CEO argues for data-driven healthcare

The U.S. doesn't have healthcare coverage for its entire population. This one sentence alone can often times be embarrassing for Premier Healthcare Alliance (San Diego) CEO Susan DeVore when she travels to another country. Not only do some other countries provide coverage for the majority of their populace, but these nations do it at a less costly rate and they have better clinical outcomes for patients.

DeVore, who took the helm of Premier, an alliance of 2,300 U.S. hospitals and 64,000-plus other healthcare sites last year, spoke to a small audience yesterday at the Health Information and Management Systems Society (HIMSS; Chicago) 10th annual conference held here at the Georgia World Congress Center.

She took part in one of HIMSS' view from the top sessions, a special kind of meeting where participants and attendees received a chance to question experts who were involved in healthcare reform. DeVore's session title was “Data-Driven Quality: Getting More Bang for your HIT Buck.“

“I travel throughout the world and the most embarrassing thing to me is that [the U.S.] doesn't provide coverage for [everyone],“ she told the audience. “Now I wouldn't like to get my care anywhere else but here – the technology is better – but the expense is higher and with poorer outcomes [for patients].“

Statistics from the World Health Organization (Geneva) show U.S. healthcare costs nearly 50% more per capita than in any other country. Most data seems to indicate that the U.S. is constantly falling behind in healthcare practices.

“Unless we're going to ration care, we're absolutely at the point where we have to change [healthcare practices],“ she said. “This is the decade we have to make a difference.“

She also noted the huge variations in the cost of a Medicare enrollee from state to state.

“When you've got the cost of a Medicare enrollee ranging from $6,000 to $16,000 something is wrong,“ she said.

DeVore cited data from the Hospital Quality Incentive Demonstration (HQID), which was a sponsored partnership with Centers for Medicare & Medicaid Services (CMS). The premise, according to DeVore, was that if you pay a hospital for its success then the quality of care will essentially go up.

The project with CMS yielded a boost in overall quality scores by an average of 17 percentage points throughout four years for the 30 standardized care measures covering five clinical areas of interest. These areas were heart attacks, coronary artery by pass grafts, heart failure, pneumonia, and replacements of hip and knee joints.

DeVore pointed out how successful the partnership was and said that through it the Premier Healthcare hospitals were seeing vast improvement and making tremendous gains.

She also added that there was tremendous progress being made in leveraging data to target waste.

These include:

• staffing productivity,

• unnecessary testing,

• hospital-acquired conditions and infections,

• non-standardization of high value items,

• readmissions,

• medication errors,

• contract non-compliance and;

• pharmacy utilization.

But having strong data isn't always enough and she said that her biggest fear was that the U.S. will became a “data dump“ for good information, but will lack a strong foundation to implement the changes or highlight the strengths the data would suggest.

DeVore spoke to the HIMSS attendees shortly before she was scheduled to head to Washington to take part in a discussion centered on healthcare reform she told the audience.

Her trip follows President Obama's $950 billion proposed plan that he reported last week. The healthcare reform debate has been contentious at best, drawing fury from both Democrats and Republicans.

“I do think what the public is saying is that we don't want the government making, or insurance companies making, our healthcare decisions, but we want our doctors and physicians making these decisions with us,“ she said. “We see the road ahead and I think this attempt at healthcare reform with all its flaws is directionally right.“

Blumenthal sees EHR systems as 'common sense'

A jazz selection played ever so quietly in the background as attendees waited for a keynote session to begin.

The mood was a bit mellow and the music almost seemed to drown out the tremendous level of responsibility that was placed on attendees in the race to initiate dynamic changes to the nation's beleaguered healthcare system. Throughout the week, HIMSS 10 participants were constantly reminded of this fact through a plethora of speakers, educational sessions and town hall meetings.

Device makers and those developing solutions responded to the call and brought out their best offerings – from smart phone applications that could specifically analyze a cough, to imaging techniques that could have a greater degree of clarity for standard imaging.

Keynote speaker David Blumenthal, MD, who serves as the national coordinator for health information technology (HIT) with the Department of Health and Human Services praised the audience for their work in pushing HIT solutions forward and told them that they were the “leaders“ in innovation that would revitalize America's antiquated healthcare system.

“I'm a newcomer to HIMSS and to this world of Health Information Technologies,“ Blumenthal told the audience. I got into electronic health records not as an informatician but because about 10 years ago an electronic health record came across my desk,“ he said. “I was trained with paper and I was quite comfortable with paper. I didn't see the need for change. But gradually and slowly I found electronic health records were making me a better physician.“

The moment of truth came for Blumenthal seconds before he was about to unknowingly prescribe a medicine that a patient was allergic to.

When he entered the prescription in electronically, an alert went off letting him know that the patient was allergic to that treatment. He said at that moment his “professional career flashed before his very eyes.“

This moment made Blumenthal an advocate of EHR systems and put him on a path to be selected by President Obama to develop a HIT infrastructure for the entire country.

“Information is the lifeblood of medicine and [HIT] is the circulatory system of medicine,“ Blumenthal said. “As long as we keep the patient as our North Star and guiding light we will not go astray.“

He pointed out current initiatives that the taskforce was working on and gave a short update on the success the group was having.

The current objectives for the HIT taskforce are: To work with Centers for Medicare and Medicaid Service to develop the proposed rule of meaningful use; To finalize standards on certification and criteria for EHR; To give notice of recognition of the certification process through regulation; and to give new guidance on the implication on the Collection of Laws for Electronic Access for the information of health exchange.

“In addition to these regulations we've announced a wide array of programs,“ Blumenthal said.

Funding from these initiatives comes from the $2 billion that President Obama authorized in the American Recovery and Reinvestment act.

“We're going to use $700 million to start up regional exchange centers to help physicians with EHR systems,“ he said. “These will be set up to help practices with [less than] 10 physicians. Already we've announced 32 of these regional exchange centers and more will be announced [later] this month.“

Another $564 million will be used to help the states with the implementation of developing an information exchange infrastructure. Blumenthal stressed that the government isn't expecting states to start implementing information exchange infrastructure – but that funding would help make the states a part of the process.

Also nearly $235 million will go toward funding communities that Blumenthal says are leaders or “shining beacons of success“ for implementing HIT.

He said that since he took the position back in March of 2009 that nearly all of the $2 billion in funding available for HIT has been designated to programs and implementation. He added that his staff, which can “fit into a school bus,“ is growing and that in the coming months the task force will be extremely busy – but their job will shift somewhat.

“Our priorities going forward will be different,“ he told the audience. “We wrote policy, now we will begin implementation.“

To date, Blumenthal said the taskforce has received tremendous bipartisan support. He touted that electronic records are a foregone conclusion and that ultimately, professionalism would help facilitate the widespread use of EHR systems in the healthcare community.

“The idea that you can be a competent professional without managing information, I think defies belief,“ Blumenthal said. “Some may see this as the audacity of hope, but I see this as common sense.“

Interoperability push spotlights imaging

Can't we all just get along? It would seem that these words fall on the deaf ears of imaging departments and information technology (IT) departments when it comes to their relationship in most hospitals in the U.S.

It's not that the two groups dislike each other, but more so that there is a huge divide between the two – one so great that it threatens to impede the U.S. implementing a competent healthcare information technology infrastructure, according to Janice Honeyman-Buck, PhD, editor in chief of the Society for Imaging Informatics in Medicine's (Leesburg, Virginia) Journal of Digital Imaging.

Honeyman-Buck, also a former radiologist and current independent imaging informatics consultant, called for the two groups to work closer together and said that attempts at interoperability with technology should not initially leave imaging out of the equation.

“There is a lot of emphasis on the new health IT programs at the government level, but maybe not quite the emphasis we need to plan for imaging,“ she said during a session at the Healthcare Information Management Systems Society conference.

“A line has been drawn,“ the former radiologist told the crowd. “On one side we have radiologists and on the other side we have health information technology [specialists].“

Honeyman-Buck said the split started from storing data to the hospital's network. Throughout the years, the issue has evolved, and the ultimate result is that imaging takes a backseat to other health information technology (HIT) needs in the federal push for interoperability.

“So why do we have this line,“ she asked the audience. Honeyman-Buck pointed to the functions of each department that seem to add to the conflict.

HIT departments typically handle fast processing of data; have a secure and private network; and use the Health Level 7 (HL7) standard for data communication and storage.

Imaging departments typically use the storage and manipulation of images; use network access for decision support; and use the Dicom standard for communication and storage – a standard that Honeyman-Buck says looks nothing like HL7 and adds to the split.

“What we want to do is build a bridge between imaging informatics and hospital IT to work together to create a system with meaningful use that includes imaging,“ she said. “We also want to promote collaboration between HIT and Imaging professionals. This split cannot continue.“

She said she was encouraged by a system called Vista that the U.S. Department of Veteran Affairs used, which was more of a blend of both text and images. She also said that she was encouraged by many vendors offering up stronger solutions that include data and text.

But those shining examples of success are few and far between, according to Honeyman-Buck.

She cautioned that if the split does indeed continue then the hospitals won't be able to accommodate the needs of imaging in the federal push for interoperability.

“Imaging has to be considered from the beginning of an upgrade, not as an eventual add-on,“ Honeyman-Buck said. “I'm afraid that people who have incentive money for hospital information upgrades will put imaging on the backburner. If it's not considered at the beginning then you're going to have to reinvent the wheel.“

The reason, she says, is because hospitals will be unable to handle the sheer enormity of the space of these medical images on their databases.

“Archiving is going to be a key issue,“ she said. “Storing images for a 600-bed hospital can easily exceed 25 terabytes a year. But the actual storage is not expensive, the management of that storage is. Storage needs to be secure and sometimes redundant. What do I mean by redundant – well simply that you're going to have multiple images per patient and sometimes per patient condition.“

Cardiology, which has huge data sets, often requires a lot of space on the network for images. She pointed out that this was a key branch of medicine that could see the biggest problems in the future if imaging needs aren't addressed upfront in the interoperability standards.

Ultimately, she pleaded with members of the audience to keep the conversation alive and to demand that imaging take a greater role in interoperability plans. She also said that any papers members could get published to journals would be helpful in combating this issue.

“Healthcare reform demands interoperability and EHR [systems] must contain a way to display images,“ she said. “This is a problem that we can't live with. We need the images, the text and information about the patient.“

Growing healthcare fraud problem

Depending on what political party you ask, the dollar amount associated with Medicare fraud is different and has estimates that reach as high as $80 billion. Attendees had the figure put into perspective by CNN's Senior Medical Correspondent, Sanjay Gupta, MD, and Harry Markopolos, the fraud investigator that exposed the ponzi scheme of Bernard Madoff.

Markopolos told the audience that every year of Medicare fraud is equal to $60 billion, or the amount of money bilked off unsuspecting victims in Madoff's ponzi scheme. He added that up to 20% of all Medicare expenditures are fraudulent.

Gupta interviewed Markopolos regarding healthcare fraud, subtly weaving in and out of the topic of Wall Street fraud – showing how the two were similar at times and also very different.

Markopolos said that Medicare fraud is easier to get away with and that healthcare fraud is a whole lot more serious than Wall Street because not only is money at stake but so are “lives.“

He said that the most common frauds are upcoding – which involves a physician treating a patient for a disease like pneumonia and submitting a billing claim that the patient was treated for complex pneumonia.

Other types of fraud occur through kick-backs for medical devices and pharmaceuticals.

Markopolos urged attendees not to take anything from vendors – whether it is a coffee mug or lunch, because studies show those gifts influence the way physicians make their purchases.

He also said that a good rule of thumb is to ask the question who benefits from this purchase from the vendor – the physician or the patient?

“Think of it as if you're a homeowner,“ Markopolos said. “If a painter paints your house, does he cut you a check after the work is done? When you're treating patients financially instead of clinically, the government will put you in an orange jumpsuit.“

Gupta asked why fraud was so rampant especially when it came to the Centers for Medicare & Medicaid Services (CMS).

“Are they not good at their jobs or are they overwhelmed . . . ?“ Gupta asked Markopolos.

Markopolos said that in some instances that the answers to both of Gupta's questions are yes. He added that organizations like CMS become “captive“ of the industries they regulate. He pointed out that this is the case with FDA too, which sometimes approves medical devices and pharmaceuticals they shouldn't.

“It happens because CMS is [underfunding enforcement] and the returns to [commit] the fraud are so high,“ Markopolos said. “When the cop on the beat is asleep this is a problem, but when he's comatose that's an even bigger problem and that's the case with CMS.“

He added that Electronic Health Records (EHR) put a different spin on fraud and serve as a “double edged-sword“ in some respects.

“The EHR can make fraud easier to find, but also makes it easier to camouflage.“

Gupta brought up recent comments made by Sen. Tom Coburn (R-Okla.), who said that the government should send undercover patients into doctors' offices to probe whether the doctors were willing to break Medicare rules — a practice that would be highly similar to mystery shoppers that help identify bad customer service at stores.

“I'm curious is that where we've arrived . . . undercover agents?“ Gupta asked.

Markopolos said that while this was an effective tool, as a citizen of the U.S. it felt a little too “big brotherish.“

“It's a proven law enforcement tool,“ he told Gupta and the audience. “I hate to say it, but it may come to that.“

But Markopolos said that healthcare had gotten into a rut and that the seriousness of fraud and healthcare spending is getting to the point where it needs some type of stricter regulation.

“That's a result of the industry not healing itself,“ he said. “Now healthcare is going to have an outsider come in and do it for them. “We're now 16% of GDP we're headed toward 20%. Medicare looks like it's going to go out in 2017 [or] 2019. We have two choices; go bankrupt as a country or we get government spending and healthcare spending under control.“

Gupta's interview of Markopolos helped close nearly four days worth of activities and sessions geared toward health information technology last week.

The key take home message from this year's meeting was that the group can be the attendees of change. The message of change ranged from being leaders in innovation that would help initiate stronger healthcare reform to not turning a blind eye to any type of healthcare fraud.

In an earlier session, HIMSS board Chairman Harry Chaiken told the audience to continue to stay the course and that their contributions would help transform healthcare.

“It's now about what you and your organization are doing to transform American healthcare,“ he said. “I suspect that some of you may see yourselves clearly within this context while others may not. Let me suggest to you today that no matter whom you are and what your role is, you have an important, if not critical, role to play to achieve transformation. You can fulfill your role by building a multidisciplinary team with the expertise needed to solve a problem. You can fulfill your role by gathering and sharing data and evidence as you go along. And you can fulfill your role by having the courage to stay the course or to change your mind – whatever the situation calls for.“