DeSalvo and Tavenner Keynote HIMSS 2014 – an online attendee’s perspective

Here are some observations from this morning’s HIMSS 2014 keynote session with Karen De Salvo and Marilyn Tavenner

Karen DeSalvo from the ONC – clearly she is an accomplished and energetic  speaker.  She gave a great ‘rally the troops’ speech about HIT which must have resonated in the hearts of the HIT and HIMSS crowd.  She clearly believes in HIT and its promise, and mentioned interoperability as a chief goal of the ONC. “Patients should not be walled into data because the vendor doesn’t want to share.“  She is clearly on board with administration speaking points regarding the current unsustainability of health care costs.  “It will be hard.  It will be fun! It will be rewarding” She emphasized her data-driven orientation: “ we need to start providing data to inform new models of care.”

Marilyn Tavenner from CMS – After a policy speak discussion of current CMS internal goals and metrics as well as their star system, ears picked up regarding the tailored remarks towards the end of her speech:

On ICD-10 implementation: “Let’s face it guys – we delayed it more than once.  It’s time to move on.  There will be no delay again.”
On Meaningful use stage 2 : “We understand, and hardship exemptions will be granted to providers/vendors but we expect all providers to be MU2 compliant by 2015”
On data : “Data is the lifeblood of our healthcare system.”

Questions asked:

To Tavenner:  Q: Regarding the challenges with stage 2 implementation, what are you able to do and what about deadlines?
A:  examples given of a vendor not ready with stage 2 technology being potentially eligible for an exemption; or a physician not able to meet hard percentages eligible for an exemption.

                           Q: her experiences with healthcare.gov, “lessons learned”

                           A: system integrator was the missing key for a multiply sourced project and they did not have that soon enough.

                           Q: Non-eligible providers.

                           A: excluded on a statutory basis, so little she could do except sympathize.

To DeSalvo:     Q:HIT can help end hunger?

                            A: HIT can help with social service integration

                            Q: Patient identification via HIE/HISP

                            A: Not as difficult as it seems – smart folks are working on patient matching algorithms and demand for this will drive development.

The final comments on the big ideas for the next 5 years: Less fee for service, more care coordination, payment tied to quality, more data being produced to be shared with the public at a reasonable cost.  Finally, DeSalvo described a virtuous feedback loop where available data informs technology that informs care and creates more data, ultimately leading to disruptive change.  (intriguing!)

That’s it for me from HIMMS 2014.  I hope that you found these posts useful and will consider coming back to read some other of my views!

HIMSS Online Day #2 (morning to early afternoon)

1.  First Lecture:  Meaningful use risk assessment: Requirements, Methodology, Challenges, and Lessons.   Joy Pritts, JD Chief Privacy Officer from the ONC and Johnathan Coleman from Security Risk Solutions.This was a very good and clear session on meaningful use risk assessment and how to survive this aspect with an ONC or CMS audit.  The clear slide session is available (in your briefcase) .  Key Points were (borrowed from the lecture):

  1. Identify the scope of the Analysis
  2. Gather Data
  3. Identify and document potential threats
  4. Assess current security measures for vulnerabilities
  5. Determine the likelihood of threat occurence
  6. Determine the potential impact of threat occurence
  7. Determine the level of risk
  8. Identify security measures and finalize documentation

Key points were that these audits were not expected to be exhaustive, but reasonable, well thought out, with good documentation and recorded policies and procedures.   Internal audits should be annual (at a minimum).
Note was made that recent audit failures with financial penalties assigned were tied to mobile.  Firewall security was discussed with suggestions to test it as well as the EHR.
A point was also made that this security is not merely tied to the EHR – the entire enterprise in the health care setting is evaluated, not just the EHR.  Vendor solutions are not (necessarily) absolute.
This is a worthwhile talk to take the time to listen to – clear, informative, and engaging!

2.  Second Lecture : RTLS – its not for just assets anymore!  Kathi Cox from Texas Health.  Very good and useful presentation about the use of RTLS (sometimes RFID; other technologies exist) fully integrated into a new hospital to track patients, caregivers, and assets.  The cost of install paid for itself in a year with a million dollars in savings.  Obvious benefit was the integration of the RTLS system with the EHR #timestamps which freed employees up from non-value added activities that create timestamps (example given of nursing call light turning itself off when nurse enters patient room).  They applied the technology to inpatient use – tried to apply it to the ER but since active technology was used, too many tags were leaving the hospital and creating unnecessary costs, so they backed off there.  Assets (patients, providers, equipment) are tracked at a central facility, and web apps can be used for locators.   #workflow benefits cited, as providers knew where patients were.  Also, examples of improved bed turnaround time were cited as once a patient leaves the room (is discharged), the cleaning team can enter and begin preparing the room immediately.  
Benefits of location were cited as to employee rightsizing (staffing to need) and bed rental management (where rental beds were used, where they were not).  infection control and temperature control also cited.  The means of creating ‘chokepoints’ for RTLS detection was shared as one monitor inside the patient door, and one monitor outside the patient door (to track movement down halls, etc..)

This was a great presentation – consideration has to be made that this was a de novo install in a new institution that had experience with prior RTLS applications.  But it does make a great argument for the RTLS technology in asset tracking.  And its nice to have providers/employees thought of as assets, instead of liabilities.

3.  Third lecture : Next Generation Revenue Cycles – Elaine Remmlinger, senior partner at Kurt Salmon.   This should have been sub-titled, “How to select new billing software to adapt to new billing paradigms upcoming”.   A detailed, and well thought out discussion of the pitfalls of purchasing this type of enterprise software was performed.  Actually, the steps and criteria could be applied to ANY sort of software purchase.  Truth be told, this lecture was most oriented towards CFO’s or finance managers concerned about bundled billing, capitation, and the like.  HMFA members would probably get the most out of this lecture.  The lecture was well delivered, I just probably am not the right audience for it.

More later!

HIMSS 2014 Meeting – The online experience

HIMSS 2014 Meeting – The online experience

I attended the first day of #HIMSS 2014 via the web (schedule conflict).  I haven’t been to a HIMSS conference before, and wasn’t really sure how relevant it would be to me as a physician interested in healthcare tech. Here is my takeaway.

1.  Very different than a medical conference.   Conflicts of interest were a bit more obvious.  However, in fairness, since industry is providing these solutions (not private research in most cases), you hardly would expect people not to toot their own horn.

2.  Keynote opener from Aetna’s CEO Mark Bertolini – was pretty consistent from what I’ve seen from insurers in the past.  Not right, not wrong, just really the point of view from an insurer.  Differences –  The usual slides on waste in healthcare were trotted out ($800 billion, but waste exists in the insurance industry too!)  Discussion of unsustainable increase in healthcare premia and progressive cost shifting to the consumer from employers who remain focused on defined contributions.  Some trends towards commodization of care, but also discussion of ACO/PCMH focused factory model of selecting the doctors that provide the best care at the lowest cost (a great #bigdata application if there was ever one).  What was interesting was how he seems to have seized upon #hotspotting of healthcare ‘super-users’ (1) as a tool for future care delivery and cost savings.  As these super-users tend to have two or more chronic conditions (and be elderly or disabled with serious medical conditions), they account for a disproportionate amount of care and spending – 1% of the plan members account for 47% of the costs.  He discussed a commitment to these individuals to get their costs down over time.  That’s interesting, because now under the ACA, risks must be underwritten (before they could be avoided, denied under pre-existing conditions, etc…)   I thought that this was a new and constructive approach – I’m curious to know how many of the other large insurance CEO’s are taking this approach.  From an executive perspective, I agree with it.

One other thing that was discussed was the use of connected devices in #heart failure.  He discussed the partnership of Aetna with Medtronic in the realm of pacemaker data – briefly discussed looking at how electrical impedance which was being routinely collected and data sent back to medtronic – could be used as a predictive analytic of impending CHF (heart failure).  This to me is significant – first because it is a great use of #bigdata analytics, second because it touches on the reality that there are huge private databases of clinical data that can be tapped in new and creative ways to improve patient care.  If this isn’t an argument for #opendata, what is?

3.  Next Web Transmitted Lecture ‘Securing Patient data in a mobilized world’ was about mobile data security.  Well done, nothing ground shaking, a good introduction to cybersecurity for the uninitiated.  Take away point – either use Citrix or Mobile Data Management software to remain HIPAA compliant!

4.  Next Web Transmitted Lecture was ‘Do you have hidden ROI’ was a decent high level discussion of challenges and benefits of technology implementation, with much emphasis on change management.  Good high level discussion, but the ‘ROI’ discussed was more of a soft return on investment (we see things are working better, and our patients/providers like it) as opposed to a quantifiable number.

While I thought the web based sessions were solid, I would liked to have had more variety and certainly some of the titles in the meeting which were not broadcast would have been my choice over these two topics (aside from the keynote).  Twitter under the #HIMSS2014 hashtag was insanely active – a firehose of information.   We’ll need some filtering there to make it useful!  

FYI – while Hillary Clinton is scheduled to speak to the live crowd, there will be no webcast, live or delayed.  A number of participants are upset over this.

Finally, there seems to be a good amount of additional material on the website – a number of lectures were placed online pre-recorded, and there are ‘e-sessions’ which appear similar.  I watched about half of a presentation on big data, which seemed to be well-done & I plan to go back and finish it.

I may post more on this topic if encouraged to do so.  
(1) http://medcitynews.com/2014/02/hot-spotting-healthcare-growing-trend-hospitals-find-super-users/