I woke up at 3:30 this morning because I slept half the day yesterday after arriving on a red-eye from HIMSS12 in Las Vegas. We were thrilled that the Annual Conference had record-breaking numbers of attendees and exhibitors. It was a fabulous week of learning and catching up with friends, and I was ready to come home. My experience with HIMSS has been tremendous and has given me a good overview of the current healthcare IT landscape. A few interesting observations from my travels:
1. Everybody has the same problems. I’ve been working at Partners for many years. People are always impressed by the name and our accomplishments in health IT. But while Partners has made many great contributions, like any organization, we also have our challenges. Our friendly competitor in town attested for Meaningful Use Stage 1 on the first possible day while we are still certifying many of our systems for attestation in 2013. Our CIO says, “We only know what we know.” That’s how I have felt — I know our integrated delivery system and the Boston healthcare market, but does that translate to what others are experiencing across the country?
It turns out that it does. I have been fortunate to learn pretty detailed information about how many organizations approach clinical care processes, research and development, teaching, and mission to their communities. Of chief interest to people like us, of course, is IT strategy and the approach to supporting these endeavors in an environment where the payment system is likely changing and resources are limited.
To my surprise, I haven’t encountered a single scenario that I hadn’t run across in my experience at Partners. Healthcare providers, large and small, are adopting EHRs to meet Meaningful Use, working on integration and data exchange with business partners, and looking to turn data into information that can be used to manage population health. All of these activities require IT departments to be more efficient and execute more projects on short timelines with the same or fewer resources.
2. “Open” versus “closed” systems. Of most interest was the very clear divide between those who are sold on the very successful vendors with closed architecture versus the few that are making their way with an eye toward open standards. I put open and closed in quotes because deeper technical dives on products can show that market perceptions aren’t always the reality. I have written in this space before about significant interoperability success with one of the “closed” vendors.
In the community setting, many seem to continue to have success with the one or two vendors who can provide a complete package and support for relatively low cost. This includes the ability to overcome regulatory hurdles like 5010, ICD-10, and Meaningful Use. In the academic/large hospital market, there are some who adopt a “nobody ever got fired for buying a certain vendor from the cheese state” theme. This also appears to be a conversation amongst some of our Clinical Chairpersons across the country. Chair of Medicine at X tells his med school buddy, who is Chair of Medicine at Y, that they have had a great experience with that vendor. Chair of Medicine at Y may have never laid eyes on the system, but he’s an evangelist at Y because of his friend at X.
On the other side of the divide, for some organizations with informatics and development ability, there is an equally strong passion for retaining the opportunity to innovate and conduct research on new clinical knowledge interventions within systems. While even these institutions acknowledge that some functions are best supported in a vendor platform, the vendor must be willing to partner on innovations and invest in intellectual property. Above all, the vendor’s architecture must support local interventions and interoperability.
We have yet to resolve this at Partners. As we look to our next generation of clinical systems to support our mission and the mandates from regulators and payers, we have the same questions. We certainly have people with passions for both of these arguments.
3. Research has different computing needs. We’re all familiar with Moore’s Law — the number of transistors that can be placed inexpensively on an integrated circuit doubles approximately every two years. There is also exponential potential in personalized medicine as we unlock the human genome and discover ways to use this powerful information in the patient interaction. Our basic science and clinical researchers have different computing needs. I’m no expert, but my years at Dana-Farber Cancer Institute and serving the Partners AMCs have shown me a few themes.
Our researchers have some common needs, but they operate very independently. In most cases, they have secured their own funding and paid the requisite “institutional tax.” When it comes to computing needs, they want to purchase the latest, most powerful computing platforms and lots of storage as cheaply as possible. While they certainly understand security and privacy issues, they often need more flexibility than our locked-down processes in the clinical care environments. They want to be able to move quickly and often need to collaborate across many institutions and business entity boundaries.
Then there is the prolific use of Apple products. For years, we have supported the MacIntosh hardware and OS on a “best effort” basis. Since the advent of the iPhone and iPad, we have established more “consumer friendly” support models that keep our security standards in place. The use of Apple products has become so large that we are now considering a standard offering and support structure. Finding ways to support this community while maintaining information security practices and rigorous budgeting is imperative.
For many organizations, building the bridge between research innovation and standard care operations is fundamental to the mission. From a technology perspective, we need to allow “coloring outside the lines” for innovation, then work hard to codify what works in technology standards. Much of the directional debate in #2 seems to be about organizational ability to execute on this point.
It’s still dark outside, so there’s plenty of time to run and then continue our efforts to meet the healthcare IT challenge.
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