People as individuals and human beings are regaining an appropriate central focus in healthcare. The shift in thinking of putting relationships back to the front and center was especially evident during the annual mass gathering of the healthcare information technology sector at the HIMSS Annual Conference. Without a so-called blockbuster announcement, the arguably most important element of healthcare was able to permeate all levels of discussion.
The focus on individuals was evident in a variety of venues from the government dropping a long-anticipated regulation just as HIMSS19 started, to the way in which companies framed their offerings, and to the gathering of different communities. Being able to consider how best to enhance the relationship between clinicians, patients, and other stakeholders was a refreshing change from chasing the latest shiny object, which was often the feeling in the past.
The Proposed Regulation
The release of a proposed rule to implement numerous portions of the 21st Century Cures Act, including the use of application program interfaces, stopping information blocking, and other means of encouraging or promoting access to data by individuals. As would be stated by various Centers for Medicare and Medicaid Services and Health and Human Services officials at HIMSS19, patients are entitled to their data and arguments over ownership should not get in the way of that access.
Staking out a position of demanding free access and flow of patient data is arguably a substantial shift by the government. While long existing laws and regulations (mostly HIPAA) have stood for the ability of individuals to access and use their data as each individual sees fit, the government has not done much to focus on such access rights or to discourage organizations from erecting barriers or hurdles to access.
The old laissez-faire approach is quickly disappearing, though how long the government remains dedicated to this approach will be worth watching. The suggestion by HIPAA enforcers that an action is coming centered around an access issue is noteworthy. If such an action is really announced, it could be one of, if not the first settlement around a patient’s right of access or really any privacy right.
Turning back to the announced regulation, the information blocking aspect is a major issue for access. The proposed rule includes potential penalties and public shaming of entities that hinder or prevent access to data. While the final means of implementing will remain to be seen, the fact that the concepts are included in the proposed rule suggests that the government will take some form of punitive action to free the data.
Given the breadth of the rule, it was no surprise to hear it as one of the most frequent topics of discussion at HIMSS.
The Tools and Vendors
In a change from promoting tools and software products as the end solution, conversations with vendors focused more on how the tools can enhance the role of clinicians and allow direct connections to be re-established. One of the most powerful statements made to me was one company suggesting that it did not want to work with clinicians or healthcare organizations that would not fully utilize a solution, which is intended to foster and grow connections between clinicians and patients. If only the clinician side was desired, there was a question as to the intention of that organization and why it did not want to engage with patients.
The sentiment of that vendor was no longer unusual. Instead, many vendors talked about the ways in which their tools would fit into the background of healthcare operations. Instead of putting the technology at the forefront, it would enable the clinician to more effectively interact with a patient, whether in person or, increasingly more likely, in between visits and as a means of reducing needed utilization of services.
Other solutions were targeted to patients themselves in order to ensure understanding of communications from clinicians or to help patients promote their perspective. Thinking of the discharge and planning process, patients can often be overwhelmed with information, which can easily undermine health once out of a facility. If that information can instead be effectively communicated to the patient or set up so it can be re-accessed later in time, then outcomes could improve. The design thinking in that instance considered issues faced by patients and a real issue at that. Instead of creating a solution and then trying to find a problem, the problem was encountered first, which lead to a workable solution.
The Healthcare Organizations
Conversations with representatives from two different healthcare organizations also revealed how people are becoming the primary consideration again. One conversation delved into the gradual development of value based care models in an organization. Instead of jumping right into the deep-end and risking the alienation of the clinicians, the organization gradually ramped up its participation. The slow and steady progress helped create an environment where success would be more likely and also permitted broader relationships with ancillary providers to be established. Creating a deliberate and thoughtful framework was seen as a means of strengthening bonds even outside the organization and owners to support the move.
The second conversation went to how change and new ideas can be communicated. When messages were sent from the top leadership, emails would not be opened and practices remained static. To gain the relatively small success of high email open rates, the sender eventually went down a number of levels until it came from someone that each of the disparate offices may actually know. When stepping back, that end result seems obvious. If a recipient actually knows the person sending a message, then engagement and response will be higher. Why wasn’t this more evident before? One answer could be that it is easy to rely on the convenience of being able to send an email whenever wanted, to whomever and by whoever. However, an underlying real-life relationship will bolster that easy means of communication.
Lastly, the one constant of personal relationships across all HIMSS Annual Conferences that I have attended are the various social media communities. The gatherings inspired by these groups only grows with each passing conference and enables any participant to walk into a conference of over 40,000 people and expect to spot someone that they know and have been conversing with at almost every turn.
Beyond the ability to see a friendly face again (or for the first time), getting together at conferences allows conversations to be energized in different ways than are possible solely online. For the HITsm, hcldr, and pinksocks communities, those conversations invariably turn to how healthcare can be humanized again and a culture of person-centered care promoted. The fact that participants in these communities come from all areas of the healthcare industry (clinicians, patients, developers, government, and more), means that all can learn from each other and bring those ideas back to the organization, agency, or other entity where they work. The free sharing of ideas can be a real spur for innovation and disruption.
A question that often came up was how to keep conversations started or encouraged by the communities from not stopping at the conference. The answer is really up to each person who engages with those communities. Will each person keep thinking about and acting upon the ideas discussed? Will each person change their perspective and then talk about the changes with other individuals who do not participate in the communities? Can the reach of the communities continue to be spread and reach into all areas of healthcare? Those questions cannot be answered, but can instead be reflected by perceptions and actions.
Healthcare will not survive without ensuring that people remain the full focus. Healthcare is ultimately about what happens to individuals and not an industry. That message can become muddled or lost, which means it should be repeated often. Never lose focus and keep straining to do better.