Summary of HIMSS 2021

If you missed this year’s HIMSS Global Health Conference & Exhibition (August 9-13, Las Vegas) or felt overloaded with the number of speeches and discussions, this summary is for you. I’ve covered the sessions I found relevant, picked up inspiring quotes and identified key takeaways from the 5-day programme.

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Artificial intelligence. Big chances but even bigger challenges

“Augmentation of human decision making is going to be greatly beneficial.”

Dr. John Halamka, President of the Mayo Clinic Platform, talked about the opportunities related to the development of artificial intelligence (AI) and machine learning (ML). In his view, it is necessary to ensure that the algorithms do not reproduce prejudices and guarantee a fair and transparent decision-making process.

AI can support healthcare professionals by analyzing large historical datasets about patients that physicians can then use in diagnosis and treatment. This information is a perfect supplement to the physician’s experience and existing information gaps. Well-functioning AI systems must be trained on high-quality data to avoid incorporating some biases into the algorithms. “The AI algorithms are only as good as the underlying data,” said Halamka, emphasizing that currently, hardly anyone documents their architecture accurately.

The solution is to define how the algorithms take into account elements such as ethnicity, race, gender, acquired education level, income, and other personal features. The President of the Mayo Clinic Platform identified four challenges on the way to adapting AI in healthcare:

• Gathering new data and their inclusion in the development of algorithms – for example, GPS information from smartphones and data generated by wearable technologies.
• Transition to creating innovation at the institutional level – people without technical knowledge should be involved in the development of algorithms.
• Algorithm validation – making sure that the way the algorithm works corresponds to the purpose for which it was developed.
• Seamless distribution of results and data – algorithms should provide physicians with relevant information in real-time.

Want to know more? Watch Dr. John Halamka talking about the future of health and medicine.

Information management

“As someone who’s been in public health for about 20 years, the idea that public health had just been in silos and institutions and government entities and now needed to be in people’s communities and hearts and minds really required a transformation in message delivery.”

Experts from YouTube, CBS News, and Facebook discussed how social media dealt with disinformation and infodemic during the COVID-19 pandemic. As Facebook and YouTube are the first source of information for many users, they faced the challenge of responsibly controlling fake news and disinformation campaigns.

Dr. Garth Graham, YouTube’s head of global health partnerships, notes that the pandemic led to a transformation in healthcare. The concept according to which public health remains closed in institutional silos, government units and scientific publications has become obsolete. Nowadays, it must be present and available where there are patients, including online communities.

In addition, information should be provided quickly, in an understandable and accessible way. For this purpose, popular communication platforms such as WhatsApp can be used. For example, in Singapore, 20 percent of residents signed up for real-time WhatsApp updates from local authorities. And in Indonesia, 500,000 healthcare professionals used WhatsApp to sign up for vaccinations.

Facebook’s Head of Health, Kang-Xing Jin, was talking about the information policy of the social media during the pandemic, including redirecting information about the pandemic to credible government websites or scientific institutions. He also mentioned activities that are to promote vaccination undertaken in partnership with the World Health Organization. For example, portal users can share their vaccination status or support for vaccination in general.

“Starting January 30th, we updated our policies to remove content that was debunked by public health experts and could also cause harm, and I think this point we’ve removed over 18 million pieces of content across Facebook and Instagram,” said Kang-Xing Jin.

Better care due to data availability

 “With hospitals, the best thing we can do is provide doctors with a much more unified view of the information of the person they are dealing with.”

“The reality is that so many errors are related to communication failures.”

Thomas Kurian, CEO of Google Cloud, highlighted how digital transformation contributes to more effective healthcare delivery. Thanks to innovations, healthcare can be provided seamlessly, physicians gain better insight into patients’ health while remaining in constant contact with them. Wearable devices may also be used for this purpose. Let me remind you that at the beginning of 2021, Google finalized the acquisition of the leader in this industry – Fitbit.

Moreover, digitization enables physicians to make precise decisions based on real-time data collected by clinical and administrative IT systems. The key here is to develop systems that provide information from various sources and present it to physicians in the form of summaries understandable at first glance.

The third potential of digitization, according to Thomas Kurian, is to increase the efficiency of care systems, thanks to which physicians will be able to devote more time to the patient. He also mentioned the potential of machine learning tools to strengthen value-based healthcare and speed up the process of developing new drugs.

At the end of the discussion, the Google representative highlighted the enormous potential of health data using the microscope analogy. “The microscope allowed doctors to find things and identify diseases they could never see before. Likewise, the data will let us see undiscovered correlations in health.

Changes in the regulatory landscape and the rise of the hybrid health ecosystem

“What happened in the pandemic, we were thrust into this digital revolution.”

The coronavirus pandemic has become one of the most critical drivers of legislative and reimbursement changes in new technologies in healthcare. Healthcare systems were forced to liberalize many regulations, allowing for broader use of telehealth solutions.

Many countries have liberalized their regulations that were unsuited to reality, developing pathways for quick approval paths of innovative solutions to the market. For example, remote health monitoring programs were launched, which were also reimbursed by insurers. Thus, patients with mild COVID-19 symptoms could be treated at home without occupying beds in overburdened hospitals.

Most of these changes have become so well received by patients that it is rather difficult to imagine a return to the pre-pandemic reality. Medical facilities have invested heavily in digital infrastructure and remote forms of service delivery.

According to the new analysis by McKinsey, telehealth use has increased 38 times from the pre-COVID-19 baseline.

Strengthening digital literacy among healthcare professionals

“People don’t feel they have the skills to do the work they need to, and they feel a little overwhelmed with the amount of data. For a lot of people who entered the profession, they never thought technology would be a linchpin in this way.”

In order to accelerate the deployment of digital technologies in healthcare and to fully use their potential, it is crucial to improve the digital health literacy of healthcare professionals. Therefore, investments in the ability to use IT systems and artificial intelligence solutions are investments in healthcare systems’ digital maturity and effectiveness.

The demand for employees with digital skills will grow rapidly, including a new generation of experts combining medical and technological knowledge. A great responsibility lies with academic centers, which have to update their curricula on an ongoing basis so that only professionals with up-to-date know-how enter the healthcare market. Skills in data analytics, AI, and virtual communication with the patient are among the most important. Many organizations have launched remote care tools overnight. However, this entirely new form of care delivery require not only medical, but also sociological and psychological skills.

Mountasser Kadrie, director of the George Washington University School of Medicine and Health Sciences, said: “Healthcare providers are going to need to have strong digital competency skills in the future, and I am confident academic institutions will align their programs to meet this demand, which will be on a local, regional and global level.”

Want to know more? Read a paper Harnessing the digital potential of the next generation of health professionals.

Creating effective behavioral health programs

“I think the future of behavioral health will be an a la carte array of options.”

Michael Hasselberg, Senior Director for Digital Health at the University of Rochester, shared his experiences in developing a virtual behavioral health program in a discussion with Julie Rish, a clinical psychologist and director of design and best practice in the Office of Patient Experience at the Cleveland Clinic. During the session, the results of the tele-behavioral model developed at the University of Rochester were presented.

The program, which started with a pilot program aimed at primary healthcare physicians, has evolved into a large-scale solution over a 9-year period. The infrastructure built at that time and the experience gained made it possible during the COVID-19 pandemic to switch to the virtual provision of behavioral health services quickly.

Technology was the least of the challenges. It was much more challenging to gain trust by building partnerships with communities and local service providers. As not every service can be delivered through telehealth solutions, having a provider network is essential.

By combining behavioral information with data from electronic health records, healthcare teams gain valuable information to design the best services for residents.

Want to know more? Read the paper The Digital Revolution in Behavioral Health published in the Journal of the American Psychiatric Nurses Association.

Technology may (or may not) drive a culture of empathy

“We have a unique opportunity now that everyone knows we can use EHRs to help bolster our empathic capacities. We’ve all learned that sharing computer screens engages patients in a way that really makes them partners in their healthcare.”

The issue of empathy in the era of new technologies was an exciting topic. Especially since there are many criticisms suggesting that IT systems consume valuable time during a patient visit, destroying good patient relationships. Nonetheless, this relationship should not be affected by how care is delivered, and whether the contact with the patient takes place via virtual or analogue channels.

Against all odds, electronic medical records can help build empathic relationships between the physician and the patient. For example, by sharing the information displayed on the computer screen with the patient, the physician involves the patient in the data collection process and allows the patient to feel like a partner in the data collection process.

IT systems can support empathetic healthcare. They enable data visualization, printing out therapeutic recommendations or drug dosages, and more regular contact (reminders, virtual check-ups etc.). Technology can’t be an excuse – it all depends on how you use it. The physician can either hide behind the computer screen or use it for better communication.

However, developers of information systems should explore and understand the physician-patient relationship to design products that are easy to use, intuitive, and require minimal physician time.

“Empathy by design” should be the new paradigm for health technology.

Collaborative health instead of one-fits-all paradigm

“Patients have insights to offer that their doctor may not understand, and when patient and doctor bring those two knowledge bases together, they become a more powerful team.”

The availability of data generated by, for example, wearable devices changes the relationship between the physicians and the patient – from transactional/paternalistic to participatory/inclusive. Thanks to access to online data sources, discussion forums and the physician’s notes, patients come to their appointments well-informed. This patient engagement creates an opportunity to improve treatment outcomes, especially in chronic diseases, and may also contribute to strengthening the role of prevention.

According to the participants of this panel, the next step should be to introduce tools that will provide patients with access to the same data that is available for the physician, allowing them to make informed decisions. The patient cannot be condemned to the best treatment option from the point of view of medical standards and treated by a physician using “orders.” It is the patient who must be free to choose among different treatment scenarios, taking into account their health condition, point of view, values, lifestyle, and personal goals.

In this approach, the patient should first receive personalized treatment plans based on electronic medical records, genetic and behavioral data. When patients feel that they are receiving individual, tailored help, they are more likely to follow the medical recommendations. Personalized care is the key to better adherence.

The challenge is to change the attitude of physicians who, brought up in an analogue healthcare culture, assume that they are the only experts “with a diploma” and that the patient should rely on their opinion because the decisive paradigm is scientific evidence, not personal beliefs.

This is a wrong approach – it is the patient who is the expert of his or her own health. And even if the physician does not understand the patient’s observations and measurements, they should take them into account in order to form a team with the patient. The path to participatory care is through trust and compassion.

Virtual therapies. Better patient experience and no side-effects  

“We can bring therapy into someone’s home.”

Medical professionals are beginning to explore the potential of virtual reality to treat certain diseases. There are more and more studies confirming effectiveness of virtual therapies (VRx) in relieving pain and treating some mental disorders. On the other hand, many healthcare professionals object to adopting another technology into their workflow because digital solutions already absorb a lot of their attention.

Brennan Spiegel, director of health services research at Cedars-Sinai Health System, a pioneer in virtual therapies, talked about his experiences with VRx. Cedars-Sinai Health System has been using VR for six years, treating more than 6,000 patients focusing on acute pain and chronic pain management. The barrier to introducing VR on a larger scale is not science but the reimbursement of this type of innovation and the lacking skills of medical workers.

Spiegel pointed out that VR works excellent for patients who do not have easy access to physical healthcare and trained physicians. It just requires the VR set to be delivered to the patient’s home and then virtual therapeutic sessions organized.

Want to know more? This video, featuring an interview with Brennan Speigel, explains how virtual therapies work.

Digitalization. A cause of burnout or a cure for it?

“There’s a huge influx of data coming into our systems.”

On the one hand, technologization of healthcare gives physicians new opportunities, such as access to the patient’s complete medical records and data management. On the other hand, technologies impose many administrative activities, stealing the time that should be spent on interaction with the patient.

Studies show that many physicians enter data after working hours because the amount of information that needs to be recorded is steadily growing. In addition, the physician often has to register data in various systems. For example, patient data – in the electronic patient file, epidemiological data – in the national registers. Not to mention that physicians who work in several facilities often operate systems delivered by different developers. Thus, technologies are both a “blessing and a curse.”

Experts pointed out that even if IT systems aim to reduce the need for additional staff, the effect is sometimes the opposite – suddenly, it turns out that there are people needed to enter data.

Physicians would like an approach where technologies are seen as a means to achieve the goal – better healthcare for patients – rather than the goal itself. In addition, clinicians’ views are not taken into account in the design of many IT systems. The problem of data overload won’t be solved quickly, for example, by artificial intelligence systems doing a preliminary data assessment. Instead, we need to focus on what can be done today – interoperability, user-friendly user interfaces, improvement of voice recognition systems.

Nurses. The unexplored source of innovation

“That equipment is given to us – processes, models of care – and we get very frustrated because they don’t quite work right or meet the patient’s needs.”

Digitalization is still too often discussed only from the physician’s or patient’s perspective, while the nurses’ point of view is ignored. This is a paradox – the nurses are closest to the patient; they are present on many levels of medical care and administrative tasks. They use IT systems implemented in healthcare facilities most intensively and know what works and what doesn’t.

Moreover, they know in details the workflows in the hospital where they work, walking long kilometers between patients’ beds and hospital wards every day. But, unfortunately, they still too often have to adapt to procedures and care models designed without their input. This happens even though they could provide an entirely new perspective on care and technology.

Without rethinking the innovation development methodology, integrating nurses into the clinical-management decision-making process and supporting their entrepreneurship, frustrated nurses will increasingly move away from hospital beds. Today, in the United States, the nursing shortage is almost 1 million. 1.2 million new registered nurses will be needed by 2030 to address the current shortage. WHO estimates that the world will need an additional 9 million nurses and midwives by the year 2030.

Because of their great empathy and close relationship with patients, nurses can be an invaluable source of ideas on reorganizing healthcare processes and implementing new procedures and technologies to support workflow. By listening to the voice of nurses, executives have the opportunity to better understand the issues facing frontline workers.

Dear Reader. I wrote this article using my own notes from the conference and information from the reports published on HealthcareITNews and on HIMSS TV. I skipped sponsored sessions.

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