Oscar & Associates for HIMSS
Like most organizations, the Healthcare Information and Management Systems Society has had a tumultuous few years. The association, which puts on the largest annual healthcare conference in the U.S., was forced to cancel the massive event  at the last minute in 2020, amid growing outbreaks of a novel coronavirus that's now plagued the world for over two years. But HIMSS turned it around for 2021's conference in Las Vegas, which saw more than 18,000 in-person attendees on the ground — though that pales in comparison to the 43,000 registrants at 2019's event. Now, just six months after 2021's event, thousands of payer and provider executives, health IT vendors, researchers and more are once again preparing to congregate for HIMSS22, this time in sunny Orlando. And the conference is up to its teeth in COVID-19 safety precautions , organizers say. All attendees are required to be fully vaccinated, with at least two doses of Pfizer or Moderna, or one of Johnson & Johnson, while boosters are strongly encouraged. All venues within the HIMSS22 campus have at least hospital-grade air ventilation systems, will use approved cleaners on high-touch areas, and will have socially distanced seating options. Additionally, the exhibition hall will include wider aisles on the floor, with booths spaced apart. And HIMSS is once again offering a digital track for any executives wary of onsite attendance. But for those with boots on the ground in Orlando, here are five panels you won't want to miss, touching on some of the hottest topics in healthcare today, from health equity to cybersecurity. HIMSS Foundation presents: Working Towards Health Equity in the United States
HHS Secretary Xavier Becerra along with CMS head Chiquita Brooks-LaSure are headlining this panel on the state of health equity in the U.S. today, a perennial issue that's been thrown into sharp relief during COVID-19 and was a major focus at last year's HIMSS event. The pandemic has disproportionately ravaged underserved communities, as people with low socioeconomic status, as well as Black, Indigenous and Latino individuals, all experienced higher rates  of infections, hospitalizations and deaths from the virus. As a result, the Biden administration has made improving health equity a key prong of its healthcare agenda. CMS is taking steps like increasingly working to weave health equity into payment models, including for end-stage renal disease and accountable care organizations in Medicare , along with factoring in social risk in measuring star ratings performance in the ever-popular Medicare Advantage program. Becerra and Brooks-LaSure are likely to stress steps the Biden administration has made on the initiative, and could provide a hint at future directions the administration may take in addressing disparities in medical access and quality for all. The panel is Tuesday at 12 p.m., in Orange County Convention Center room W320 - Chapin Theater. Cocktail Hour Panel: Aging in 5G
Telecommunications giants are racing to ramp up their 5G coverage, which has the lowest latency of any cellular network ever, meaning it takes almost no time for the network to respond. Telecom experts say 5G will be able to handle 1,000 times more traffic — and be up to 10 times faster — than today's 4G LTE networks, which ( in healthcare ) could mean increased reliability for time-sensitive health activities or requests, more web-connected medical devices and better real-time monitoring of patient health, especially outside of the hospital setting. This session will cover the opportunities and challenges of operating 5G-enabled technology to help people age in place, and includes representatives from some big names in the industry, including Google and AT&T. Home tech for older people is at the intersection of two major trends in the healthcare industry today: care — including hospital-level care — is increasingly being delivered in the home, and the population is skewing older and older. By 2030, the Census Bureau projects the percentage of Americans 65 years or older will outweigh the percentage under the age of 18 for the first time in the country's history , making products and tools that can enable aging in place increasingly important. This panel is at 4:45 p.m. on Tuesday, in room W230A. An Update from the National Coordinator for Health IT and the CDC
Ensuring the free flow of electronic data across the healthcare ecosystem and modernizing the U.S.'s outdated public health data reporting infrastructure grew in importance during COVID-19. The pandemic illustrated how clunky data sharing can stymie the public health response, leading President Joe Biden to issue an executive order focused on evaluating public health data systems. Last year at HIMSS, National Coordinator for Health IT Micky Tripathi and Daniel Jernigan, acting deputy director for public health science and surveillance at the Centers for Disease Control and Prevention, took the HIMSS stage to share lessons learned from the pandemic, including the importance of unifying the public health response, integrating public health into the health tech ecosystem and nixing data sharing barriers. The ONC and the CDC have an interagency work group on modernizing the U.S. public health response, which has been working on a report in response to the executive order that's supposed to be delivered early this year to the HHS secretary. Tripathi and Jernigan are returning to HIMSS in this panel, and are likely to share more current thoughts on the nation's public health response — along with a potential update on that report. The panel is Tuesday at 5:30 p.m., in Orange County Convention Center room W320 - Chapin Theater. Keynote: Preparing for the 2022 and Beyond Workforce
Resignation rates in the U.S. have skyrocketed, and the healthcare sector has been no different, with workers facing acute burnout and intense stress after two years of COVID-19. That's resulted in mounting labor expenses for hospital operators forced to spend more on salaries, bonuses and traveling nurses, with a quarter of hospitals reporting to HHS that they faced critical staffing shortages  in early January. The workforce is also experiencing a generational shift, as millennials are projected to make up three-fourths of the global workforce by 2025. This session will address the ripple effects of the pandemic and the current makeup of the U.S. workforce, hitting on labor sustainability, retaining talent and prioritizing work-life balance. Panelists include Johnny Taylor, CEO of the Society for Human Resource Management; Tamara Sunbul, the medical director of clinical informatics and strategy at Johns Hopkins Aramco Healthcare; and Diane Swonk, chief economist and managing director at Grant Thornton. The keynote is at 8:30 a.m. on Wednesday, in the convention center's Valencia Ballroom. Healthcare: Post COVID-19's Most Lucrative Cyber Target
Cyberattacks have risen in frequency  over the past few years. That pace is only expected to accelerate as COVID-19 lingers in the U.S. And the issue certainly hasn't been helped by Russia's unprovoked invasion of Ukraine, which caused the federal government to warn hospitals and other companies about the potential for Russian cyberattacks . This cybersecurity panel includes Hussein Syed, chief information security officer at RWJBarnabas Health, and Michael Melore, executive cybersecurity advisor at IBM. During the session, Syed and Melore will go over the latest bad actor techniques that are being used to infiltrate healthcare organizations, and the best methods to protect against these increasingly sophisticated and frequent threats — including how hospitals are utilize advancements in artificial intelligence and behavioral anomaly detection to circumvent attacks. The session is at 2:30 p.m. on Wednesday, in room W311E. Follow Rebecca Pifer on Twitter

5 can't-miss HIMSS22 panels

At HIMSS21, Celona CTO Mehmet Yavuz explained some of the benefits of this up-and-coming connectivity technology. Photo: Oscar & Associates for HIMSS
While hospitals are just starting to deploy private 5G networks, other industries are further into the rollout of the technology and have seen major benefits to a connectivity infrastructure that offers low latency and consistent connection quality, features that can be lacking with cellular or WiFi. At a session at HIMSS21 earlier this month, Celona CTO Mehmet Yavuz laid out some of the benefits of private enterprise 5G networks as well as some potential use cases for the healthcare sector. "Think about wireless as a highway," Yavuz said. 'You have a lot of lanes and WiFi is like those regular lanes where you have a lot of devices causing a lot of traffic. 5G and LTE are like an HOV lane. It’s a special separate lane that devices can go on as you choose. ... It’s a separate spectrum just for this service and that won’t be all these consumer devices or mobile hotspots or all these things on there." A 5G network can offer very low latency, a very wide range (a mile radius or more per base station), and consistent connection throughout a facility – no dead spots. Yavuz laid out X ways these benefits could help hospitals. 1. Clinical communication
Whether doctors are using a clinical communications offering from their EHR vendor, a medical-specific vendor like Voalte or Vocera, or an enterprise technology like Apple's iMessage or Microsoft Teams, they rely on connectivity to communicate mission-critical information. That's one of the reasons the pager has held on as long as it has in healthcare. "The frontrunner at this point is clinical communications and monitoring applications," Yavuz said. "There’s a desire to have that reliable network. ... Bottom line is wherever there is mobility, someone is moving around, and you need reliable connectivity. That’s really where this solution comes into the picture." 2. Telehealth
Communication outside the hospital can also be affected by the hospital's network, as long as one party is in the hospital walls. "This can be between personnel within the healthcare environment, or it can be for telemedicine," Yavuz said. "The doctor wants to have a video-conferencing session, and sometimes they experience an outage during the video conference they have with the patients. Typically their device will be connected to the WiFi at the hospital, and that link can be compromised by interference from other devices. Visitors, patients, they’re all using the same network." 3. Exterior operations
During COVID-19, many hospitals set up operations that went beyond the walls of the clinic in order to support social distancing and keep staff and patients safe. "For example, with COVID we have seen a lot of these pop-up operations in the parking lot, where patients may be driving through and the healthcare professionals in those locations want a reliable connectivity for their handheld devices," Yavuz said. "So 5G provides extended outdoor coverage." 4. In-hospital retail
Another use case Yavuz pointed to was point-of-sale systems for hospital gift shops and cafeterias. Even though these aren't clinical operations, long lines or delays caused by point-of-sale systems going down can negatively impact patient experience. 5. Augmented reality and virtual reality
Where low latency really shines, Yavuz said, is in emerging applications that use AR and VR, especially in the surgical space. "You see that in multiple forms," he said. "One is in the operating room, where these augmented reality devices are starting to be used by doctors and other personnel. They want really low-latency for the augmented reality. And in some cases there’s remote learning. The doctor may be performing the operation and there may be other people who want to see that in real time. And they may be in front of their desktop somewhere." HIMSS21 Coverage
An inside look at the innovation, education, technology, networking and key events at the HIMSS21 Global Conference & Exhibition in Las Vegas.

5 use cases for private 5G networks in hospitals

Frank Cutitta told HIMSS21 attendees that he was struck by how lonely he felt throughout his time battling the coronavirus. Photo: Oscar & Associates for HIMSS
In late March of last year, Frank Cutitta was admitted to a Boston-area hospital with COVID-19. He wouldn't walk out again until the Fourth of July, 100 days later. "My name is Frank Cutitta, and I am very happy, literally, to be here," Cutitta told HIMSS21 attendees on Thursday. As the former HIMSS senior director of content analytics and the founder of HIMSS Media Lab, Cutitta, now the founder and CEO of HealthTech Decisions Lab, treated much of his time in the hospital as a longitudinal case study. From his frustration with patient portal updates to his adulation of the noble shower chair, Cutitta observed which high-tech – and not-so-high-tech – tools he relied on throughout his battle with COVID-19. This past spring, Cutitta said he'd felt a week of symptoms he'd written off as allergies before a friend loaned him a pulse oximeter. Even when his oxygen saturation levels read at 82%, Cutitta wasn't overly concerned. After all, 82% is more than a passing grade on an academic scale. "Well, that's not that far off from a B," he remembered saying. On the contrary, he was told: "You're going to BE in the hospital very quickly."  
By the time his wife finished parking the car, Cutitta was sent to the intensive care unit. He was given Propofol and spent more than a month unconscious. Even then, he said, technology played a role. In addition to the tools keeping him alive, his family made him playlists – heavy on Luciano Pavarotti and the Beach Boys – and set up an iPad to watch him. After Cutitta regained consciousness, he still faced a long road to recovery. What particularly struck him, he said, was the loneliness. He spent 23 hours a day by himself, with only the occasional, transactional interaction with a masked clinician to break up the isolation. And when Cutitta finally told a doctor how he felt, the provider responded that he, too, was lonely: He was an oncologist who yearned to be able to hold his patients' hands. "I'm a lonely person being treated by lots of other lonely people," Cutitta realized. "It's like a lonely marathon."  
In addition to the emotional challenges, Cutitta experienced firsthand how health IT can present hiccups and headaches of its own. For instance, he said, "electronic medical records are great – if people read them." Because his record had so much information in it, his nurses didn't initially realize he'd been approved to have ice chips, which he desperately wanted. He also encountered barriers to interoperability in the most visceral way possible, when it came time to remove his feeding tube. Unfortunately, the tube had been inserted at another hospital and his doctor didn't have access to the users' manual – requiring an ambulance ride and an ensuing story about the device's removal through Cutitta's throat that left many in the audience wincing. "To the best of my knowledge, they're still repairing the hole in the ceiling from when I jumped out of my bed," Cutitta laughed. "I just have a slight idea, in a minimal way, of what it's like having a baby."  
After Cutitta left the hospital, he took advantage of remote patient monitoring technologies like a palm-sized EKG monitor, video telehealth appointments and Apple Health's pedometer function. He also praised one of the lowest-tech devices he used: the shower chair, which allowed him to clean himself without getting fatigued. "Those are the things I learned about how important the nexus of high-tech and low-tech really is," he said. HIMSS21 Coverage
An inside look at the innovation, education, technology, networking and key events at the HIMSS21 Global Conference & Exhibition in Las Vegas. Kat Jercich is senior editor of Healthcare IT News.

The digital health tools one COVID-19 survivor relied on during his 100-day hospital stay

The national coordinator for health IT laid out some of ONC's priorities under the Biden-Harris administration and explained why he thinks "info blocking" needs a rename. Photo: Oscar & Associates for HIMSS
LAS VEGAS - At a recent HIMSS21 session, National Coordinator for Health IT Micky Tripathi laid out some of ONC’s priorities under the Biden-Harris administration, as well as discussing some specifics of the recently imposed information-blocking regulations. “What are the things we want to accomplish?” he asked. “Well, we certainly want a health IT system that directly serves patients, providers, payers and public health workers. We want a platform-based business and technical model that allows for a rich and private technology ecosystem and complements the EHR systems that are in place today. "We want health information networks that operate in the background to make basic clinical data available universally across the continuum in a commoditized, i.e. low-cost, high-consistency, way. And we want systems that help us identify health inequities and facilitate interventions that prevent such inequities from further turning into healthcare disparities," he continued. ONC intends to use a number of levers to accomplish this goal, including regulation like the Cures Act, but also convening the industry to collaborate and, if necessary, nudge it along from the bully pulpit. “So what is it you should expect out of ONC under the Biden-Harris Administration? First, a focus on what's practical and feasible, and at times pushing the envelope on what's practical and feasible, without losing sight of the vision,” he said. "Letting the market lead when it can, and providing enough leverage to put it in a position to lead when it can't. And doing that with as much transparency as federal processes will allow." Tripathi laid out five priority areas for ONC:
Continued COVID-19 response and support of the public health system. A renewed focus on “the spirit and the letter” of 21st Century Cures. Promotion and adoption of EHR interoperability standards. An enhanced focus on health equity. Alignment and collaboration with other federal agencies. 'Information sharing'
Tripathi believes that what have come to be called the "information-blocking" rules need a reframe: He’d prefer the positive framework of “information sharing.”
"We don't believe that every provider, vendor and the health information network is presumptively guilty until proven innocent being an information blocker," he said. "That's why I want the law to talk about information sharing. The industry has actually made tremendous progress in information sharing in a relatively short period of time. "That said, in a highly fragmented system, progress is really patchy and is not uniform, and it suffers from different priorities among industry actors. And that creates, on unequal footing, with at least the benefits of interoperability, barriers to [the] scale of the nation for developers. "The information sharing requirements of the Cures Act bring consistency across the industry by directing providers, vendors to health information networks to begin to make information sharing their default posture, which is a paradigm shift from HIPAA, which permits but doesn't obligate such sharing of information," he continued. While the law gives the ONC the power to set info-sharing guidelines, Tripathi reminded the crowd that the Office of the Inspector General is responsible for enforcement. “When we took office, there were a number of gaps in the enforcement side that we're now filling to getting clarity and transparency to the market and ensure efficient use of taxpayer dollars. Perhaps the biggest gap being filled on the enforcement side is the definition of 'appropriate,' disincentives for providers found in violation of the law. "The law specifies civil monetary penalties for members of certified technology and information networks of up to one million dollars per incident. But it delegates to the Secretary of Health and Human Services the responsibility for defining appropriate disincentives for providers. Unfortunately, not only have such disincentives not yet been identified, there was no process in place for determining how they might even be defined and managed.”
HHS is addressing these gaps via a cross-agency work group that’s already begun its efforts. "In addition, we're finalizing processes for managing and tracking complaints, mechanisms to give individual complainants some visibility into the status of their complaints and processes for reporting aggregated information on the number and types of complaints received and adjudicated," Tripathi said. Keep the feedback coming
He asked people to keep asking questions and offering feedback, but to accept that certain questions - like those concerning case-by-case enforcement - are beyond HHS’ purview to answer. "We'd also be doing you, you know, a great disservice by even stepping into that, because we'd be giving you a false sense of security, because we're not responsible for investigation and enforcement," he said. In general, though, Tripathi vowed to continue to communicate clearly and transparently, even as he asked the industry to keep talking to HHS. "There remains confusion in the marketplace, both from what we've published [and] questions we haven't yet answered," he admitted. "We do take this feedback very, very seriously. We assure you communication, after all, isn't about what I say. It's about what you hear. "And so, redouble our efforts to get industry feedback through even more proactive reach-out to stakeholders through increased frequency, timeliness, the relevance of our reviews and other communication channels, such as targeted blogs and information briefs to give more plain English, nontechnical, non-legalistic explanations of the key issues at hand. You'll be seeing those very, very soon."  
HIMSS21 Coverage
An inside look at the innovation, education, technology, networking and key events at the HIMSS21 Global Conference & Exhibition in Las Vegas. Topics:

At HIMSS21, Micky Tripathi weighs in about what to expect from ONC

At HIMSS21, Lt. Gen. Ronald Place of the Defense Health Agency said trust in data has been essential to the DoD's decision-making processes as it works to keep service members healthy and maintain operational readiness. Photo: Oscar & Associates for HIMSS
LAS VEGAS – "I've been looking forward to this engagement since you first invited me ... in 2019," said Lt. Gen. Ronald Place, director of the Defense Health Agency, as he began his View from the Top session at HIMSS21 on Wednesday. Yes, the world looks quite a bit different since March of 2020, when the novel coronavirus first upended the world and forced the cancellation of that year's edition of this conference. But for all the pain and disruption over the past year and half, it's worth noting how much the healthcare system has learned since then. "It's important to pause and recognize the work that all of you put in," said Place. "The sacrifices that each of you individually and collectively, have made over the past 18 months have gone into the solutions that we have in place today." Across the U.S. and the world, hospitals and health systems, public health authorities, government leaders and others have responded to the pandemic the only way they can, he said: "trying to make sense of the information that we had, and then using that to make decisions." The same process occurred across the Department of Defense, as the enormous national security implications of COVID-19 became apparent in early 2020, said Place. "How can we safely keep ships at sea? How can we launch submarines and aircraft? How do we manage troop movements around the world with … this?" And the answer is information. We need it right, we need it fast. And we need it to make decisions on how to manage the pandemic and still preserve our ability to project a fighting force." The DoD quickly stood up a task force to develop a testing strategy across the entire Armed Forces, he said. "How much testing could we do, what was our capacity, how accurate were we, how soon can we get results from our laboratories in the Military Health System? The pandemic reminded us of the connectivity between disease and readiness." There's a reason the U.S. military will soon be requiring COVID-19 vaccines, after all. "It takes away from the mission," he said. "It takes aircraft carriers away from the mission. It has the potential to ground airplanes, keep submarines in port. Takes health care workers out of their usual work and makes them do other things, perhaps in other areas of the country. It slows down our process for training new recruits." The Military Health System is the largest organization of its kind in the world, said Place, with 600 hospitals and clinics serving 9.6 million Americans, staffed by 150,000 people and a budget of $54 billion. One of its major initiatives over the past several years, of course, has been its massive electronic health record modernization project with Cerner. MHS Genesis is now operational in about 30% of MHS facilities around the world, said Place, and implementation work continued all during the pandemic. "Unlike many in the private sector, we in the military don't really have the luxury to work from home," he said. "Home is where the mission takes us." Place said the technology enabled fast response to testing and treatment – helping laboratory leaders and health informaticists standardized nomenclatures for the novel virus, for instance. More recently, EHR workflows were updated to prime the system for mass vaccinations. "In the military, we do a lot of vaccinations," said Place. "It's just part of our culture to have mass vaccinations in the Department of Defense." Case numbers and vaccination totals are still updated daily and posted on Defense.gov – all part of a "disciplined process to capture what the science was telling us." The MHS has updated its decision support mechanisms since the start of the pandemic and has "adapted clinical practices to treat unknown effects and symptoms of COVID-19 exposure." It stood up a COVID-19 registry with nearly 200 separate data elements for every positive patient – enabling continuous learning as the virus evolves. "COVID-19 is not going away," he said. "But how much it occupies our waking hours is largely up to us." Place said a technology-enabled and data-driven response like the DoD's – with leaders and stakeholders who understand how to explain and manage risk, have trust and confidence in information integrity and embrace transparency – will help enable more effective management of "the most serious public health crisis of our lifetime."

DHA Director: Information and technology drive effective pandemic response

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