Agency Chief of Staff Mark Kinsela reports from the 2019 HIMSS Global Conference.
The $200 billion global digital health market is huge, I really mean huge. So any conference that attempts to bring together 90+ countries and 45,000 professionals for education, and collaboration to transform health through information and technology – all at one time, all in one place would have to be enormous.
This is what the annual Healthcare Information and Management Systems Society’s (HIMSS) global conference attempts to do, over the course of four days. The scale of this conference can only be truly appreciated in person. This year over 45,000 participants attended, with 11,000 organisations showing off their products on a showroom floor that was almost 2km long. There are only three conference centres in the US that can host an event of this size, which literally books out every hotel in Orlando, Florida.
The major theme of this year’s HIMSS19 global conference was interoperability. From smart patient bedside monitoring that automatically connects to the hospital’s EMRs1, to wearables and all things FHIR®. It was fantastic to see the founder of HL7 FHIR, Grahame Grieve, treated with absolute reverence, as the adoption of FHIR is helping to overcome many of the interface issues between previously unconnected technologies and implementations.
The National Coordinator for Health Information Technology of the Office of the National Coordinator for Health Information Technology (ONC), Karen DeSalvo, in an opening panel said she felt the US had gotten it wrong by talking about “technology interoperability”, rather than “person-centric interoperability” saying “health is more than health care … we need to look at the use cases which benefit the consumer”. On the same panel, Aneesh Chopra, the former Chief Technology Officer to President Obama, stated “the consumer should have the choice to use an app to connect to their health information. We need all of industry to speak the same language”.
ONC Information Blocking Rule
The first day of the conference, 11 February 2019, coincided with the announcement by the ONC of the draft rule on interoperability and data blocking.2 The rule itself is a massive step toward enabling consumers to take their health information with them, regardless of which organisation provides their health cover. In a consumer panel on choice and privacy the audience got involved and asked “what is the role of the consumer in deciding who can access their health information?” It’s interesting to see the United States now embarking on the same conversation we have been having in Australia over the last six months.
The President and CEO of HIMMS, Hal Wolf, said the draft rule would be a turning point for the United States, particularly complementing the ONC’s position that a person’s health data should always be free for them to access – at no charge.
Power Plans and coordination of care
In a visit to AdventHealth, the largest Cerner implementation in the US with 60% of their 48 hospitals having reached HIMSS Stage 7, it was interesting to see how health data is being used to drive better patient outcomes. AdventHealth has implemented “Power Plans” through their EMR, where a treating clinician is able to access best practice and peer reviewed treatment plans for key conditions, such as sepsis. AdventHealth has seen a 67% reduction in patient harm over 5 years from implementing these digital tools.
Their approach to digital health is to support their clinicians, through data, to best treat their patients. AdventHealth has changed the way they are coordinating patient care, both to drive digital adoption and to better support patients with multiple co-morbidities, by admitting the majority of their patients under a Hospitalist (something equivalent to our salaried Career Medical Officers or a Gen Med team). The Hospitalist is responsible for coordinating the patient’s care while they are in hospital, which includes specialist consults and procedures. I’m not sure the model would work in the Australian context, or if it’s a cost-effective model of care, but it’s certainly one to think about when looking at models of care coordination in the hospital setting.
Getting identities right
Australia’s digital health system leads the world in multiple respects, which is something that we should all feel incredibly proud of. The Individual Health Identifier (IHI), though rarely touted, is one of our success stories. In Australia more than 97% of patients can be matched with their IHI, a fact which had the executive at EMSA in complete shock and asking how they could implement such an identifier.
California’s Emergency Medical Services Authority (EMSA) is leading the way in the United States with a mobile patient record. They have just successfully trialled bi-directional exchange of information in a pre-hospital setting for emergency services. However they still only have a 35% patient match rate – that is, one in three patients can be identified successfully with their health information. For return patients, the match rate increases to 40%.
Consumer trends in healthcare
It’s not surprising that the major consumer trend toward smart voice recognition and voice activated products is also finding its way into health care. One Australian hospital, Prince of Wales Hospital, was recognised at HIMSS for trialling the use of “Alexa” in patients’ rooms. The voice-activated device enables patients to listen to music, news services or call a nurse. It also enables clinical staff to order basic hospital functions like asking for an orderly to prepare a room for the next patient. Anecdotal findings from the trial were that 100% of patients engaged with their voice assistant, and a general reduction in the use of pain medications was seen. We don’t have any hard data as yet, but this is clearly something to watch.
At the end of the day, it’s all about people
While HIMSS19 leaves you with no doubt there are some very big dollars involved in digital health, there are also some incredibly compelling use cases for how technology can not only improve the safety and quality of health care, but empower patients and their clinicians. To quote Hal Wolf again “we have all fallen in love with the word ‘and’ – health and technology, rather than just health technology”. There is a real sense that the conversation is no longer about technology – the conversation is about people, their health and how technology can better support them and those who care for them.
Mark Kinsela is Chief of Staff at the Australian Digital Health Agency.
EMR = electronic medical record. ↩
Information blocking, as the term suggests, occurs when health information is deliberately blocked from being shared. ↩