HIMSS Preview: Health Care Tech Revs Up As Stimulus Begins

The American Recovery and Reinvestment Act is a boon to health-care IT, with President Barack Obama's stimulus package promising $19 billion over the next two years to promote the adoption and use of electronic medical records (EMRs) in the U.S. and pledging as much as $50 billion more for EMRs over the next five years.

Stimulus appropriations for health-care IT don't exactly stop there, either. Everything from $2 billion in yet-to-be-written grants from the Department of Health and Human Services to various agency upgrades with health-care concerns is expected to get a piece of the pie, and health-care interests in the energy and green initiative sides of the stimulus also are at stake.

But as the Healthcare Information and Management Systems Society's (HIMSS) 2009 conference gets underway in Chicago on Sunday, everyone from solution providers to CIOs to IT vendors with skin in the game seems to be of the same mind-set: We need more information, but we're going to do the best we can with what we know now.

EMRs are driving the broader health-care IT push. Data from IDC puts the EMR market at a growth rate of 15 percent a year, expected to reach $4.85 billion by 2015. About six percent of U.S. hospitals overall report having comprehensive EMRs, and 17 percent of physician practices do, according to the New England Journal of Medicine.

But "having an EMR" is still itself a matter of perspective, and what isn't known, for starters, is what will constitute "meaningful use" of an EMR. Part of the stimulus health-care IT funds will come in the form of incentive payments of, on average, $40,000 to physician practices, for example, who can demonstrate "meaningful use" of an EMR.

"But there has to be something in place so someone can't buy Microsoft Word and keep their notes in Word and say the fact that they're keeping medical notes in Word qualifies for a rebate," said Jack Smyth, CEO of EMR vendor Spring Medical Systems. "We have to keep track of quality reporting metrics -- those will be part of what the 'meaningful use' requirements are and things we have to keep track of."

Here's what has changed, at least from a mind-set perspective. Already, the cost of EMR implementation will come down as more implementations take place. What that means is that the formerly prohibitive cost of EMRs for a four-physician practice will be less expensive.

"Now that the cost might be less of a barrier, [VARs] play a critical role," said Frances Dare, director of health-care consulting at Cisco Systems' Internet Business Solutions Group. "How to get the systems in place, how to do training -- there's a planning piece that's vitally critical. The legislation says you need an EMR, but physicians don't want to be in the business of IT. Small practices don't have a staff that can do the IT work. They need help getting up to speed."

"It's fascinating how many VARs I run into who don't want anything to do with health care," said Wesley Gipe, president and CEO of AgilIT, a Troy, Ohio-based solution provider and EMR specialist. "It's demanding. You take a lot of flak that's not due you and it's high maintenance. But once they trust you -- and that takes a long time with physicians -- and you hold your ground on a solution that will perform like you said it would, you're in. Health care is great from that perspective."

Next: Where The Money Is

With the incentive payments not coming until 2010 at the earliest, the stimulus money for health care isn't going to have a huge impact in 2009, said Tiffani Bova, Gartner vice president of research for worldwide indirect programs and sales strategies.

But for VARs, now is the time to lay the groundwork through aggressive, unsolicited bids and making nice with the local health-care community.

"If you're counting on money for 2009, you're being optimistic," said Bova, speaking at Ingram Micro's VTN Spring Invitational in Orlando, Fla., Thursday. "But try to get ahead of the curve -- make unsolicited bids. You want these [organizations] aligned with you before they get that check. There's still a lot to know, but that doesn't mean you can't become the go-to guy for the 10 to 15 doctors in your area."

One study on EMR adoption rates was published in the New England Journal of Medicine in March by a team of researchers that included Dr. David Blumenthal, President Obama's new national coordinator for health information technology. The study puts the adoption rate as low as 1.5 percent in hospitals, determined after looking at 3,000 acute-care hospitals in 2008 and finding only a tiny fraction that had electronic records systems able to perform all of 24 functions described by a research panel as "important."

HIMSS executive board members said Thursday at the conference that while only six percent have "comprehensive adoption," about 67 percent of U.S. hospitals are just two steps away from having an EMR -- meaning they're missing applications, such as ancillary department information systems or computerized physician order entry (CPOE), that would put them over the goal line.

"Our data show that the majority of U.S. hospitals tracked by the HIMSS Analytics Database are just two stages or less away from having the applications implemented to achieve an electronic medical record tool capable of realizing 'meaningful use' objectives," said David E. Garets, HIMSS Analytics' president and CEO. "That means that almost three quarters of U.S. hospitals are on the right track to EMR implementation."

The HIMSS Analytics EMR Adoption Model (EMRAM) divides EMR implementation into eight stages. About 31.2 percent of the 5,166 U.S. hospitals it surveyed, according to HIMSS, are at stage 2, meaning they have a clinical data repository that contains orders, lab, radiology and pharmacy data. Another 35.7 percent are at stage 3, which means they've reached the point where electronic nursing documentation capabilities have been reached in at least one hospital unit and they have clinical documentation to support it. About six percent have hit stage 4 or better, meaning advanced EMR capabilities such as CPOE, physician documentation, data warehousing and full radiology PACs.

"We fully recognize that implementing the technology is necessary but not sufficient as change management must also be a component of the EMR implementation process," Garets said. "We believe that 'meaningful use' will demand measurement and reporting of clinical quality, patient safety and cost reduction data, for example. That data should be available to hospitals as a by-product of their EMRs' clinical documentation and reporting tools."

Next: The Bigger Health IT Picture

Regardless of how much is still up in the air about EMR adoption in U.S. health-care settings, there's broad consensus that the stimulus package's health-care emphasis has turbocharged the industry. The push toward EMR affects almost every other technology piece in a health-care setting -- which means it affects health-care VARs who don't sell EMR specifically as much as it does those who do.

"The stimulus package just added emphasis for a sense of urgency to something that was already under way," said David Muntz, senior vice president and CIO at Baylor Health Care System in Dallas. "It's going to force us to collaborate and coordinate in ways we had not been able to do before. The way we're able to exchange data in a meaningful way is really our biggest headache."

Muntz said Baylor's network of about 3,500 physicians is at an EMR stage where they have a portal and are able to "dump information from inpatient and outpatient facilities into that portal."

The EMR is through GE (which on Thursday said it would partner with Intel for home health-care delivery), and while Muntz said he hadn't relied on solution providers for much of the implementation, he sees integrators especially as "facilitators" -- experts who can help integrate EMR into a health-care setting's workflow through unique knowledge of that workflow's pain points.

"I usually bring someone in from the outside who has a deep expertise and forces us to have crucial conversations," Muntz said. "I see [integrators], though, as playing a bigger role at the community level. If you look at what's going to have to happen with health information exchanges, you have to think about who would be the right people to have those conversations and get data rationalized at that level. Someone has to do the work. It's valuable."

Joanne Sunquist, R.N., M.S., the CIO at Hennepin County Medical Center in Minneapolis, said she has faith that the major EMR vendors (Cerner, McKesson and others) have offerings that are going to meet whatever the definition of "meaningful use" is. (Hennepin County Medical Center has had a full-time EMR from vendor Epic up and running for 18 months, she said.)

"I'm not worried about that," she said. "From my organization's perspective, my priority is getting every dollar of that stimulus package we can, given the level we're already at. And now, my priorities are shifting to other things: storage, a lot of the infrastructure pieces, virtualization and servers. All that's going to continue to be a hot topic, same as the privacy and security."

An EMR is never 100 percent completed, Sunquist argued, because "you're constantly optimizing." During implementation, she said, Hennepin County worked with Deloitte Consulting. She hasn't had to call on Deloitte "in a while," but she said as EMRs continue to proliferate, services will continue to be a major solution provider piece.

"I would guess there's going to be a big push with people trying to outsource support," Sunquist said. "We're not looking at that right now, but I'm betting an organization that needs to do things a little cheaper will look to outsource to Siemens, or Perot Systems or whoever."

Next: Programs For VARs

With HIMSS happening and the spotlight on health-care IT solutions brighter than ever, many vendors with robust health-care communities -- Hewlett-Packard, IBM, Cisco and Microsoft, to name a few -- are expanding their practices in all directions.

Along with distributors such as Ingram Micro, Tech Data, Synnex, Avnet and Westcon Group, many vendors are offering health-care specific training to VAR communities -- and even then, health-care training specific to understanding stimulus opportunities.

EMR proliferation raises every boat in the health-care IT tide, in other words, from storage to networking to security to infrastructure.

Pam Markle, senior government marketing manager at Ingram Micro, said about 90 percent of the products and vendors on Ingram's line card have an obvious health-care play, and that Ingram was continuing to develop new programs to engage its reseller community with those opportunities.

"Almost everything we sell, from the networking to digital signage, plays somewhere in that vertical these days," Markle said. "And the stimulus package is the impetus to get this stuff moving."

"There's a lot of noise," said Cisco's Dare. "We're working across all our various partners from EHR vendors to channel partners. Different partners go to different market segments, but we're looking at everything from large enterprise hospitals to small physician practices. This is direct funding in the legislation and we can make a broad impact to touch each of those. From the channel, we're getting a lot of requests for how to sell effectively."

IBM is expanding its health-care-specific ecosystem apace, according to Dan Pelino, general manager, IBM Healthcare and LifeSciences. On Wednesday, Big Blue said it would partner with the Mayo Clinic to offer natural language processing (NLP) technology to open-source developers.

Pelino called those types of opportunities "tremendous" for IBM's health-care community.

"When you look at health-care systems, in the past, they've been vertical -- you do an EMR with a vendor that's out there," Pelino said. "The value creation in health care is no longer vertical, it's horizontal. How does the data flow with the patient? How do you take the obligatory clipboard out of everybody's hand? How does it fit with a master patient index, revenue cycle management and optimization? How do databases share and store information? How do you save money and develop quality metrics?"

With seemingly so many ways to take advantage of the push toward EMR adoption, experts expect the tenor of conversations at HIMSS to be on how to change the mind-set of the health-care industry in general.

"The locus of control is moving to the receivers of care," offered Kaveh Safavi, vice president and global lead for Cisco's IBSG Healthcare Practice. "The record doesn't belong to the doctor or the hospital -- it belongs to the patient. The challenge isn't the technology so much as getting people to understand what's possible."