The Healthcare Information and Management Systems Society (HIMSS) Convention, held February 16-20, 1997 in San Diego, provided 14,000 attendees with a mixture of latest information system (IS) trends, professional networking (sic) opportunities, and plenty of hands on opportunities for examining hardware and applications as displayed by over 400 healthcare vendors. "The Big Picture" captures not only the essence of the convention's theme -- planning and operating healthcare applications in an integrated delivery system -- but the convention's size and spirit as well.
 
HIMSS, founded in 1961 as a not-for-profit professional membership organization, has more than 7500 members worldwide. Members include healthcare professionals in four constituencies: clinical systems, information systems, management engineering, and telecommunications.
 
Scheduled conferences included presentation tracks covering the Internet, managed care, strategic planning, Department of Defense health affairs, computer-based patient records, re-engineering/redesign, clinical decision support, patient focused care, ROI/cost analysis, international systems, emerging technologies, and hot topics. Afternoon sessions focused on real-world problems such as electronic patient record security and confidentiality, and issues involved with systems that measuring physician productivity. New this year was a series of networking groups, which served as forums to discuss common problems and springboard future interactions. These groups included managed care, computerized patient records, re - engineering and performance improvement, outcomes measurement, and academicians in health care.
 
After the conference each attendee received the full proceedings on CD-ROM. Conference proceedings are available as summaries of each author's presentation, either at the Web site or on a CD-ROM available from HIMSS.
 
Highlights of the conference included the Emerging Technology track, with discussions on wireless computing, smart cards, and telemedicine. The greatest projected growth in smart card technology is expected to occur in finance, identification, and in health care. Several real-world smart card applications were presented. Most applications in health care are implemented in Europe and range from insurance verification and billing across Germany to Dialybre, a French application that uses smart cards issued to each of the country's 20,000 dialysis patients, allowing them to receive dialysis at any site in France. The consistent theme of the presentations was that to be successful the smart card application must target a manageable population and/or be narrowly focused. Pilot projects in the United States, just beginning, include portable medical records and demographic/billing information for national managed care provider organizations.
 
Telemedicine providers are most concerned about the legal liability for providers of telemedicine services across state lines. This and other issues of provider qualifications/credentialling were discussed in the group sessions. Another topic, from the opposite perspective, was the confidentiality of electronic records as perceived by the patient. To those not familiar with computers, security of records over telemedicine links is thought to be looser than in paper or electronic charting. Overall, the complexity of issues is such that dialog among experienced telemedicine groups could only frame the problems and highlight potential areas of advancement in the field.
 
The Management Engineering track illustrated how an organization might use a management engineering specialist to help plan and manage complex installations. By incorporating work flow variables that might be ignored in simpler IS installations, these specialists can provide a functional perspective on installing systems that affect its many users.
 
Exhibition hightlights: The JCAHO announced Oryx, its initiative to require healthcare organizations to supply a new set of provider performance measures as part of the next round of accreditation. The Oryx process, described on Oryx initiative, requires organizations to transmit this information to the Joint Commission through one of a number of vendors of performance management software that have received approval from JCAHO. For more information on Oryx see MCToday's Views.
 
Medicomp Systems of Chantilly, Va., announced publication on CD-ROM of its long-awaited standardized medical vocabulary Medcin. Unlike other products, Medcin includes a wide range of history information, including a variety of signs and symptoms that map to coded information for later database retrieval. A Web-enabled application is under development. The company's direction is to partner with a variety of electronic medical record vendors to incorporate data standards that will promote sharing information across applications for better disease management.
 
New patient education and electronic medical record software products were popular vendor displays.
 
Other highlights: as a convention co-sponsor, the Department of Defense (DoD) was a major presence both educationally and in the exhibition hall. DoD hosted ten educational sessions ranging from medical information systems in theater activities, information technology strategic planning, and designing medical decision support systems. Exhibitions included several military health information systems, and a display of mobile monitoring vehicles simulating medical care in battlefield situations.
 
Not unexpectedly, the HIMSS convention drew its share of popular and controversial keynote speakers. Married politicos Mary Matalin and James Carville shared banter over the realities of American politics, while Chairman of the Board of the American Hospital Association Reg Ballantine shared his vision of the future of U.S. health care. Mr. Ballantine stressed the growing importance of the virtual health organization. He feels that the consumer will interact with the healthcare system through vehicles like the Internet to evaluate care options, choose a provider or become better educated about his or her disease. Other well-received speakers included cartoonist Scott Adams (Dilbert) and author/poet Maya Angelou.
 
The Leadership Survey conducted annually at the convention provided some insight into this year's attendees' concerns. For example, regarding unauthorized access to computerized medical information, 40% identified curiosity seekers as the number one culprits while only 18% worried about external breaches of security by computer hackers. Other topics of concern include the integration of applications across a wide delivery system, involvement of physicians in benchmarking, change in healthcare delivery, and productivity measurements for providers. Physician benchmarking is increasingly being used to compare providers' performance with that of their peers, in a variety of areas, including cost management, disease treatment effectiveness and patient outcomes (measured by return to work or improvement in functional status). 87% said their organizations use an institutional connection to the Internet, primarily for e-mail communication. Interestingly, responses by 20% of respondents indicated their organizations have already developed an intranet, and an additional 36% said intranets are in various stages of development. Full survey results are listed on HIMSS' Web site.
 
From February 22-26, 1998, HIMSS will again tempt the snowbound IS executive, physician, and healthcare computing professional with another major convention set against a sun-and-sand backdrop -- this time in Orlando, Florida.

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