HIMSS2019: Day Two Begins

Today was supposed to begin with the Keynote addresses --- starting at 8:30 a.m. Well, despite a timely departure, there were delays getting to the Convention Center (the bus took the wrong route and several wrong turns). This prevented an on-time arrival -- kind of like flights to a meeting where one experiences delays. And, even when my busload of folks arrived at the Convention Center, it was like we were at the bottom of a ski slope where one then needed a chairlift or gondola to get to the point where one begins the actual activities. 

As I was “chairlifting” to the Keynotes, I encountered the amazing Delos (Toby) Cosgrove, the former head of the Cleveland Clinic (which thrived under his leadership) and prior to that, an extraordinary cardiovascular surgeon. I have known Toby for years.  He walks way faster than me – over 6” tall compared to my 5’1” – so as we “walked together” to the Keynotes, one of us was strolling and one of us was running.

I remarked that people must pass out and have heart attacks at this event as they get from place to place; there had to be medical facilities on site. Dr. Cosgrove then remarked, calmly and with assurance, “All the people on earth are pre-op.” 

What a line. What truth. What wit. A statement worth repeating as we reflect on healthcare delivery. We all will become patients, if we are not one now. And, while it took a former surgeon to zone in on surgery ahead of us all (although surgery is changing and so are recovery times), he’s right:  Healthcare is ubiquitous and we would do well to focus on its improvement.

That line was followed by a different line from the CEO and President of HIMSS, Hal Wolf:  “Watch out for the gray tsunami.” Being gray haired and reflecting on Dr. Cosgrove’s observation, I saw a link.  With an aging population that will live longer and live with diseases that once killed us, we will all become patients.  And, that means the medical profession needs to be ready for us all. Yes, technology can help fill the shortages in health services. 

But, and this is the key point: tsunamis are dangerous. People get hurt and lost. And we should be focused on preparedness, not just being reactive post disaster.

These two just identified phrases got me thinking: why don’t I share the key sentences and phrases uttered during the Keynotes? And, if one then compiles them, one sees the major themes and realities of healthcare and the HIMSS conference. And, as I say to children with whom I work on poetry, different children can write different lines and we can put them together as a poem. So, I’m creating a HIMSS medical “poem.”

Dr. Karen DeSalvo said (in sum), “Most health outcomes are not determined or remediated within the healthcare system.” Think about that: the causes of our health dilemmas are external to it and we need to focus on the social determinants of health if we want to make progress. In short, we will never get people well if we only focus on healthcare delivery. We will always be behind the proverbial 8 ball. We need to step outside the health walls and see what affects people’s health.

Aneesh Chopra had a myriad of lines worth savoring and remembering. Try this one: “We now have plumbing in place for data sharing.” In healthcare, it has been hard to get data transmitted from one doctor to another doctor and determine what data gets sent and in an open and cost-free way (if possible). To make this happen, we need to work together and share information and make systems interoperable and have standardization. We are, with very new government regs, on this pathway. My observation: plumbing is basic. We need plumbing for sure and are better with it than without it.  But, it is not enough. It’s a start.

Former Governor Leavitt talked about the importance of bipartisanship and working collaboratively as we move forward to get standards. His line was this:  “What is a community?”  Who is in that community? Who can be added or deleted from a community?  Which social determinant of health has the biggest power for a community? Rulemaking is one thing.  We need more than words though; we need action within the private sector. A rule isn’t enough.

Chopra then added a sentence well worth considering as we reflect on implementing change, in this case in healthcare data sharing with standards that work across programs. He noted that change seems overwhelming and getting everyone working together on a shared language and technical data model feels like a vast project. And, we need to move fast. But, he noted, with wisdom, “We will move at the pace of consensus.“ We can move no faster than our capacity to speak a shared language. 

This raises the critical question about how we reach consensus. Not so easy, is it? I am struck by the questions posed by James Ryan in his fabulous book, Wait, What? One of his key 6 questions is basically, “Can we at least agree that….”? That is what Chopra is saying, and we will make change faster if we work off a consensus model as opposed to a divided mode. (More on Ryan’s questions in a later article.)

One final line from the Keynotes: We need Blue Button 3.0.  Blue Button is an application that lets consumers access their own health information. It has grown and is a remarkable accomplishment that can serve as a basis for expanding patient engagement. And, for the record, Blue Button is used with Veterans today, and its value cannot be underestimated. Yes, build on it. Make it available to us all on our phones and other devices.

So, the Keynote (and pre-Keynote walk) poem with wee edits to make it work better:

All the people on earth are pre-op. 

Watch out for the gray tsunami. 

Most health outcomes aren’t solved within the healthcare system.

We need Blue Button 3.0.

All the people on earth are pre-op.

We will move at the pace of consensus.

We now have plumbing in place for data sharing.

What is a community that needs health benefits?

All the people on earth are pre-op.

Watch for the next article. Onward.