HealthTech

HealthTech is pleased to announce its daily news coverage of the Healthcare Information and Management Systems Society (HIMSS) conference being held April 4-8, 2009. Follow Dr. Tinstman as he attends sessions, talks with thought leaders and presenters, explores technology exhibits, and witnesses the launch of new products.

At the conclusion of each day, Dr. Tinstman will write a news update highlighting key presentations while giving his reactions to innovative IT and systems management solutions.

Respond to HIMSS daily news by asking HealthTech and Dr. Tinstman your HIT questions, or express your opinion by leaving a comment on our webpage. Posts will be updated daily for the duration of the conference with a full conference summary released in the next few weeks.

The full conference summary on HIMSS 2009 can be found  here.

April 7, 2009

HIMSS is a combination of a trade show and educational presentations focused on healthcare change that is supported by technology.  Historically, there has been an unofficial theme that crosses the vendor booths on the exhibition floor.  This year there wasn’t an obvious or common theme that crossed suppliers.  Remember, the vendors had to make their plans before the election and their booths were on the road before the ARRA was much more than a conversation.  Although there wasn’t a single theme, potential future themes appeared.

To my knowledge no EMR vendor has been able to quench their customer’s thirst for a data warehouse with good analytical tools and more importantly, benchmarks.  The result is an emerging number of companies offering third-party analytical services.  Improved interoperability may result in the evolution of analytical solutions designed to accept administrative data, financial information, process metrics, and clinical data (from EMRs) from disparate systems.  As the terms of the ARRA investment in health IT and healthcare reform move forward, a detailed understanding of your patients and the services you provide them will become increasingly important.  

The educational presentations have transitioned from historic discussions about selection and implementation of clinical applications to presentations focused on clinical decision support used to improve patient safety and the quality of care.  Hallway conversations between the presentations showed an increasing interest in how vendors could improve their user interfaces to assist the clinician in decision-making and facilitate data entry.  Presenters made fewer references to “meaningful use” while there was increasing reference to coming changes in reimbursement. Discussion centered on bundled or episode reimbursement that combines Medicare parts A & B payments, leaving the physician and hospital to decide on the distribution.

April 6, 2009

ARRA continues to work its way into all conversations, most presentations, and was the exclusive topic of discussion at three meetings I attended today. Best guess is that “meaningful use” will be defined in phases with the expectations increasing over time. Initial criteria will include the use of a CCHIT-certified EMR with Stage 3 or 4 capabilities as defined by the HIMSS adoption model (such as clinical data repository, CPOE, and nursing documentation) and with the ability to exchange information electronically with other patient care organizations and the government. The earliest effective date for implementation is probably the Fall of 2010.

Real time location systems (RTLS) continue to make slow, steady technical progress, but examples of comprehensive implementations (equipment, supplies and people) remain few. A new technical development is a system using ZigBee to create a mesh network. This approach may decrease the cost, simplify the infrastructure and increase precision. If this is successful, it means there are now four technologies to choose from—Wi-Fi, ultrasound, infrared, or ZigBee.

The snow was replaced by sunshine, but it is not any warmer!

April 5, 2009

HIMSS officially opened with the actor Dennis Quaid as keynote speaker. He introduced himself by explaining he had never played a physician and has only just learned to use e-mail and send text messages. Then he related the heart-wrenching story of how his young twin babies were admitted to the hospital to treat an infection. They received 10,000 units of Heparin instead of ten to flush their IVs, not once but twice, before unexplained bleeding was noticed and the medication error recognized. He related the multiple system failures and human errors and politely pointed out that airlines have successfully worked to eliminate system errors and use technology to reduce the risk of human error. He challenged those present to work energetically to bring health care up to the standard of safety achieved by the airline industry. His twins are now eighteen months old and at this point don’t show any adverse health effects.

Within the first three paragraphs of every presentation, speakers mention ARRA, the stimulus bill, and then point out that they are waiting for the definition of “meaningful use” and certification. Speculation abounds. Representatives of the relevant government agencies are gathering input. The first regulations will be presented for public comment in mid-May. Stay-tuned.

What’s new? Geographic information systems (GIS) are appearing on the trade show floor. The first iterations combine mapping with publicly available information about health services to support planning. I suspect this is just the beginning, with more innovative applications using GIS to come. T-Mobile has done it. They offer a service that allows an employee or physician to walk from the parking lot into a hospital and have their T-Mobile handset pass their call from their network service to the organization’s Wi-Fi network without dropping the call. Multiple suppliers now recognize the home as another and increasingly important venue of care.

What’s not new? Clinician devices for accessing clinical information systems. So far it is still computers on carts, computers attached to the wall and handheld tablets. I’ll keep looking.

A further word about the weather - Chicago is living up to its name as the “Windy City”. The icy snow is traveling horizontally. I’m freezing.

April 4, 2009

Historically, the HIMSS Annual Conference has been held in a sunbelt city in February and officially started on Mondays. For the first time that I can recall HIMSS is in Chicago, in April, and starts on a Sunday. And guess what else is new! They are forecasting snow.

People attend HIMSS to stay connected and to learn what’s new. Registration this year is down 10% so there is some chance that connection won’t be renewed.

What’s new? ARRA or the American Recovery & Reinvestment Act came up in every presentation today. What everyone wants to learn but is probably unknowable at present is the exact definition of “meaningful use” in order to qualify for the EHR incentive payment. I don’t see a knowledgeable government person on the agenda who could answer that, but one presenter guessed that the first few years will require e-prescribing and adherence to the Continuing Care Document standard.

This year’s conference theme is “transforming healthcare through IT.” The consensus is that ARRA will incentivize transformation. The whispered fear is “what if we can’t meet the expectation” of this investment in transformation.

Stay tuned for what I see that’s new and the conversations from around the “water cooler” about transformation.

Biography

Dr. Tinstman has expertise in process redesign and his extensive knowledge of technology are tools he uses to advise health care delivery organizations on improving safety, efficacy, cost, and satisfaction for the clinician and patient in both inpatient and outpatient settings. Dr. Tinstman was the Executive Director for Clinical Information Systems at University of California Davis Health System (UCDHS) in Sacramento, California, from 2001 until January, 2007. In this role, Dr. Tinstman was responsible for information systems strategy, implementing and operating all clinical systems and Health Information Management. Prior to joining UCDHS, Dr. Tinstman was the CMO at Cerner Corporation for six years. Dr. Tinstman served as Director of Medical Informatics at the University of Texas Medical Branch in Galveston, Texas. Concurrent with his appointment at the University of Texas, Dr. Tinstman was Associate Medical Director for the Texas Department of Criminal Justice. Dr. Tinstman practiced in Omaha, Nebraska, for seventeen years, during which time he also served as CEO of a major medical group for three years. From 1989 - 1993, Dr. Tinstman served on the Patient Focused Care Steering Committee of Clarkson Hospital in Omaha, Nebraska, which focused on reengineering the patient care process. Dr. Tinstman earned his bachelor’s degree from the University of Nebraska and his medical degree from the University of Nebraska College of Medicine. He completed post-graduate training in internal medicine, pulmonary medicine, and critical care at the Mayo Clinic in Rochester, Minnesota.