Saturday, March 05, 2011

HIMSS 2011 Wrap-up: Big and Small

The Buzz: Rise of the "Extender Companies"
It was the biggest HIMSS ever (over 31,000 attendees) and yet it was the smaller companies that were the ones to watch. In the past, HIMSS was mostly about the HUGE booths and parties thrown by the top vendors. But this year the buzz was shifting away from the big vendors and towards the rise of the "Extender Companies", who are creating products and services which build around the larger ecosystem created by the established HIT infrastructures in place (and yes, "ecosystem" is already threatening to become the most overused buzzword of 2011).

This should not be a shock, the newer, smaller companies can be quick and innovative while the major HIT vendors (running the gamut from the giants like GE, Siemens and McKesson, to the big boys like Cerner and EPIC, to the now well established middle-tier companies like Allscripts, NextGen and eClinicalWorks) all are BIG BOATS that can't maneuver quickly and are pretty much focused on MU for the next few years anyway. But that's OK - this is a good thing, and parallels the situation seen in other IT industries… the "base level" is being set (just like Microsoft and Apple did with operating systems) and it's time for the next generation of HIT companies to start creating the products that actually move the pointer from "up and running" to actually "usable and useful". The good ones will thrive (and likely be acquired), the bad ones will fade away quickly - and there are books to be written and movies to be filmed about it all in the years to come.

Examples of companies to be on the lookout for (in no particular order or ranking):
• Quipp from Medicomp: a new way to document
• Salar: also new modules replace the note
• Phreesia: office "check in" tools
• Epilogue systems: automated creation of help tools, simulation environments, and testing for EMRs
• Aventura: technology to make computer logins quick and easy
• Precyse: coding support
• dbMotion: system integrator
• Elsevier: content, content, content
• MeDecision: data aggregation and analytics
• Halfpenny Technologies: data integration tools and services
• Merge: kiosks, patient portals
• IMO: standardized vocabulary (so your docs never need to learn ICD 10!)
• CareFx: web-based data aggregator (bought by Harris Corporation)
• AnvitaHealth: data analytics and content tool
• Eprocrates: various content tools
• Sensible Vision: fast access and continuous security authentication via facial recognition
• Logical Images: database of images for every disease
• Phytel: identify patients who need care gaps resolved
• Symphony Care: ACO software

The HIT X.0 Conference: Innovation and Future Thinking
HIMSS knows that it cannot just serve the needs of large hospitals installing monolithic HIT systems, and so I give them a lot of credit for creating the HIT X.0 sub-conference. The idea was to create a series of sessions that spoke more to innovative ideas in HIT and a look at the future. I was fortunate to moderate several sessions including the following:

HIT Geeks Got Talent
This was a take on "America's Got Talent" or "American Idol", in which six "contestants" got to show their "newest product" to a panel of judges who got to provide feedback to each of them. Based on judge and audience feedback, the top four advanced to the final round the next day.  General criteria to use for assessment include:  Usable, Unique, and Useful
In other words (1) Is it usable (easy to use), (2) Is it Unique, and (3) Is it useful (how does it provide value).
The best part of this was easily hearing the judges frank and incredibly insightful comments to each of the contestants - basically they each got invaluable consulting and coaching from some of the top minds in the business.  Additionally, anyone in the audience who might be thinking about starting a new company or launching a new product benefitted from hearing these folks think out loud.
* Erica Drazen, FHIMSS: Partner in Emerging Technologies, CSC Healthcare Group
* Dave Garets, FHIMSS: Executive Director, Advisory Board Company
* Jonathan Teich, MD, PhD, FHIMSS, FACMI: Chief Medical Information Officer, Elsevier

And now, here are the list of the six contestants (in alphabetical order), what they presented, and what happened to each of them:
* Anagraph ( A mobile application to support provider communication. The judges and I thought it was a cool concept, but the audiences didn't quite get it, and they were knocked out in the first round.
* Datatech Solutions ( A data analytics solution from a programmer in Canada. It allowed for a very cheap, very graphical view of complex data sets. Jeremy (the programmer and head of the company) was easily the worse presenter - a true data geek who had trouble explaining his solution in the few minutes he had. However, the judges "got" what he was doing and rewarded him the top prize "The HIT Geek Champion".
* Epilogue ( This tool automates the process of creating EMR help documentation, as well as allows for creation of a "simulation" environment and a testing application to help confirm user proficiency in the EMR system. The judges were worried that Help documentation wasn't "sexy" enough, but the audience understood the need for this type of application and pushed them into the final round.
* Napochi ( They created a very graphical "Wound Module" that could be used with their EMR or others. The judges felt it was an interesting niche, but they did not make it to the final round.
* PatientKeeper (  They unveiled their latest product - a mobile CPOE application. While the judges liked the concept, they worried this product might run into trouble truly integrating with the native CPOE products, and questioned whether all the clinical decision support could be handled as well on a small screen. In the end, they were first runner-up in the contest.
* YourNurseIsOn (  A SAAS communication staffing tool which allows hospitals to more easily staff nurses and other positions. The judges liked the concept, but wondered if a small company could challenge a big dog like Chronos. The rumor is that this company got so many requests for work after the contest that they felt they could easily out-innovate anyone else.

Iron Programmers
I started off this session with an overview of the importance of agile programming and why hospitals and vendors need to start thinking outside the big EMR box and recognize there is also room for agile development to create quick wins to solve problems as well as "lead the way" to better thinking about how to evolve their EMRs in the future. The full slides are below.

The basic definition is that agile programming involves two core elements:
• Rapid cycles of iteration
• User-Centered Design (Strong customer focus and interaction)

Why is this concept important? Ask yourself these four questions:
• Do your clinicians feel your current HIT system provides the most efficient and highest quality way to practice?
• Do your clinicians ever look at your EMR system and say, “How come it can’t do that?”
• Do you ever feel like you can’t do anything outside the scope of your current EMR system because it would “distract” from your core competencies?
• Do you feel like you can’t do anything “extra” because it costs too much in time, resources and money?

I then reviewed the idea of a paradigm shift away from incremental improvements to an EMR (e.g. annual upgrades) towards the concept of "Focused Innovation" (e.g. create a specific solution for a specific problem and then use it alongside or within your EMR). The results are:
• Solve an immediate need
• Provide an easy and cheap way to "pilot" or test out a new concept or workflow
• Be more creative in your approaches to problem solving
• Create the building blocks or direction to help guide development of more robust solutions within your EMR system

Then I presented an example of this type of "agile project", which was supported by the Szollosi Healthcare Innovation Program ( The concept was how could we help our physicians more easily communicate with our emergency department (ED). The result was ExpectED ( - a web-based system which allowed physicians to fill out an "Expect Note" to send into the ED. It was launched independently in 2008, and by 2010 we had incorporated it into our EMR. A more complete explanation will soon be available on the AHRQ Innovations Exchange (

Next, we highlighted this concept further by using the "Iron Chef" format of challenging two teams to use agile programming to create a product in two weeks - thus was born "Iron Programmers"! Each team was comprised of a front-end user interface expert and a back-end database programmer. About 2 weeks before HIMSS, they were given instructions to build a system which allowed for physicians to more easily communicate with the ED about incoming patients. This was not a competition as each team was asked to focus on different aspects of programming - Team one was focusing more on web based solutions, Team two on mobile based solutions.

Team One was Jon Baran and Ash Gupta from Healthfinch ( - a new company creating workflow tools which make life easier for physicians and their staff (BTW - I like this concept so much I'm working with these guys to build out these types of tools). They showed a web-based version of their "ExpectER" program, including the ability to access on a smart phone, and ways to send messages via text or automated voice technologies.

Team Two included Hunter Whitney ( and Doug Naegele ( They showed a pure mobile-based app, as well as a web-based "control system" to help edit the questions asked in the mobile version.

It was a very impressive showing of programming prowess as all of these were working versions of software. To make it even more fun, we had each team give the audience a choice of options for an additional function to be added to their systems. Then each team had to program live on stage to show their completed results… they each finished strong and wowed the audience.

If you want some more info, well known HIT writer Neil Versel did a nice writeup at:

And finally, my slides for the Iron Programmer session:

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