Clinicians express views on the digital future at #HIMSS22

The majority (56%) of clinicians participating in a large, global survey believe that “the majority” of their clinical decisions in the future will be made with tools using artificial intelligence (AI)

However, in the poll of about 3000 physicians and nurses conducted in 111 countries (including Canada) by Ipsos for Elsevier Health,  the majority of respondents expressed concern that medical and nursing school training was not keeping up with the need to educate them properly with the knowledge and skills needed to use modern technologies.

Findings from The Clinician of the Future study were released during the Health Information and Management Systems Society (HIMSS) annual meeting here and discussed during a sponsored session by Dr. Ian Chuang, chief medical officer for Elsevier Health.

Meanwhile results from HIMSS own State of Healthcare survey conducted at the end of last year and including 359 physicians from five countries was also releasee and discussed at the meeting. That report confirmed clinicians feel digital transformation is well underway with 90% of respondents identifying ongoing digital initiatives within their own organizations.

Interestingly, while many health system leaders polled in the HIMSS survey had reservations about the pace of digital transformation within healthcare, 16% of US clinicians said they felt their organizations had completed the transformation process and about half felt the process was well underway.

According to U.S.-based clinicians, tools that do not fit into clinical workflows, lack of proper training and lack of clear communication within the health organization are impeding transformation efforts. However, UK clinicians identified lack of clear communication as the top barrier to digital transformation.

While 88% of clinicians in the HIMSS survey reported their digital skills have improved over the past year and 79% reported choosing to use digital health tools on their own initiative, respondents in the Elsevier survey were less confident of their skills in using new digital technologies.

Of those responding to the survey, 69% feel the widspread use of digital health technology will be a challenging burden on clinician responsibilities if clinicians are not appropriately supported. In addition, 83% felt training needs to be overhauled to keep pace with intro of new technologies. Dr. Chuang said there is a sense that it is not just new information that needs to be taught but rather a shift in the whole medical education paradigm. As one US clinician quoted in the report said: “There’s no time spent separately to learn technology. That education needs to be instilled into the system to ensure all doctors are educated.”

The survey also found that 69% of clinicians globally felt overwhelmed with the current volume of data they had to deal with. While 38% of the clinicians felt receiving training and education in order to remain current will be the top educational priority over the next decade, a similar percentage believe training in the effective use of digital health technologies to assist in the delivery of patient care remotely will be the second priority


Cyberattack: Not “if” but “when”

“An ER doctor is on the 26th hour of her 28 hour shift and she hastily clicks on a link which she thinks will take her to an update from a patient’s family. All of a sudden her monitor is red with a black skull and crossbones flashing and a message demanding payment immediately. She looks up and sees the same message on the other monitors across the ER. Doctors and patients are starting to notice. And the ER, which is always experiencing a low level of chaos, kicks up into high gear as doctors have to work with first responders to divert patients to nearby hospitals. This is the nighmare scenario which has become all too commonplace.”

                                                 Lauren Boas Hayes describing a fictional ransomware attack

Orlando, Fl — Cybersecurity has joined interoperability as a standing theme at the world’s biggest health information technology conference – demonstrating how modern technology has now become a major threat to healthcare in addition to being a transformative asset.

Long gone are the days when ransomware and other security issues were a hypothetical threat discussed in one of the more obscure rooms at the HIMSS (the Health Information and Management Systems Society) annual convention.  At this year’s conference, cybersecurity was the topic of a full-day pre-conference symposium and had its own Command Center in the exhibit hall with several dozen companies presenting a series of talks on a variety of security issues.

Cybersecurity was similarly featured at the new ViVE22 health technology and innovation conference held the week prior to HIMSS in Miami Beach.

The issue is not just preoccupying the healthcare community in the US. In Canada, HealthcareCAN and the CIO Strategy Council announced last week that they were launching a project to develop standards to support cyber resiliency. “It is no secret that Canadian healthcare and health research institutions have proven to be popular targets for cyber attacks and the frequency of these events is only increasing, which brings an increased risk to patient care,” said Paul-Émile Cloutier, President & CEO of HealthCareCAN in announcing the project.

Despite the resources being put into combatting security threats in hospitals and healthcare systems it is clear the problem is growing and experts note physicians and others working in these organizations are still not conscious of the problem and how they can inadvertently contribute to it.

At the HIMSS conference, the organization discussed results of its 2021 cybersecurity survey which showed phishing and ransomware were the most significant security incidents reported by all types of US healthcare organizations among the 167 responding organizations.

In a news conference, Lee Kim, director of privacy and security at HIMSS, said the issue is not “if” a healthcare organization will be subject to a cyberware attack but rather “when”. With phishing being a major cause of security breaches, Kim said it made sense for organizations to have requirements with “teeth” to make sure employees follow proper procedures when dealing with emails.

While hackers are hitting healthcare systems all the time, Kim said only 78% of healthcare organizations are implementing firewalls across the board and there is not nearly enough encryption of data occurring. Security is still not being adequately funded at many hospitals and other healthcare institutions, she added

At ViVE, Lauren Boes Hayes, senior advisor for technology and innovation at the Cybersecurity and Infrastructure Security Agency (CISA) gave a brief but comprehensive presentation on the scope of the cybersecurity threat in the US and basic measures physicians could take to counter it.

“The healthcare industry and first responders have felt the disruptive impact of cyber attacks more so than any other industry over the past couple of years as the scourge of ransomware attacks has plagued healthcare systems around the world,” she said.

Hayes said healthcare organizations are particularly prone to ransomware attacks because “up time is everything” and these institutions are mostly likely to pay a ransom to regain control of their systems.

She detailed three fundamental bad practices which CISA feels can impair security.

  • Using unsupported software
  • Using default passwords or common passwords
  • Using single factor authentication especially remotely

“Investing in the technologies and teams who can implement a secure technology architecture with appropriate network segmentation, device inventories and exhaustive backups are proven to prevent catastrophic loss in the event of a successful attack,” Hayes said.

That word again at #HIMSS21Europe

It was the word that highlighted discussions at last year’s virtual HIMSS Europe conference and trust was also the word heard again and again during the main presentations at this year’s #HIMSS21Europe meeting that has just concluded.

The big difference this year was that trust was used primarily in the context of encouraging COVID-19 vaccination to help end the pandemic and only secondarily with sharing of patient data.

This year’s HIMSS Europe meeting continued with the usual major topic areas showcasing advances in European countries and the UK with respect to digital health and virtual care. However, the keynote sessions focused to a greater degree on COVID-19 and the steps needed for Europe to adapt successfully to a post-pandemic era.

At last fall’s conference delegates and the health IT world in general were still basking in total transformation of health care delivery from in-person to a virtual basis because of the COVID-19 pandemic – a goal many had been working on fruitlessly for decades. Now as Dr. Ran Balicer, chief innovation officer at Clalit Health Services in Israel said on the conference’s first day “providing care at a distance is how you provide care”.  He added that the whole concept of telehealth has become some redundant as health systems have adapted to hybrid models of care delivery that combine in-person and virtual care.

Back to trust.

“The key to every vaccination program is trust,” said the World Health Organization’s Dr. Hans Kluge during the opening plenary session. This point was hammered home during a session of dealing with COVID-19 misinformation and fake news in which data was presented from surveys in several European countries indicating where trust in government was highest, people were also supportive of COVID-19 vaccines.

The importance of promoting digital trust in developing an inclusive society in the post-COVID-19 world was referenced during the main closing plenary session on global inequities by Dr. Ahmed ElSaaed, Focus Area Lead for Innovation Scaling at the United Nations Global Pulse Finland.

In the same session, Dr. Deborah Maufi, chief medical officer for Babymoon Care B.V. in The Netherlands, said trust was needed to build “key and targetted campaigns” aimed at specific communities to encourage vaccination.

Trust also surfaced in a sessions dealing with the use of patient data. Such trust is the key to sharing patient data for secondary use, said Seamus O’Neill, Chief Executive at the Northern Health Alliance in the UK.

People have been more trusting in sharing their personal health data during the COVID-19 pandemic, he said, because this was being done on an emergency basis to deal with an immediate, threat to personal health. However, he said, one should be wary in assuming people will continue to maintain the same high degree of trust over the longer term after the pandemic. “The volume of health-related data is increasing exponentially … and patients have to be convinced their data is being shared responsibly” said Dr. Rowland Illing, a radiologist and chief medical officer at Affidea in the UK, at the same session.

(Photo of Helsinki – where once again we are not meeting (but should have been) for HIMSS Europe because of COVID-19)

Morphing with Moomins: #HIMSSEurope19


To be honest, one of the main reasons to write this blog was the chance to use the headline – which probably needs some explanation. And if the explanation doesn’t make too much sense then I can only blame jet-lag and a degree of digital health overload from attending the first day of the HIMSS Europe 2019 digital health conference in Helsinki, Finland.

And just to be even more inexplicable, the main theme of this blog is – as it has been a few times this year – AI and its applications in health care.

It is currently impossible to avoid AI as a conference theme/main topic of conversation at health technology or digital health conferences. In fact, as this conference goes on in Helsinki another conference in Boston dedicated specifically to AI and machine learning is just about to begin. To quote from an AI session description here at HIMSS: “Personalized medicine, predictive analytics, augmented diagnostics, real-time processing of wearable data… AI is buzzing and feeding our imaginations with hopes and dreams of a truly data-driven healthcare with optimal clinical and financial outcomes.”

But what struck me while listening to that well-attended sessions is that AI has morphed from Big Data as a major theme in digital health care.

Remember how just a few years ago everybody was talking about Big Data (with the capitals) and the potential benefits for care delivery from the incredible amount of data being accumulated on all aspects of people’s health? Well, it is clear that this theme has been coupled with machine learning and artificial intelligence to take the potentiality to another level. Now when speakers – such as those from the Helsinki University Hospital (HUS) talk about the “data lake” they are filling with a wide range of genetic, demographic and health data from their patients, they are doing it in the context of taking all of this information to create algorithms to enable AI use.

In fact, according to session moderator Dr. Mikka Korja, a neurosurgeon at HUS, Helsinki is one of the world leaders in exploring the use of AI in health care with 100 projects underway here.

That data are critical to effectively utilizing AI in health care is without question. But, as speakers repeatedly noted, it is not just the quantity of data points needed to create effective algorithms but also the quality of data required. It is clear that effective use of AI is impossible without standardized digitized data collected in an electronic format. The point was also made that most health care organizations are currently not configured to continually gather data and feed it back into the system in a manner that is required to develop AI functionality.

Most of the speakers at the HIMSS session discussed the potential applications for AI to improve clinical diagnosis and this remains the most sexy aspect of AI. Yet, I thought it was actually Dr. Kaveh Safavi, senior managing director at Accenture Health, who gave the most compelling presentation when he noted that enhanced diagnosis is actually one of the more challenging roles for AI to play in health care. During question period he noted that that for AI to augment diagnosis requires a high level of machine learning with masses of data which might require years of work and with all of this compounded by dealing with privacy and security concerns.

Where AI can and will have a huge impact, Dr. Safavi said, is in cost reduction and improving the consumer experience, in addition to outcome improvement. He argued that effective use of AI will help reduce staffing requirements and increase capacity at a time when “we’re running out of people to provide health care.”

Dr. Safavi also quoted an Accenture study showing the main benefits from AI in health care will come in areas unrelated to diagnosis with the biggest estimated potential benefits being in the areas of; robot-assisted surgery, virtual nursing assistants, administrative workflow assistance, and fraud detection.

For all the hype you hear about using AI to better detect melanoma or leprosy, Dr. Safavi’s comments are worth serious consideration.

Oh and about that headline. For those unfamiliar with Finnish culture, Moomins are an incredibly popular family of fictional creatures created by Tove Jansson in the 1940s and featured in books, comic books, TV, plush toys etc. And at a conference in Finland who could resist working them into a headline.



Patients at #HIMSSEurope18: From ‘a’ to ‘the’


To have the patient voice presented articulately from the podium isn’t all that unusual at medical and health conferences these days.

However the fact that this occurred at a major digital and health information technology conference – until recently the domain of companies and organizations wanting to do things to and for patients (often for money) rather than with them – is worth noting.

To its credit, the HIMSSEurope/Health 2.0 meeting in Sitges, Spain did not just have prominent patient advocates such as Marie Ennis-O’Connor (@JBBC) and Anne-Miek Vroom (@annemiekvroom) speaking at plenary sessions but throughout it also reflected a new paradigm of providing health care services and products that patients want, delivered where and when they want them.

Although some feel more can be done: “The most powerful force in health care innovation (the patient) is yet to be unleashed,” said Ennis-O’Connor.

“To me, empowerment is not just having an app with all your health care information, it is about being part of the system,” said Miquel Bru, VP of business development for Made of Genes, during a session on precision medicine. As Vroom pointed out in her address, you don’t need a program or project to work with patients, just ask their opinion and incorporate them into the workflow.

It was Vroom who also pointed out that while virtual care, mobile apps, and telemedicine innovation are all being applauded as breakthroughs for patient care they do not automatically improve the patient experience and can still be challenging for those with disabilities.

In his keynote address, Dr. Robert Wachter, chair of the University of California, San Francisco department of medicine and oft-time critic of electronic records and their impact on physicians, noted that the “perfect patient” ready, willing and able to adopt digital tools to manage their care is not common. Instead, he said, digital tools and information will have to be customized to accommodate patient preferences and knowledge levels.

“There is no such thing as a ‘one size fits all’ patient,” said Ennis O’Connor who also noted there is some concern about the growing gap between digitally literate and engaged ‘super patients’ and those who are not.

While the conference was filled with speakers discussing tailoring their digital solutions to what patients really wanted, Ennis O’Connor challenged people to act on truly involving patients in their work. She said that patient engagement has become a leading theme at conferences (including this one) but said there has been no significant movement to change this rhetoric into a tangible reality.

However, Lucien Engelen (@lucienengelen), a global digital health strategist and patient engagement champion, who served as master of ceremonies for the Sitges meeting said he perceived the tendency to involve ‘token’ patient has been decreasing while meaningful involvement of patients at conferences has been increasing.

And while the yardstick may not have moved as much as patient advocates may wish there was a definite sense here that digital health innovators, policy makers, and providers are starting to view patients as partners and not simply subjects for the next shiny new digital healthcare toy.

Something is happening here … #HIMSSEurope18


You try so hard but you don’t understand
Just what you will say when you get home
Because something is happening here but you don’t know what it is
Do you, Mr. Jones?

                                             Ballad of a Thin Man: Bob Dylan

The problem with a Health Information Management Systems Society (HIMSS) meeting – any HIMSS meeting – is that there is so much going on at one time that it is impossible to craft it into one coherent narrative.

That is the challenge with HIMSS Europe 18 currently underway here in Sitges near Barcelona, Spain as hundreds gather to discuss the latest in digital health and health information technology and to network, network, network. And it’s doubly challenging as this meeting is being held in conjunction with Health 2.0, the health innovation conference recently purchased by HIMSS.

(Now wait a minute, wait a minute you say – you get to go all the way to a resort hotel in Spain, with a clothing optional beach within 5 minutes walk, where they serve wine at the some conference buffet luncheons, only to cop out and say you can’t write coherently about it. Patience please).

As a social media ambassador here and lively live tweeter I can supply you with an endless number of insightful tweets or sound bites from just the first 24 hours. For example:

“We have gone from a paper world to a digital world in a short period of time”: Dr. Robert Wachter

“There is a lot of tokenism in health(care) innovation, and some think you can change or even fix health(care) overnight. It is not about technology, nor about the process, it is about changing the culture of an organization”: Lucien Engelen

“Pay patients and value them as the experts that they are”: Marie Ennis-O’Connor

But while I think these tweets provide a useful running commentary of the meeting they – and even the twin meeting hashtags #HIMSSEurope18 and #health2con – provide only a partial and episodic picture of what is going on.

Individual presentations or sessions are also noteworthy. For instance I have never heard as passionate a presentation supporting the role of nurses in the future digital world as that given by Angelien Seiben and Shawna Butler from Radboud University Medical Center. And Dr. Jordi Sorreno Pons a GP and CEO of the Universal Doctor app jammed so many ideas into his 8 minute presentation on future developments in medical innovation that it was almost incomprehensible.

The big subject areas – patient engagement, big data, artificial intelligence – are all given their own sessions or streams here.  But in the time available they tend to focus on specific projects or regional initiatives.

Certain things have changed from HIMSS or eHealth meetings held 15 or 20 years ago. The digitization of patient records is now a reality and not a vision and patients are not only discussed but included (#patientsincluded) as presenters in their own right.

But as to what all of this means for the future of digital health in Europe or worldwide – we are too much in the moment to have a clear picture given the complex nature of health systems and the endless number of variables that impact such systems.

For the numerous people here with an start-up to promote or an niche application to profile the meeting is a far simpler place.

(This is the first of what we hope will be a series of posts from Sitges)

From #HIMSS16 to #ehealth2016 – new work, new roles and a new language


“We need the Intelligence Augmenter, stat!

“The diagnostic algorithm’s out of whack and the Transition Specialist wants to know how the interface outflow is correlating the patient’s Fitbit data into the Director of Decentralized Asset Management’s new discharge interface. And we can’t reach the Business Analyst for Patient Workflow.”

The above is not a conversation you are likely to have heard in your hospital lately.

But if you listen to Mark Casselman (@markcasselman), the CEO of COACH (@COACH_HI), Canada’s Health Informatics Association, it is the type of exchange that could be a reality in the not too distant future.

In a recent address at the #HIMSS16 conference in Las Vegas, Casselman gave a thoughtful overview of how the changing landscape around how digital health care is going to fundamentally change not only how care is provided to patients but also the roles and responsibilities of those providing that care.

Casselman noted we are currently in an environment where we have two distinct health care delivery ecosystems working simultaneously – the traditional health care delivery system based on face-to-face interactions between provider and patient in either an office or hospital setting, and the new and evolving consumer-based digital health system – the world of virtual care, apps, engaged patients and the quantified self.

“The traditional health care delivery ecosystem is mostly operating distinctly and differently from these fantastic innovations. They’re operating at different clock speeds.”

He notes that virtual care is evolving along the whole continuum from the traditional clinician/patient interface through team-based care to the new personalized patient-centred approach to care.

“It’s almost impossible for these things to be embedded in the traditional system because they’re changing so quickly,” he said.

These evolving forms of digital care and the underlying beliefs and concepts that support them are creating dynamic tension for those used to working in the traditional health care environment.

In part, he said, this is because the traditional evidence-based model of care which relies on the randomized controlled trial as the gold standard, cannot adapt quickly enough to assess and absorb the changes being brought about by digital health innovations.

To Casselman – and seemingly to the 42,000 delegates to the Vegas meeting – the new reality is one Canadian physicians, hospital administrators and all others employed in the system must start to acknowledge.

“Health care professionals, teams, and organizations must consider what novel skills and capabilities are needed to deliver virtual care effectively,” he said.

Casselman’s organization – COACH (one of the main sponsoring bodies of the upcoming #ehealth2016 conference in Vancouver) has done much to define the 65 existing roles and responsibilities involved in health informatics in Canada today and as developed a professional skills matrix for those roles.

But with the emerging digital health world, he said, there is now a need to re-examine this and determine the new roles that will be needed to provide care in the new world of health delivery.

Using artificial intelligence to augment care with algorithms, harvesting big data for insight, precision medicine, and digital care provided through mobile in the home and the community will require many different skills sets and roles –the type of currently fictitious roles noted by Casselman in my introductory vignette.

But Casselman goes beyond this onto more dangerous ground when he questions whether the patient electronic record of the future will even be the primary point around which patient care will be focused

“We’re digitizing our physiological indicators, we’re sharing them and its creating a real tension in the world of health informatics,” he noted.

Maybe the physician-owned patient record in the EMR is only a segment of what will really be needed to deliver care in the future as the patient tracks his or her own indicators and brings this to the table.

Much to think about and we can only be thankful that Canadian informatics leaders such as Casselman are giving it some thought, especially when he prefixes it all by stating “At the end of the day, it’s all about the care.”

(The summary sides from Casselman’s full presentation can be accessed here).

A Canadian leaves Vegas (#HIMSS16)


I came to this year’s HIMSS annual meeting in Las Vegas to find out more about the current status of patient and physician engagement in the US health care system.

As always, HIMSS came through – (if you will pardon the Vegas-type analogy) in spades. But as always with HIMSS it was too much of a good thing and attempting to synthesize what you see and hear is almost an impossible task.

First there was the language barrier. No, not that I was trying to navigate the conference in French but rather the confusion in English health care terminology between the US and Canada.

Forget about your MACRA and your MIPS and other acronyms that bewilder and confuse Canadians; we are talking about more common terms

In Canada we talk about population health in the public health sense of maintaining the health of the entire population through preventive measures. Here, well, even those at HIMSS seemed unsure even though it was the phrase de jour  for the second year running.

As Mike Miliard, editor of Healthcare IT News wrote: “Whether looking at it as a big-picture value-based care model (an ACO, a patient-centred medical home), or the nuts-and-bolts needed to manage specific segments of patients (mobile engagement tools, HIE analytics), getting a handle on the concept of population health can be tricky.”

Population health as a proxy for focusing on chronic disease management and tailoring treatment appropriately – well, sure that make sense as that’s the preoccupation with Canadian providers and health policy makers as well. Why didn’t you just say so?

Once we get around terminology, the messages out of HIMSS were more comprehensible.

Physicians remain seriously PO’d with their EHRs and what they are doing to their health and well-being. Even Andy Slavitt, acting director of the Centers for Medicare and Medicaid Services (CMS) admitted as much.

But improvements are promised and leading US physicians acknowledge EHRs are here to stay and that multiple clicks thing to do something as basic as give a flu shot will be corrected soon.

What was much more fascinating in Vegas is how the whole patient engagement field is evolving.

Discussion of patient portals has given way with extreme rapidity to acknowledging virtual care must span a whole range of apps, devices, platforms and wearables. Many hospitals are ahead of their counterparts in Canada in enabling the use of tools such as apps to improve the patient experience.

But despite the growth of the Open Notes movement and the necessary sharing of patient records with the patients themselves, an Accenture survey released during HIMSS was an eye-opener. It showed physicians are becoming less likely to support full sharing of patient records even while patients are requesting same in greater numbers. A conundrum to be addressed, surely?

And then there is the question of just how engaged people really want patients to be.

Dana Lewis, a pioneering patient advocate closed the day at the patient engagement pre-conference symposium by discussing how she hacked her devices to improve management of her type 1 diabetes. And please, she said, call her a person with diabetes not a diabetic because she is not going to let her disease define her.

Fast forward to a panel discussion later in the meeting where consultants and providers discussed innovation in diabetes care  sans patients and using the term ‘diabetic’. As with so much of HIMSS, it struck me that patient engagement is applaudable but please have more patients in the room and avoid viewing them as objects, or heaven forfend, revenue sources.

HIMSS16 SMA Badge [8339409]




#HIMSS15 – Will the physician voice of angst be heard?

When it comes to the frustrations associated with health IT and the use of electronic medical or health records, U.S. physicians should know your Canadian colleagues feel your pain.
A national survey of Canadian doctors conducted last year (known as, wait for it, The National Physician Survey) with responses from more than 10,000 physicians documented many of those concerns.
While use of EMRs has grown rapidly among the Canadian physician population in the last decade there are still significant areas of the country where access to an EMR system is not available. More significantly, the majority of physicians continue to use a combination of paper and electronic records and many joke that the fax machine continues to hold sway in this country.
Perhaps what is more concerning is the percentage of physicians (17%) who feel the use of an EMR has decreased rather than increased their productivity and the high percentage of doctors who are only using their EMR as an electronic record keeping device rather than for any of the multitude of other functionalities that are available. For example, electronic prescribing in Canada still remains a vision for the future rather than the cornerstone of effective EMR use.
Interoperability continues to be the bugbear for both policy makers and individual physicians. in Canada. While Canadian doctors do not face the situation of U.S. physicians who having dozens of competing EMR vendors trying to sell to them most are still unable to easily exchange data electronically with the hospitals, other physicians, pharmacies or other providers in their communities.
Worse yet in the eyes of some physicians in Canada are the disappearance in the biggest provinces of government programs that paid the majority of costs associated with putting a computer on the desk and providing the software to digitize patient records.
“Meaningful use” has little meaning in Canada in the legislative sense but many Canadian doctors would sympathize as the U.S. federal government starts to implement the “stick” phase of the “carrot and stick” plan for encouraging use of electronic health records.
And don’t even start on the issue of patient participation as in Canada few patients can easily access their own record electronically and even fewer can communicate with their physician by email about their health concerns.
So, as speakers such as American Medical Association (AMA) President Dr. Robert Wah start to outline the challenges and opportunites facing U.S. physicians with health IT (in his address at the Innovation pre-conference symposium this morning) Canadians will be listening closely.
From the viewpoint of an external observer there has been a growing chorus of U.S. doctors recently vocally expressing why they are unhappy with the experience of using electronic health records – with even organized medical groups such as the AMA chiming in.
It will be interesting to see whether such concerns are heard in the evangelical atmosphere of HIMSS15 in Chicago this week.

#HIMSS14: The patient has no clothes


Someday, the opening speaker at the Health Information Management Systems Society (HIMSS) annual meeting will not say that this is the best year ever for health information technology.  But not this year.


“What a fabulous time it is to be working in health IT,” said Scott MacLean, chairman of the board for HIMSS exclaimed as he opened the world’s largest annual meeting on health IT – with an estimated 37,000 delegates and 1200 vendors in attendance.

MacLean is speaking to the converted, and the boosterism rampant at the meeting makes it difficult not to turn a jaundiced, journalistic eye to the proceedings. This meeting is filled to the rafters (or, in the case of the kilometre-long Orange County Convention Center – skylights) with either those who truly believe health IT is going to transform the health care system or those who want to sell something to the former.

Too few speakers echo American Medical Association president-elect Dr. Robert Wah who spoke to a physician symposium yesterday and stressed that health IT is just a tool and a means to an end.

Electronic health records, mobile health tracking devices, patient portals and the like have been transformed into a pantheon of icons that will benignly change the wasteful and expensive U.S. health care system into vision of efficiency and positive health outcomes.  And the latest addition to the pantheon is patient engagement through digital means.

Few would deny that patient engagement is a good thing especially since it no longer means just ensuring that patients do what doctors tell them to do. But stating that patients will be intimately involved in decisions about their own care, will have access all of their own medical records, and will even be involved in developing health care systems is one thing. Operationalizing this is quite another.

Dave deBronkart (aka e-PatientDave) told an audience yesterday that while the majority of patients will discover errors in their own records when the evaluate them, there are few mechanisms or resources in place for doctors’ offices to correct those records.

And deBronkart’s physician Dr. Daniel Sands, who has been integral in nourishing the engaged patient movement, noted at the same seminar that many physicians are unprepared for the impact truly engaged patients will have on their workflow.

While patient engagement may truly lead to more efficiencies by saving some steps in the patient visit, it is not means certain such engagement is going to lower system costs.

To quote another of yesterday’s speakers Christine Bechtel, quoting Leondard Kish, patient engagement may well be “the blockbuster drug of the century.” But surely as with too many other blockbuster drugs in recent years, it is being put into widespread use with insufficient randomized controlled trials and little monitoring of adverse events.