HIMSS Takeaways: Size Doesn’t (Always) Count, Johnny Appleseed and MomGPT

By MICHAEL L. MILLENSON

Live and in-person once again, HIMSS 2023 attracted more than 30,000 attendees to the exhibit halls and meeting rooms of Chicago’s sprawling McCormick Place. Although no one person could possibly absorb it all, below are some harbingers of the health care future that stayed with me.

Size Doesn’t Count. Exploring the remote byways of the cavernous exhibition areas, it became clear that it’s not the size of the booth, but the impact of the product that counts. At a pavilion highlighting Turkish companies, for instance, R. Serdar Gemici stood in front of a kiosk that might fit into a walk-in closet.

The display listed an impressive roster of clients for a chronic care management platform, prompting me to stop to learn more. The smartphone user interface for “Albert,” the namesake product of Albert Health, the company Gemici co-founded and leads, immediately impressed me as one of the simplest and yet comprehensive I’d seen. (Indeed, the company website boasts of the “world’s simplest health assistant.”) Albert Health has begun working with England’s National Health Service and large pharmaceutical companies, though I found myself wondering how the name resonates in the Turkish- and Arabic-language versions the company touts.

Another far-off cluster of kiosks hosted a company called Dedalus, which promised an interoperable, whole-person care platform. A demo included a graphic showing a breadth of holistic personalization and collaboration capabilities I’d not seen elsewhere. It turns out that while Dedalus only entered the U.S. market in late 2021 – which explains why, as the nice woman showing me the presentation noted, Americans mostly haven’t heard of it – Italy-based Dedalus Global’s software and services are used in more than 40 countries by over 6,700 health care organizations.

Oh.

Size Does Count. When I sat down with Dr. Jackie Gerhart, Epic’s vice president of informatics, and Seth Hain, senior vice president of research and development, at their very large and very busy booth, I had in mind Epic CEO and founder Judy Faulkner’s reputation as a tough, my-way-or-the-highway businesswoman. But Gerhart and Hain were so nice and down-to-earth, earnestly extolling the company’s culture of collaboration, that it was initially as disorienting as watching Elon Musk help a little old lady across the street. (A colleague assured me that, yes, this is actually the way many Epic employees act.)

Nonetheless, Epic remains a 500-pound gorilla, with a third of the hospital electronic health record (EHR) market. Its Cosmos platform, containing records from over 184 million patients and 7 billion encounters in all 50 states, is the largest integrated database of clinical information in the nation. The company is currently working to integrate Microsoft’s ChatGPT generative AI with Cosmos’s data visualization capabilities, which presents fascinating possibilities.

Ask around, though, and you’ll discover that not all hospitals are comfortable with Epic’s control of information. There will certainly be competitors, perhaps including the Mayo Clinic Platform.

A colleague related that many years ago big tech firms marketing their own EHRs warned prospective customers that choosing Epic meant relying on a company that might not be around very long. Instead, those competitors aren’t. Underestimating all those nice (and perhaps some not-so-nice) people at Epic would be a serious mistake.

Who’s Your Daddy? So, DeloreanAI, you appear to be just one more small vendor promising to apply predictive analytics to help prevent and treat chronic disease. And you, Medeanalytics, at a neighboring kiosk in the Innovation Pavilion, how do you expect your revenue cycle management product to compete with the big guys? Wait – you’ve both got Optum (2022 revenues: $183 billion) “white labeling” your technology? Never mind.

Digital Health Has a Johnny Appleseed. “Johnny Appleseed” (the nickname of John Chapman) famously planted apple trees across the American frontier. Israel’s Eyal Zimlichman, a physician and researcher, is doing much the same globally with ARC (Accelerate, Redesign and Collaborate), the center for digital innovation he launched at Sheba Medical Center in 2019. ARC brings together top-tier medical centers (like Mayo and Mass General Brigham in the U.S.), researchers, start-ups, investors and established companies from 16 different countries to plant the seeds that allow health system redesign to grow and flourish. ARC affiliates have been responsible for a total of 179 patents and 221 trade licenses.

Zimlichman, who heads ARC and also oversees Sheba’s innovation and transformation efforts, presented to a HIMSS forum on quality and patient safety, topics close to my heart. (Disclosure: In 2013, I co-authored an academic paper with Zimlichman.) He spoke about artificial intelligence (AI) advances enabling real-time clinical decision support during surgery; sensitive alerts to prevent medication errors and falls; and reducing deaths from intracranial surgery.

ARC wants to establish a “Future of Health” community that will “impact the course of global health through shared belief and collective wisdom,” Zimlichman said.

As the Yiddish expression goes, “From your mouth to God’s ears.”

People to Watch (1). Jean Druin, MD, MBA, founder and chief executive officer of Clarify Health, volunteered to help out in Nelson Mandela’s South Africa straight out of college and, while still in his early 30s, helped redesign England’s National Health Service as head of strategy for NHS London. As befits that background, Druin believes that building and automating effective processes provides the foundation for improving health care outcomes. A quality improvement culture, he told me, “always emanates from having strong underlying processes and systems that enable them.” To help organizations operating in a value-based care environment make that happen, Clarify’s platform provides access to data covering over 4 billion patient care journeys.

People to Watch (2). The National Committee for Quality Assurance, better known as just NCQA, is an independent nonprofit firmly ensconced in the Washington policy community. But Dr. Bradley Ryan, NCQA’s first chief product officer, comes from a very different world, having worked for McKinsey and IMS Health and co-founded a health tech company. Ryan is frustrated by the persistence of poorly collected, non-standardized health data that obstruct efforts to make care better. (Many others are, too, as these experts recently vented.) “I’m passionate about the way we evolve quality improvement,” Ryan told me. His goal is to reinvent NCQA’s plan and provider measurement for the digital age in order to improve data accuracy, trustworthiness and usability.

People to Watch (3). Vibhor Gupta, a veteran oncologist and entrepreneur, presented at the Microsoft booth about his newest company, Pangaea. Pangaea applies AI to the unstructured data in physician notes in order to identify undiagnosed or miscoded patients having one or more of 4,000 “hard-to-diagnose” conditions, including complications of cancer. “More than 50 percent of codes are incorrect,” avers Gupta, before diving into why Pangaea’s unsupervised AI can dig out data conventional natural language processing cannot. The easy path, of course, is finding patients for drug company clinical trials, but when I speak to Gupta afterwards, it’s clear he’s equally committed to improving everyday patient care.

People to Watch (4). Before there was an Intermountain Healthcare, a physician informatics pioneer named Homer Warner developed digital patient monitoring systems at what was then Latter-Day Saints Hospital way back in the 1960s. I’d chronicled Warner’s achievements in my book, so naturally I was interested in talking to Mona Baset, Intermountain’s vice president of digital services. Baset came to health care from financial services, where a consumer orientation is imperative. “We need to get Intermountain to the point where it’s an amazing experience, and the experience is the advantage,” she told me. “Amazing” health care experiences? I’m skeptical, but perhaps with Baset we can bank on it.

People I Could Barely Watch. A HIMSS plenary session entitled, “Healthcare Disruption: Accelerated Opportunities for Care Delivery Alternatives” should have been an episode of the TV game show, To Tell the Truth, in which you have to guess which contestant’s story is true.

Was the real disrupter Andrea Walsh, chief executive officer of Minnesota-based HealthPartners, who declared, “Our commitment is to bring care to people where they are at”? Maybe.

Was the disrupter Deborah Di Sanzo, president of Best Buy Health? Trick question! Only if you think “care delivery” means physically delivering and setting up medical equipment. “We can make a difference in the plumbing role,” Di Sanzo insisted, while perhaps thinking to herself, “I used to run a division of IBM!”

Or was the disrupter Tim Barry, chairman and founder of VillageMD, who described the significant changes to the delivery of primary care his company has already implemented, as well as plans to spread its model to multi-specialty care?

“One of the things we have to acknowledge as a health care system,” he said, “is that not everyone can win.”

You mean disruption is disruptive? Barry’s the one telling the truth!

Technology Like Mom? I was due to a meet a colleague for lunch at a restaurant a few blocks from McCormick Place, but I wasn’t sure which exit in the massive complex would point me in the right direction. As I stood on the third floor of the central concourse, Google Maps had the answer: “Go down the staircase,” it directed me, with a map showing that I would then go out the door, cross the street and turn right.

Google can see that I’m standing next to a staircase inside a building?! Yup.

Someday soon there could be an app whose detailed spoken directions include adding that I shouldn’t have waited until the last minute to leave for lunch, not to mention lamenting that I wasn’t dressed warmly enough given the temperature outside.

This, of course, would be MomGPT.