The crowds at HIMSS this year may have been smaller due to COVID-19 concerns, but the conversations at the annual health IT conference were just as weighty as prior years.
The conference, which spanned several Las Vegas resorts from Caesars to Wynn, netted roughly 19,300 in-person attendees and 5,000 digital, organizers estimated late Thursday. Roughly 700 exhibitors stood up booths on-site. The figures were about half of attendence numbers in 2018 and 2019, but higher than some feared as COVID-19 cases continue to rise in Nevada.
But to many, the lure of the massive healthcare conference — and its considerable networking opportunities — was too good to pass up, especially in light of extensive COVID-19 precautions.
"We're all vaccinated and had so many meetings and thought, why not," Michele Perry, CEO of patient engagement startup Relatient, told Healthcare Dive on the sidelines of the conference.
At HIMSS, experts shared their thoughts on the future of digital health, artificial intelligence and virtual care; methods to tackle health disparities and cybersecurity breaches; evolving fraud regulations; mental health and more.
The coronavirus was the strain running under it all, as attendees focused on how the sea changes brought from the pandemic will reverberate in healthcare for years to come.
Pandemic forecast: 'Guarded optimism'
The past few months have seen an unfortunate surge in COVID-19 cases, "that's in proportion, and reminds us of, what we've seen in previous pandemic waves before we were vaccinated. And right now the challenges seem to be the same," Ran Balicer, chief information officer at Israeli company Clalit Health Services, said.
Driven by the highly infectious delta variant, COVID-19 cases hit 205 million on Thursday, while the death toll climbed above 4.32 million, according to a tracker maintained by Johns Hopkins University. The U.S. — which leads the world with total caseloads and deaths as the virus spreads quickly, especially in states with low vaccination rates — is still facing many of the challenges that defined 2020, including misinformation, vaccine hesitancy, a paucity of data and the politicization of the public health response.
But despite rising cases, the world is facing this resurgence with one weapon it didn't have early last year: knowledge. Along with the availability of multiple viable vaccines, the public emerged from 2020 with more information on sanitary handwashing, social distancing and masking practicing, experts said at HIMSS. That could make this surge easier to curb.
"It feels like we can move forward with some guarded optimism," HIMSS CEO Hal Wolf said.
That optimism comes even as many predict this coronavirus will never be eradicated completely.
On Wednesday, Moderna CEO Stéphane Bancel told HIMSS attendees that he predicts the coronavirus will continue to mutate for another 12 to 18 months, and that people will likely need booster vaccinations every year, like with flu shots.
"The virus is never going to go away from the planet," Bancel said.
Throughout the five-day conference, speakers stressed that public health infrastructure needs to become a political priority to deal with future outbreaks. The countries that have fared best in COVID-19 response are those that have historically invested in an integrated system of public health, like Israel, said Hans Henri Kluge, Regional Director of the World Health Organization.
"Healthcare is not an expense. It's an investment. And if you think for one moment healthcare is not an investment, look at what's happened to economies around the world when we've been unable to respond quickly to a pandemic due to a lack of actionable information," Wolf said.
Speakers stressed the need for international transparency and partnership, and parsed out how digital tools can help manage future crises.
On a panel on implementing technology to combat health emergencies, speakers recommended governments and health systems prioritize evidence-based protocols and messaging to citizens; establish standard data sets for public health data reporting and a governance structure specifically for communicable diseases; ensure medical organizations have the necessary tech for timely data collection and sharing; and spur the development of digital tools and services to support health programs in areas like disease prevention and testing, among other strategies.
"Digital public health is clearly what matters these days. And the future is digital," said Bandar Al Knawy, CEO of India's Ministry of National Guard Health Affairs. "Hopefully, we can have a real time approach to monitoring and surveillance to what leads to infectious diseases."
Digital health revolution ongoing, but legacy organizations lagging behind
Digital health will play a key role in ameliorating some of the biggest problems facing the U.S. medical system today, experts predicted at HIMSS, but how much of a role depends on uptake.
Management consultancy the Chartis Group released a survey finding 52% of healthcare executives say they haven't progressed beyond the pilot stages of digital integration, though they understand the need.
Close to half (47%) of the 220 executives surveyed said digital was a "top organizational priority," while 80% said they planned to increase their digital investments in the future.
"What happened in the pandemic, we were thrust into this digital revolution," said Thomas Kiesau, senior partner with the Chartis Group, on Wednesday — and many organizations have been trailing behind.
But it's not that hard to catch up, attendees said. Payers and providers have many tasks that can be done automatically based on protocols, not only around clinical pathways but routine front office work, according to Nick Patel, chief data officer for North Carolina nonprofit Prisma Health.
Digitizing such tasks is an important tool to free up a workforce, especially as physician and nurse shortages continue in the U.S., Patel said.
Collecting data is the first step, especially as health systems manufacture and mine more patient information. But it's important that executives know what they're trying to solve with technology before implementing it, ensure any new tools integrate in existing workflows and understand how it fits into their overall strategy, attendees said.
"Will knowing your readmission rate help you to drive change in your readmission rate?," Nick Stepro, chief product officer of population health management company Arcadia, said. "You need to know what products to build and what's the net benefit beforehand."
To solve this, payers and providers should focus on the consumer experience and ensure data is underpinning the products they're building, according to Aaron Martin, chief data officer of health system Providence Health.
"I am demanding from my team that every service we provide has a digital endpoint to it. And [application programming interfaces] — you've gotta have an API for every one of these different services," Martin, who left Amazon for Providence in 2014, said.
And the ROI for building and integrating these digital tools is "obviously there ... you need to stay out in front," Martin said. "All this is just in an effort to catch up to what consumers expect in any other part of their lives."
Nassar Nizami, chief information officer for Philadelphia-based academic medical center Jefferson Health, agreed.
"I firmly believe in the long run our investments in digital front door will pay dividends," Nizami said on the same panel.
Artificial intelligence, machine learning gains steam
Unsurprisingly, artificial intelligence and machine learning were front and center at the conference, with executives at many leading systems talking about how they've been ramping up investments in algorithms during COVID-19.
Rush Medical Center, for example, is building predictive models to try to bolster its social determinants of health screening platform so it can better connect patients with resources in the community, Bala Hota, Rush's chief analytics officer, said.
Similarly, Cerner Intelligence Vice President Tanuj Gupta said its hospital clients were looking for more AI-enabled tools to do the same jobs its software has been fulfilling for years. That interest has caused the health IT vendor to rapidly ramp up its clinical model output.
"The jobs are the same," Gupta said. "The tools are evolving. So you're going to see a lot of digital health companies evolving, hopefully, to bring you those tools."
One fledgling area where AI is being leveraged is emergency forecasting to predict future public health crises, experts say. Existing players are already taking on the challenge, with Optum Director of Research Danita Kiser telling attendees the UnitedHealth-owned health services business has created an algorithm for infectious disease forecasting.
"If we can forecast a week or two in the future, we can put prevention measures in place to save people's lives," Kiser said.
Telehealth: 'Much more popular' once again
Telehealth got a huge boost during the pandemic, with many outpatient visits switching to virtual almost overnight and regulators and vendors scrambling to create a structural foundation to support them.
Many health IT experts at HIMSS argued the U.S. needs to work now to make that foundation permanent so that the gains notched during COVID-19 don't dissipate after the public health emergency expires.
"Policy reform is clearly needed in this area," said David Bates, chief division of general internal medicine and primary care at Brigham and Women's Hospital. "There will be much more use of telehealth. This experience really underscored the importance of patient portals and the digital divide ... Organizations need to streamline their policies to set up approaches for acting more nimbly."
Estimates as to how much medical utilization will be conducted virtually varied, with Teladoc president of hospitals and health systems Joe DeVivo telling Healthcare Dive in an on-site interview the vendor predicts between 20% to 30% of all visits will be virtual post-pandemic.
Wherever utilization ends up stabilizing, early data suggest telehealth visits are once again rising in tandem with COVID-19 cases. The sector could enjoy another short-term burst, experts said.
"The height of the pandemic is back to us so we're going to see telehealth become much more popular once again," Jeff Sturman, chief information officer of Memorial Healthcare System in South Florida, said.
Along with regulatory uncertainty, significant question marks still dog the industry, including varying reimbursement by payer and service and the sustainability of consumer demand. Some experts stressed payers won't feel confident even considering permanent coverage until they have more cost-efficiency data from a more normal utilization year.
Interoperability fervor toned down, but focus remains
At HIMSS in 2019, one couldn't walk down the hall without hearing multiple conversations about interoperability. At the time, HHS had yet to finalize two long-awaited rules codifying key tenets of the 21st Century Cures Act that promised to reshape how data was shared across the healthcare ecosystem, and stakeholders eagerly waited for Office of the National Coordinator for Health IT and CMS representatives at the conference to drop any news.
At HIMSS21, however, more than a year out from the publication of the final rules, attendees focused more on digesting implications for their businesses.
On a session on interoperability and ONC priorities, ONC head Micky Tripathi said he's been getting a lot of questions from providers on exceptions to the new interoperability mandates.
"We recognize there are good and valid reasons not to share information," Tripathi said. "I strongly urge you to look carefully at the exceptions."
Tripathi also noted HHS was making progress on codifying appropriate disincentives for any providers found information blocking, and would share more information "as soon as it's available."
Regulations or not, numerous speakers over the week reiterated the important of de-siloing the healthcare system in pursuit of better patient care.
"Especially during the pandemic, there has been a growing realization that all the ecosystem players have to come together to drive patient centricity. There has been a missing link and that's trust," Shreesh Tiwari, a principal at professional services firm ZS, said.
Interoperability is key to fixing this, Tiwari said. "We are just getting started with creating interoperability of that data in the ecosystem ... and creating that common link trust to bring those silos down."
Health equity will take top-to-bottom interest — and careful touch with technology
The pandemic highlighted inequities inherent in the U.S. medical system, bringing the conversation about health disparities to the forefront of the public consciousness. HIMSS was no different, with experts saying COVID-19 amplified the discussion, but meaningful change will take significant enterprisewide investments, targeted partnerships within the community and a whole lot of data.
"We need an integrated system … making sure that people who are digital health illiterate or they don't have financial means that they’re not discrimated, and there's no discrimination on the basis of gender, or sexual orientation," WHO's Kluge said.
To get there, industry needs to foster "tangible, meaningful solutions that work toward building health equity, and most importantly, trust," Michael Petersen, chief clinical innovation officer at NTT DATA Services, said at a panel on disparities.
Health systems and payers need to make sure they have comprehensive population-level data to know where to target these solutions, attendees said. Digital health can help, but it's imperative organizations are careful with technological interventions so they don't accidentally worsen inequities, said Denise Fair, the chief public health officer for the city of Detroit.
And though leadership prioritization is important, fostering equality needs to be an organizationwide goal, said Ronald Copeland, the chief equity, inclusion and diversity officer for integrated health giant Kaiser Permanente. Copeland suggested making health equity a formal dimension of quality improvement, to make sure executives were focused on equity in every organizational shift.
Hopefully, the pandemic will bring about meaningful change, not just more lip service, on this front, several speakers said.
"Enough is enough. If I can be very real, we're tired of having the same conversations," Fair said.
Rising importance of cybersecurity
With the recent rash of cyberattacks lending credence to analyst worries that COVID-19 would accelerate the number of hacks and breaches in healthcare, cybersecurity was unsurprisingly a major theme.
Along with outlining the pros and cons of paying following a ransomware attack (hint: There's no right answer), experts stressed that medical companies need to prepare as thoroughly as possible for an attack.
Panelists recommended companies assess their IT strengths and weaknesses to know how to prepare, with the option of role-playing a breach to see how their staff responds and any contingency processes play out in real time.
Prepping "should be boring," said Michael Coates, former chief information security officer for Twitter. "What builds resiliency in cybersecurity is thinking about fundamentals. And that is boring, and it's also hard."
How healthcare fraud — and OIG enforcement — are evolving
HHS Office of Inspector General officials discussed how healthcare fraud is evolving with technology and noted some recent hefty settlements for alleged anti-kickback and False Claims violations among digital health companies
For every dollar spent combating healthcare fraud, OIG returns $4 to the federal government, according to the agency.
Some recent actions include a $18.25 million settlement Athenahealth agreed to pay in January for allegedly paying illegal kickbacks to boost sales of its EHR product.
And a year prior, EHR vendor Practice Fusion agreed to pay $145 million after admitting it received kickbacks from a major opioid company in exchange for using its EHR software to influence physician prescribing of opioid pain medications.
"This case is really a cautionary tale, and the takeaway here is that you cannot pay or give anything of value in exchange for promoting your products," Lisa Re, assistant inspector general of legal affairs at HHS OIG, said virtually.
Telehealth fraud is also on the rise, and often involves criminal organizations leveraging fake telemedicine companies and unscrupulous providers to generate fraudulent referrals, experts said.
Both the criminal organization and physicians sending medically unnecessary or unsupported claims can be held liable, Andrew Vanlandingham, senior counselor of Medicaid policy/acting health IT and HHS OIG, noted.
"Recognize that as these expand and go from sophisticated criminal organizations to more run-of-the-mill healthcare fraud, which we are seeing, that there is liability for both criminal organizations … but also the doctors," Vanlandingham warned.
Mental health a key post-pandemic challenge
The COVID-19 pandemic exacerbated existing mental health issues, and "clearly we have not been having the conversations we need around mental health," Patrice Harris, CEO of at-home testing company eMed, said at a panel on lessons learned from the pandemic.
"Now we need to be about the business of including mental health into overall health," Harris said. "And that goes into how we think about regulations, and how we think about financing, and how we think about policy."
Merging increasing mental health needs with other medical needs is a challenge for the Department of Defense and its 9.6 billion beneficiaries, Terry Adirim, acting assistant secretary of defense for health affairs, said.
"It's a huge issue for us," Adirim said.
A significant portion of those beneficiaries are military children who frequently move and experience the stress of their parents' jobs. The agency has been able to reach that population through telebehavioral health visits that have greatly accelerated, giving families better access to care, Adirim said.
And while stigma around seeking mental health treatment is still a problem, telehealth can help.
Esperanza Health Centers, a federally qualified health center on the southwest side of Chicago, made telehealth available to patients sitewide early in the pandemic.
No-show rates for mental health visits pre-pandemic hovered around 30%, and as of July 2021 were at 17%, Jessica Boland, the health system's director of behavioral health, said.
'Stepchild' femtech industry speaks up
Digital health companies already shattered last year's record for funding, reaching $14.7 billion in July, according to Rock Health. But most of that money isn't flowing to tools that cater to half the population.
"Femtech still continues to be the stepchild for digital health," Reenita Das, a partner at Frost and Sullivan, said.
Companies that provide digital health tools for women accounted for just 1.8% of the investments in Rock Health's report.
One reason is a lack of women in venture capital, Das said. Another is that pitching to male investors still remains a hurdle.
"Today we're really a niche business with lots of startups on the horizon," Das said. In the first quarter of 2021, nearly 70% of the women's health deals were for early-stage companies, according to Rock Health.
The market for women's health tools currently revolves around early life concerns like fertility and reproduction, but more tools are needed for menopause and senior care issues, Das said.
Over 100 women's health tools currently cater to women of reproductive age (15-40), who accounted for 37% of the population and had a $29,000 median income in the US in 2020, according to an analysis from Frost & Sullivan.
Less than 20 tools exist for menopausal or senior women (40+) who account for 38% of the population and had a median income of $47,500 in the U.S. in 2020.