BB&T Contributing Writer
NEW ORLEANS — Those interested in taking the pulse of and pace of ongoing developments in health information technology (HIT) can find it best at the annual conference of the Health Information Management Systems Society (HIMSS; Chicago). A large irony of this year's event in late February was that the fast pace of these developments was set against the conference's location, a city attempting to recover from the large setback delivered to it by Hurricane Katrina.
Nine weeks after Hurricane Katrina hit New Orleans in 2005, Stephen Lieber, president/CEO of HIMSS, flew to the area to determine the feasibility of holding the organization's convention there. Lieber found the convention infrastructure intact and the organization decided to remain in New Orleans, trusting that the people involved in the massive cleanup would prevail. And HIMSS was making a concerted effort to support the New Orleans economy, by bringing attendees to the annual February meeting and assisting the recovery in various other ways.
Throughout the conference HIMSS showcased the Katrina/Phoenix project in which the organization is assisting 10 of the area's physicians in their post-Katrina recovery. Another irony was that Katrina has helped to demonstrate a key benefit of electronic HIT systems. Prior to several keynote speeches, video-taped testimonies featured area physicians who had lost all their records because they were running paper-based officers. But following Katrina, they had quickly scaled the EHR learning curve to become electronic-based.
In addition, HIMSS is supporting Common Ground, the free clinic for New Orleans people set up after the hurricane, attempting to fill the gap left when seven of the city's 10 hospitals were damaged or lost. The clinic serves any and all who come, but it is restricted by limited staff and physical capacity. The free clinic is providing many essential screening services to the 50% of the pre-Katrina population that remains, with people arriving at 5 a.m. each morning to be seen, hopefully, that day.
Conference registration was 23,320, about 2,000 less than expected — not because of any fall-out from Katrina but due to winter storms across the Midwest and Northeast and the shutdown of hundreds of flights. About 50% of attendees were exhibitors staffing the 900-plus exhibits, almost 25% of which were first timers and nearly 60 more than the vendor numbers in 2006.
Conference organizers said attendees included more physicians and nurses, but that is a group it traditionally doesn't attract. Thus, many of the 200-plus companies product electronic health records (EHRs) and most of the 198 computer practice management vendors don't exhibit, particularly the smaller ones. It does, however, attract hospital chief information officers by sponsoring organizations like CHIME.
Titans moving into HIT arena
Parallel to other areas of med-tech where the the industrial conglomerates are moving into clinical healthcare, various software titans are developing critical mass in HIT, this trend offering another major theme at the HIMSS meeting.
Intel (Hillsboro, Oregon) is moving into the sector as it realizes that the healthcare market represents a significant potential for large chip/device sales. The newly appointed CEO of HL7 (Ann Arbor, Michigan), the organization that provides the framework and related standards for the exchange, integration, sharing and retrieval of electronic health information is Charles Jaffee, MD, PhD, who is being supported by Intel. Along with Linux supplier Red Hat, Intel is also involved in development of the Red Hat Enterprise Healthcare Platform, an enterprise version of Linux tailored for healthcare applications and adopted by McKesson (San Francisco) for some of its patient care applications.
Michael Simpson, chief technology officer for McKesson Provider Technologies, said Linux is "a high-value, open platform designed specifically for the needs of healthcare IT [that] represents a major step forward in encouraging the use of the open source technologies instead of closed, proprietary technologies that are costly to acquire, maintain and scale." McKesson has already deployed many of its Horizon applications to Linux, running on Intel-based hardware instruments, which are significantly less expensive then if running them on Microsoft proprietary platforms.
"The collaboration between McKesson, Intel, and Red Hat will be defining for healthcare customers as it represents a shift from traditional costly platforms to a reliable, scalable platform," said Matthew Szulik, CEO and chairman of Red Hat.
Intel also has been working with Philips (Amsterday) and Motion Computing (San Francisco) to introduce a new type of healthcare computer platform, bearing the most resemblance to a PC Tablet, but with a large handle molded into its case. That may not sound like an important feature, but it made holding the platform securely in one hand practical, whether you are left or right handed, making it practical for the first time. We saw these new devices at the booths of Philips, Welch Allyn, Motion Computing and many others, indicating that Intel had done its design homework.
McKesson keeps growing
But the big news at the show for McKesson wasn't just Linux. Mckesson used the meeting to announce its purchase of Practice Partner (Seattle). The Practice product is a complete solution — including software, billing and collection services, supplies and connectivity — targeting physician practices, regardless of size, specialty or geographic location. And the product has a substantial market share in the physician office sector.
This acquisition, supplements McKesson's previous investments in Per Se and Relay Health, rounding out its movement into the lucrative physician office market.
The acquisitions by McKesson are just the latest among other recent consolildations and partnerships in the space: Siemens' partnership with NextGen; Cerner acquiring Vitalwork; GE Healthcare acquiring SEC, Millbrook and IDX; Allscripts acquiring A4 Health Systems and Advanced Imaging Concepts; Eclipsys acquiring Athena Health; Meditech partnering with LLS Data; Misys acquiring Amicore — just to mention a few. All these competitors have carefully crafted acquisitions over the last 15 months to position themselves as suppliers through the group practice EHR developers they have acquired or established partnerships with.
Microsoft hypes futuristic HIT
Another big player in computing with a growing presence at HIMSS is Microsoft (Redmond, Washington). CEO Steve Ballmer presenting the opening keynote speech in which he painted a broad, futuristic and somewhat surrealistic picture of future healthcare using Microsoft technology. In his presentation, Ballmer rolled out the current bio-intense buzz words — genomic research, protein mapping — combining these with the IT-intense currency of XML, natural Language Processing and others.
While reporting that Microsoft's Healthcare Group now employs 600 healthcare workers, Ballmer did not detail the specific directions Microsoft plans to take in the healthcare field. Indeed, Microsoft's latest OS version — Vista — is not ready for medical "prime-time," having broken many of the applications that its previous Windows XP version was compatible with.
Ballmer also referred briefly to Azyxxi as a Microsoft acquisition, without explaining this software. But a visit to the Microsoft booth revealed that it is sort of HL7-CCOW on steroids. Rather than just communicating with multiple legacy applications to coordinate their data on a patient and make it available via a dashboard, Azyxxi actually retrieves data from various other repositories, builds its own structure a layer above its own SQLServer databases and then provides a well-done user interface for clinicians to slice, dice and filter view of the data collected.
However, this approach raises concerns about data privacy, data ownership, and the potential for logical data errors and inconsistencies. We found Azyxxi to be less revolutionary and foundational than the futuristic healthcare vision described by Ballmer.
Microsoft also reported launch of its Connected Health Framework (CHF) architecture and design blueprint, a free download of code and instructions to assist CIOs to leverage web services and integrate disparate applications.
In addition, through the acquisition of Medstory (Foster City, California), Microsoft wants to empower medical consumers by employing the software which applies artificial intelligence techniques to health and medical journals, government documents and the Internet.
Progress at IHE Connectathon
A forward-looking and effective presentation at HIMSS was its Connectathon, a connectivity demonstration of its traditional IHE (Integrating the Healthcare Enterprise), sponsored by HIMSS, the Radiological Society of North America (RSNA) and the American College of Cardiology. IHE is a global initiative in its ninth year with the goal of creating a framework for exchanging and sharing health information across the healthcare enterprises.
The Connectathon featured 76 EHR companies (up from 61 in 2006) testing their products for adherence to the IHE's technical frameworks aimed at reducing implementation and integration costs, supporting more efficient workflows across the healthcare industry and enhancing patient safety. It attempts to get over the barriers offered by technologically-advanced clinical environments that typically house different systems with disconnected data silos.
New at the IHE connectivity demonstration were hospital medical device vendors showing interoperability. This was demonstrated by a walk-through scenario of a woman arriving at an emergency department (ED) with chest pain prior to her scheduled cardiac surgery. In the ED, she is connected to a monitor from Welch Allyn (Skataneales, New York) that captures temperature, pulse, blood pressure and Sp02.
Upon transfer to the ICU, the data was sent to a Philips monitor, and the woman was intubated and placed on a ventilator by Draeger (Telford, Pennsylvania) where the physiologic parameters were transferred to an anesthesia system from GE (Waukesha, Wisconsin) prior to surgery.
As of now, these scenarios are virtual only and have not yet reached the "real world" clinical setting, but at this year's HIMSS, IHE reported the beginning of an effort to track feedback from actual installs of not only medical equipment and interoperability but all the other arenas that IHE tracks.
Tracking as well as computing
The complexity of healthcare delivery in the modern environment creates a wide array of problems, from the disappearance of assets — none as "shrink" in the retail environment — to unnecessary mortality as the result of medication errors. These issues have offered a diversity of product opportunities, and these were among the most interesting, and potentially useful, offerings at the HIMSS exhibit. Some examples:
• InnerWireless (Richardson, Texas), a provider of in-building wireless systems, reported that its real-time location system (RTLS), called Spot, is commercially available following a year of successful beta testing and integration with location-enabled applications. InnerWireless said that Spot gives "room-level" accuracy for tracking and locating critical medical devices and assets.
Spot uses architecture comprised of master radios, beacons and asset tags that work together to locate equipment in real time, down to room level. Spot also is wireless, predominately battery operated and requiring virtually no cabling, so its wireless infrastructure "is as easy to install as a home's smoke detector and does not disrupt the sterile hospital environment," the company said. The company noted that Spot is an open solution to ensure that location information can be integrated into applications. InnerWireless said it has completed integration with PanGo Networks (Framingham, Massachusetts) for location management and asset tracking; St. Croix Systems (Burlington, Massachusetts) for enterprise asset management; and SYMX Technologies (Santa Clara, California) for equipment and resource management.
• NEC Unified Solutions (NEC; Irving, Texas), a developer of voice-over-Internet protocol (VoIP) and data communications, exhibited its Univerge Assured Mobility portfolio with the addition of a location tracking component for healthcare. The Wi-Fi-based radio frequency identification (RFID) solution operates within NEC's Wireless Optimized Architecture (WOA) to track the location of medical devices, patients and hospital staff, "increasing workflow efficiency and reducing costs for healthcare organizations," it said.
NEC's Location Tracking is designed to enable hospital staff to track and quickly locate tagged equipment and patients. In addition, patients can alert doctors and nursing staff in critical situations through a remote call button at any point after admittance. The system also provides hospital staff with a record of where a patient was taken and the types of equipment used in their vicinity, allowing for improved billing efficiencies through location-based association.
Location-based events (i.e., a patient entering an unauthorized zone or equipment requiring immediate delivery) automatically trigger alerts and notifications.
• IntelliDOT (San Diego), which focuses on patient safety and workflow management solutions for healthcare, exhibited a new handheld system featuring RFID capabilities for use with the CAREt System, IntelliDOT's handheld barcode patient safety technology. According to the company, it is the first nurse-centered workflow manager to connect caregivers with the information systems they need at the point of care (POC).
With the RFID feature, the nurse no longer needs to see the patient's wrist to scan the barcode. Instead, the reader can be within a few inches of the patient's wristband to verify the five rights. IntelliDOT will also read RFID information on clinicians' name badges to ease workflow, in addition to wristbands for patients.
• Aethon (Pittsburgh), a developer of mobile autonomous robots for practical business applications, reported the availability of what it said is the "first mobile autonomous asset utilization solution designed to locate, deliver and recover hospital equipment." The solution, which the company said is the only one capable of automated transportation, features HOMER, Aethon's RFID-based asset tracking system, and TUG, the company's asset delivery and recovery system.
Leveraging the TUG platform, HOMER employs a single mobile antenna that eliminates the typical infrastructure hurdles of competitors' systems, according to Aethon. This translates into more efficient organization and location of pumps, wheelchairs, monitors, respirators, beds and virtually any other assets hospitals are interested in tracking, the company said.
TUG is an autonomous mobile robot that requires no extra infrastructure investment, is simple to install and has many applications such as central supply, dietary, pharmacy, laboratory, medical records, nursing and linens.
• Cardinal Health (Dublin, Ohio) reported launch a point-of-care (POC) offering designed to help hospitals reduce medication errors. The company said that nurses and other clinicians will be able to use one application to monitor orders for their patients, determine the location of medications, pre-program pumps for IV infusions, verify the accuracy of medications administered and document to the hospital's existing IT systems.
The company said this system is made possible by a combination of its Care Fusion bedside verification application, MedStation units from Pyxis (San Diego) and system IV pumps from Alaris (Hampshire, UK).
A Cardinal spokesperson said, "We're managing the information, but we're also managing the physical product flow and the actual devices and I think that's the difference between what we're doing and what most of the players at HIMSS are doing."
The new POC technology also allows clinical data to flow from the hospital pharmacy information system through a single Cardinal interface. The system will also support reporting to other information technology systems in the hospital.