Thoughts on US health IT from HIMSS

I was away at the HIMSS health IT trade show in New Orleans this week, and was struck by just how similar some of the themes from the Big Easy were for the English NHS.

The main one was how much everyone is talking about interoperability and the need to make data liquid between different healthcare providers and avoiding lock-in within any one system.  This was something that ONC co-ordinator Dr Farzad Mostashari described as the tendency to data ‘hoarding’.

Interoperability is the focus of the next stage of meaningful use and looks to be the priority for the next couple of years, after four year in which the dash to EMR has been the focus.  The suggestion is that the US is inadvertently creating islands of unconnected digital data.

There was also some interesting research out from Black Book Consulting suggesting that a lot of family doctors are unhappy with the EMR they put in to meet meaningful use requirements and are now looking to change.

With the DH apparently gearing up to have another push on EPRs in England, its interesting to get a perspective on what happens once record systems have gone in.  A theme I heard a dozen times over the week is that getting an EMR live is just getting to the starting point, the real job comes in getting the clinical and business benefits from changing processes, redesigning care and reviewing performance.

As well as interoperability there was again a lot of vendors pushing analytics and smart use of data to actually make use of the vast piles of data being generated bu the US healthcare system.  Healthcare providers now need to use data effectively to deliver a better patient experience based on understanding how and when they want services, in the way Wallmart or Amazon, was the main message of Thomas Warner, chief executive of Louisiana’s biggest healthcare provider, Ochsner Health System.

The need to provide patients with access to services through the channels they want to use was also the message of Dr Kate Christensen, medical director, internet services at Kaiser Permanente.  She told me that they love being able to view test results, book appointments, order prescription refills and email their physician. Interestingly, she says that Kaiser no longer thinks internet services save money, by reducing office visits, but they do lead to better patient retention and more activated patients, more likely to better manage their health.   Some 4m Kaiser patients now use My Health Manager, over 63% of the total. Another striking figure quoted by Dr Christensen is that over 22% of patient visits are mobile.

The other big theme that is getting a lot of attention in the US is population health management and accountable care organisations, paying a fixed fee for providing all the healthcare for a given population.  A big move from fee for service payment models. It’s all part of the attempted shift to new payment models that can contain runaway healthcare costs.

Just how big that challenge is was set out by former-president Bill Clinton who said the US healthcare system was broken and spending roughly one trillion dollars more a year as a percentage of GDP than leading European healthcare systems.  he said the soaring costs of healthcare – about 2.5 trillion dollars a year – were hobbling the US economy and one of the main reasons that median household incomes hadn’t increased in a decade.

Clinton said health IT had a vital role to play both in integrating the system and empowering citizens to take better care of their own health.



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