HIMSS 2010 – Monday

We may be in the middle of a major recession, but they forgot to tell the organizers and attendees of the 2010 HIMSS Conference in Atlanta. The Georgia World Conference Center is bursting at the seams, and teeming with activity. If you didn’t know any better, you’d think the government was about to pump a few billion dollars into the healthcare industry.

So far, most of the energy seems to be around Meaningful Use (and, by extension, EHRs and interoperability in general), ICD-10, and 5010, in that order.

Meaningful Use is, of course, a very broad topic, since it covers requirements ranging from clinician workflow to interoperability to patient communication, and beyond.

Patient Portals

I attended a very interesting presentation by Dr. Eric Liederman and Jan Oldenburg of Kaiser Permanente this morning, explaining why and how they built a “transactional patient portal” and deployed it to all of their members (the last hospital to implement the system will go live this week).

Kaiser Permanente has the largest civilian EHR deployment in the world.

Some no-brainer points of interest:

• According to a 2009 Deloitte survey of healthcare consumers, 57% of patients want a secure website to “access their medical records, schedule office visits, refill prescriptions and pay medical bills.”
• Among Kaiser Permanente members, the retention rate is 2.6-4.6 percentage points higher among patient portal users than the rest of the population.

Some surprises (at least to me):

• The most popular feature on KP’s patient portal is lab results.
• Initially, only “normal” results were available to patients via the portal. Eventually, though, most KP regions started posting all results (that can be provided legally) on the portal, because they got more from people wondering why some of their results were missing than they would from people worried about abnormal results.

Patient portals (or something very close) will be required in 2013, so it’s inevitable that most doctors will need to find and implement a solution pretty soon.

5010/ICD-10

I also attended a great round table session on 5010 and ICD-10 migration. As we’ve known for a while, there is a lot of anxiety out there around these requirements and—surprise!—healthcare providers expect software and clearinghouse vendors to solve their problems for them.

In fact, there is a lot that technology can do (and providers will absolutely have to leverage technology to address the issues), but clinicians, coders, billers, office managers, front desk staff, etc., will all be heavily impacted by 5010 and ICD-10, regardless of what their software and clearinghouses do for them.

Much of the angst right now is centered around providing training and education to staff. Providers are looking to HIMSS, AHIMA, WEDI, and CMS for guidance.

Incidentally, a Product Manager from RealMed was sitting at my table and said that around 40% of their customers are still sending claims as print image files (PIFs) of HCFA 1500 forms and NSF files, and RealMed is translating them to 4010s. He anticipates that he’ll have to continue to convert those archaic file formats to 5010. Yikes!

NAHIT "Defining Key Health Information Technology Terms"

NAHIT recently released a document called (get this):

The National Alliance for Health Information Technology Report to the Office of the National Coordinator for Health Information Technology on Defining Key Health Information Technology Terms

Basically, it has some interesting definitions for some common healthcare terminology. The location of the original document (along with the rest of the NAHIT site) appears to be down at the moment, but John Mertz at NeoTools has conveniently listed the terms for us, so I'll repeat them here:

• Electronic Medical Record: An electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one healthcare organization.
• Electronic Health Record: An electronic record of health-related information on an individual that conforms to nationally recognized standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one healthcare organization.
• Personal Health Record: An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual.
• Health Information Exchange: The electronic movement of health-related information among organizations according to nationally recognized standards.
• Health Information Organization: An organization that oversees and governs the exchange of health-related information among organizations according to nationally recognized standards.
• Regional Health Information Organization: A health information organization that brings together health care stakeholders within a defined geographic area and governs health information exchange among them for the purpose of improving health and care in that community.

I don't know whether there is industry-wide agreement on these definitions, but they're an interesting start for the uninitiated.

Microsoft HealthVault and Google Health

Long-time rivals Microsoft and Google have found something (relatively) new to bicker about: Internet-based personal health records (PHR).

Microsoft HealthVault and Google Health aren't the first PHRs on the block. Existing players include AllOne Mobile, Revolution Health, and dozens of others (see myPHR.com for a lengthy, but still incomplete, list).

In a way, HealthVault and Google Health aren't really PHRs at all, but rather platforms that PHRs can be built upon, or used to aggregate data. Microsoft, in particular, insisted at their recent HealthVault Summit that they don't intend to compete with Google Health, but rather to seek opportunities to integrate with it.

So, where are these guys going with this?

Microsoft HealthVault
Microsoft has had a great deal of success pushing their products through their partners, particularly ISVs. For example, we've benefited in the past from the fact that not only do we use Microsoft servers in our data center, but we also require the use of Microsoft Word for certain functions within AdvancedMD. Microsoft appreciates that, obviously, and helps us out with software licensing and co-marketing opportunities.

In the case of HealthVault, Microsoft hosts an annual HealthVault Solutions Conference where participants "hear directly from healthcare professionals, consumers, and Microsoft product managers to better understand the overall health landscape and product roadmap."

At the most recent conference, 40 vendors demonstrated products that they are building to interact with HealthVault.

Microsoft also announced that they would be awarding $4.5 million in grants to support organizations that are developing applications that are using the HealthVault platform.

Working through partners may help Microsoft overcome a lack of trust that the public has in the company to protect sensitive information, partially due to the highly-publicized security holes in Microsoft Passport.

Of particular interest is Kaiser Permanente's pilot program to provide health information to its nearly 160,000 employees using HealthVault. If the pilot is successful, it is likely that the program will extend to all of Kaiser's 2 million+ members.

Google Health
For its part, Google Health seems to be pursuing the consumer market more aggressively, which makes sense given its huge popularity and trust among everyone from 16 year-old script kiddies to 90 year-old grandmothers.

Even so, it seems reasonable to assume that Google will rely just as heavily on participation from partners (including Microsoft?) to achieve success, as a report from IDC suggests.

Blue Cross and Blue Shield of Massachusetts recently announced that they will be providing their members with a mechanism to import claims data into their Google Health accounts, via their consumer health portal. The integration should be completed before the end of the year.

For a very interesting inside look at Google Health, check out this post by Robert Wachter, a contributor to The Health Care Blog. Fellow contributor Matthew Holt posted this in-depth test drive, also very useful.

So, is this healthcare's 21st century version of the battle between Beta and VHS? (For our younger readers, consider the fight between HD-DVD and Blu-Ray.) Or can the two behemoths coexist?

It's hard to say. As a Microsoft Gold Partner, it is likely that we'll look most closely at HealthVault first. Ultimately, we (and other ISVs and health plans) will need to integrate with both. And they'll need to make nice and integrate with each other.