The Healthcare Information and Management Systems Society (HIMSS) held its annual conference in Chicago from April 17 – 21. With more than 60 years of history associated with the advancement of medical technology, the organization has certainly seen a lot of change. Its mission is to “reform the global health ecosystem through the power of information and technology.”
With over 120,000 individuals and almost 1,500 organizational members, HIMSS certainly covers a broad spectrum of the medical universe. I hadn’t attended the conference for a few years so was anxious to re-engage to see how the pandemic may have impacted one of the industry's largest gatherings. With almost 35,000 attendees this year, it promised to be a great forum for seeing the promise of the connected care environment.
My interest in the connected health space goes back to the late 1980s when the emphasis was on defining DICOM (Digital Imaging and Communications in Medicine) an international standard for medical images and related information first published in 1993. This work laid the groundwork for the connected PACS networks of today which have replaced the radiologic film rooms of the past.
Fast forward to the latter part of the first decade of the 21st century and the emphasis was on connecting smaller, more patient-centric devices such as oximeters, blood pressure cuffs, and ECGs, driven by efforts of the Continua Health Alliance, which was focused on connection of medical-grade data among sensors, gateways, and services. This effort focused on the connection of devices and data at the other end of the medical spectrum.
Continua certified its first product, the Nonin 2500 PalmSAT handheld pulse oximeter with USB, on Jan. 26, 2009. At that point, it seemed that telemedicine or digital health was right around the corner, as million-dollar digital imaging modalities and now 100-dollar monitoring devices were being connected. Fourteen years and one pandemic later, we’re still waiting for the healthcare revolution.
However, that doesn’t mean that incredible progress hasn’t been made. Certainly, technology has evolved and is no longer the limitation that it once was. It is in that context that I would like to comment on this year’s HIMSS conference.
The growth in interest as evidenced by the number of attendees and exhibitors was a positive sign. At the opening keynote, Hal Wolf, HIMSS CEO, noted that the growth in the interest in what is becoming a global health ecosystem was due to several factors, including the silver tsunami or aging population, geographic limitations, the need for increased access to healthcare, desire for information, staff shortages, and the emergence of the hospital-to-home movement.
It is impossible to summarize the breadth of this conference in one short article. However, there were several noticeable trends that are specifically worth mentioning. One of the new and potentially most disruptive capabilities widely discussed at the conference was Artificial Intelligence.
Artificial Intelligence on the Rise
The opening keynote session addressed this through a panel tackling the subject of Responsible AI: Prioritizing Patient Safety, Privacy, and Ethical Considerations. The moderator was Christopher Ross (CIO, Mayo Clinic), with the panelists including Andrew Moore (CEO, Lovelace AI); Peter Lee (VP of Research & Incubation, Microsoft); Kay Firth-Butterfield (CEO, Centre for Trustworthy Technology); and Reid Blackman (CEO, Virtue). Personally, the breadth of the panel as well as the willingness to discuss the challenges openly even when disagreements arose was a breath of fresh air. The discussion was very insightful, and a few key items will be summarized here.
- The first use of the term AI was in 1955. We’ve been through four or five generations of AI, but this may be the first one that has the capability to impact people in a broad way.
- Generative AI can create a wide variety of data, such as images, videos, audio, text, and 3D models by learning patterns from existing data, then using this knowledge to generate new and unique outputs.
- The promise of Big AI and its ability to address the challenge of global health and pandemics attracts a lot of attention. However, Little AI has the potential to address everyday solutions and real use cases that can improve things now.
- AI results have been studied and certain examples have shown that the “correct” results may be achieved about 95% of the time. For medical diagnostic and treatment applications, however, that might not be good enough.
- The Black Box model of AI means that the model is complex enough to not be easily understood by humans. This term has long been used in engineering classes to indicate a system where you know what goes in and what comes out, but don’t necessarily understand what is happening in between. It has its uses, particularly for system analysis in engineering school, but the question about how to apply this to AI remains an ethical and moral challenge. How much uncertainty are you willing to tolerate in a medical environment, which will likely drive the first applications to healthcare?
- On the question of ethics, key issues involve availability to all, management of bias in the system and how to manage it, informed consent by the patient, fairness, accountability, and the ultimate source of truth (the source of the data, quality, amount, etc.).
- Concern was raised about the potential threat that the irresponsible release of this technology might pose. The discussion ranged from taking a “time-out” to outright delay to the continued introduction of “responsible” AI. This debate will undoubtedly continue.
- As with any new technology, adoption poses risks. Since medical technology development is all about risk management and mitigation, a reasoned application to operational efficiency areas such as information assistance to clinicians and patients, additional visibility and clarity to the huge amount of medical information being generated annually, and provision of clinical decision support to health care practitioners may fit well. More extensive use of AI to make decisions independently, particularly from a Black Box perspective, will be more problematic, particularly regarding some of the ethical questions noted earlier.
Healthcare, Anytime, Anywhere
The second topic of note is that of providing healthcare outside of the traditional environment. While commonly called hospital-to-home, it more accurately reflects the delivery of care anytime and anywhere. This was addressed at the keynote on the second day of the conference entitled Healthcare Disruption: Accelerated Opportunities for Care Delivery Alternatives. The moderator was Vin Gupta (Chief Medical Officer, Amazon Pharmacy, NBC News Medical Analyst), with panelists Deborah DiSanzo (President, Best Buy Health); Andrea Walsh (President & CEO, HealthPartners); and Tim Barry, CEO, Village MD). The structure of the panel was interesting as it involved two large retail companies, a large insurance and medical services provider, and a primary care company seeking to remake healthcare.
- The COVID-19 pandemic opened our eyes to at least some level of telecare, replacing in-person clinic visits with Zoom calls with medical personnel. However, what is going to happen post-COVID? McKinsey recently noted that 25% of Medicare fee-for-service and Medicare Advantage client care can be provided in the home by 2025 without quality or access reduction. That demand will be further supported by the increased focus of baby boomers and children regarding senior care and aging in place.
- Today’s system was noted by Barry to be a “sickness system,” not a healthcare system, with 90% of the emphasis on mitigating chronic conditions and 10% on preventive care. Healthcare in the US today is a collection of individual components. Without interoperability and good system design, however, even the best components won’t play well together, resulting in the inefficiencies that we see today.
- DiSanzo discussed Best Buy’s role as a technology enabler company. While Best Buy has invested heavily in digital health companies (i.e., GreatCall, Current Health), they will be enabling the move to distributed health care by providing the infrastructure and collaborating with delivery companies such as Atrium Health.
- As CEO of an integrated healthcare organization and the largest consumer-governed nonprofit healthcare organization in the nation, Walsh noted that improving access to care, providing more preventive care, and being there for people in the moment were critical to the evolution of healthcare. This will require rewiring the system to transcend location.
- The panel was asked how to know when these initiatives for alternative care would be considered successful. The simple answers to this complex question include:
- People in homes receiving the care they want and need. (DiSanzo)
- Easier access to more trusted care. (Walsh)
- Improved quality and reduced cost. (Barry)
These two keynotes highlighted perhaps the two latest trends, Artificial Intelligence and Hospital-to-Home. With the large number of attendees and exhibitors, what other observations could be made? Interest is high in the connected health space as shown by the large number of attendees. General discussion with some of the more experienced attendees noted that while technology has moved forward, the rest of the healthcare infrastructure may still be lagging. Information is critically important, but interoperability remains an ongoing issue. A declining number of healthcare professionals are entering the field and those who remain are burning out. AI technology might have a delayed impact on this issue by improving the efficiency of care delivery. To realize the promise of digital health, the infrastructure of care delivery will likely have to change, with payers, providers, and patients adjusting to the new normal. Hopefully, we won’t still be having this conversation in another 10 years.