HIMSS ‘99 will be latest edition of the biggest event in the healthcare IT secto
HIMSS 99 will be latest edition of the biggest event in the healthcare IT sector
By ARTHUR GASCH
Healthcare InfoTech Contributing Editor
It’s almost here HIMSS, that is. This year’s Healthcare Information and Management Systems Society (Chicago) meeting in Atlanta Feb. 21-25 will be even bigger than last year’s gathering, with more companies, more attendees and more hot issues to discuss. Here’s a sneak preview of what to look for.
Realistically, the conference is just too big for one person to see it all, even if you stay the entire four days of the conference and the pre-conference. Since different attendees will have different interests, we have organized this article around general themes. Attached is a list of the key HIMSS exhibitors and their booth numbers, to help you plan who to see.
This year’s key themes:
• The continuing saga of Y2K readiness, tools and status.
• Client/server vs. thin client/server.
• Microsoft vs. Sun and others.
• Active X for Healthcare vs. Corbamed
• HL7 and XML.
• The emerging role of voice recognition technology in healthcare.
• Application security on the Internet and intranets.
• Development of the new intranet.
• The emerging role of wireless technology.
• The computer-based patient record (CPR), always an issue.
• Repositories and electronic medical record automation progress.
• Continuous Quality Improvement (CQI), pathways/ protocols, and decision support progress.
Y2K readiness
A key theme at last year’s HIMSS gathering in Orlando has mushroomed in importance during 1998. Now new software tools which track CPU and application Y2K conformance, and help identify problems have been introduced by a variety of companies. However, the real issue is not the PC hardware or operating system so much as it is the dedicated applications that run on these platforms, and the picture even at this late date is still a bit murky. Last year, this issue alone slowed the pace of sales of many companies, but accelerated the sales of others. This year will be a repeat. Microsoft (Redmond, WA) and a number of other vendors are now offering hardware and OS tools. Recently the Productivity Research Group (Burlington, MA) published a probability list of various "consequences" of Y2K in the U.S.
Some of that group’s estimates of "probable Y2K disruptions" include:
• Loss of local electric power for more than one day, 55%.
• Loss of regional electric power for more than one day, 40%.
• Loss of international telephone service, 35%.
• Errors in Social Security payments, 35%.
• Delays or cancellations of airline flights, 25%.
• Loss of local telephone service, 20%.
• Errors in bank account balances, 15%.
• Water shortages or rationing, 7%.
• Food shortages, 3%.
Software Productivity reports that about 15% of the code that has been installed to fix Y2K problems has not fixed all the problems and that the fixes themselves are creating new problems in about 7% of the code installed.
Client/server wars
There continues to be strong interest in "thin" client/server technology, whether offered by Citrix or by Microsoft (Winframe) in its "partners" 150 Pavilion in the upcoming release of Windows NT 2000. This technology allows an IDN to downscale its workstation platform horsepower, and to upscale its server platform horsepower, as the server executes all of the applications, and the clients simply sends and receives keystrokes and screen displays over the network. Questions about this technology include its true cost-effectiveness, its high-end scalability, and how it integrates with a multi-server network required by larger integrated delivery networks (with thousands of workstations), particularly in light of Windows NT’s multiple server limitations. One recent development to check out is Citrix’s extension of "thin" to Unix and other non-Intel hardware platforms, broadening the mix of workstation types that can be supported.
Microsoft vs. the world
While Microsoft remains the one to be seen with at the healthcare dance, and it has no lack of partners on the dance floor, recent market and legal developments have breathed a bit of life and competition into the market. Intel (Beaverton, OR) has expressed its dissatisfaction with Microsoft’s market approach, and high-pressure tactics, by introducing chip sets and entering into alliances which support various flavors of Unix for healthcare and the general market.
Sun Microsystems (booth 3436) has rushed Java 2 and Jini to the market, and revamped its marketing agreements with all major Java licensees to open up Java a bit, and quell some of the criticism that Sun was controlling the direction of Java a bit too tightly. This will be one of the first opportunities for most healthcare providers to get a good look at the Jini technology.
Microsoft will have its own pavilion at HIMSS for itself and its partner companies, where attendees can see a more TCP/IP load balanced, scalable Windows NT Server Edition 4.0, important for the growing web-enabled applications being run on this platform. Microsoft will be competing here with new Hewlett-Packard Unix servers, which have added centralized fault management, and with new IBM AS/400s, which enhance the platform’s web server characteristics.
HIMSS should offer peeks at Windows 2000 Beta 3 candidates. The real Beta 3 will be released the end of April, only a couple of months away. This is important if it turns out this is the last beta before commercial release, which could then come before the end of 1999. Since there will be no further 9X versions of Windows, sizing up what is involved in migrating to NT 2000 is important. While Microsoft doesn’t like to admit it, there is notice in the halls of Redmond of the growth of Red Hat and other shrink-wrapped, build-your-own versions of LINUX, which is getting friendlier and friendlier, and easier to use, install and administer. Adding new commercial packages are Lotus Development and Corel, along with other vendors. The longer it takes for NT 2000, the more the erosion of the current user base, and for specialized applications like small office file server, web servers and firewalls, turnkey, pre-configured versions of LINUX are making some inroads in systems that otherwise would go Microsoft.
Microsoft will continue to push Active-X (COM and DCOM) for healthcare, while the Unix bunch will be pushing Corbamed, which is now committed to supplying a middleware layer of COM+. Some vendors are squarely in one camp or the other and others are just as squarely straddling the line, with feet in both camps. There should be interesting announcements from both sides at HIMSS.
HL7 and XLM
HL7 will be demonstrating its new Version 3.0 which includes Extensible Markup Language (XML) at HIMSS in booth 511. This is their latest interoperability effort. Other vendors showing Version 3.0 functionality will include Care Data Systems, Care Flow/Net Inc. (booth 2675); Epic Systems (booth 2546); MedicaLogic (booth 2633); Oceania (booth 2039); Sequoia Software (booth 154); and Software Technologies Corp. (STC), booth 2345. There’ll be opportunities to learn more about "Kona" technology, now known as HL7 Patient Record Architecture, which is an XML scheme for document exchange and manipulation. The implementation of Reference Information Model is the technology that has been incorporated into HL7 to facilitate these enhancements. There will also be CCOW demonstrations of new User Link and Patient Link capabilities in booth 2611, with new web-based access features shown.
Also watch for major announcements from Lernout & Hauspie (booth 2223) regarding XML-enabled, enterprise servers from voice-prompted medical records. (More on this later technology in next week’s Healthcare InfoTech.) HL7 now has 170 organizations as members, and about 210 participating vendors across six continents. Watch for announcements yet this month on HL7 and X12N as part of HIPPA rules on claims attachments. Other HL7 meetings of interest include the Spring Working Group gathering in late April in Ontario. Contact HL7 headquarters in Ann Arbor, MI, for more information.
Repositories and EMR automation
Electronic medical record automation, repositories, and medical records departments has been a hot topic. Scanning, CD jukebox, RAID and other technologies have been applied. The problem is the huge amounts of data and the fact that not all information which must be stored is yet electronic. Radiology tests make up a great percentage of the data in the medical record, and making that electronic has been a challenge. There is PACs and Mini-PACS, but this has been expensive. See some new approaches at HIMSS. Storcomm (booth 1113) and MedPlus (booth 2615) have teamed up to offer a new solution based on MedPlus’ ChartMaxx and Storcomm’s ImageAccess technologies, which have been integrated.
Data security
What with HIPPA regulations, HCFA guidelines, and increasing interest in the Internet for the transmission of all sorts of medical and patient information, security has become a hot issue elevating firewalls, encryption, biometric ID, and other technologies to the spotlight. HIMSS is the place to check up on all the latest developments, from Compaq’s (booth 1038) less-than-$100 fingerprint ID scanner to the more exotic face/voice print and infrared security devices. Companies wishing to participate in EDI functions such as order entry, status tracking, etc., are particularly at risk, as are physician offices with simplistic or no security systems. Given that almost 60% of sites on the Internet doing business electronically are aware of at least one security breach in 1998, this issue is of real interest, given the teeth in current and proposed medical privacy legislation.
Middleware vendors
Middleware vendors are companies whose customers are other healthcare IT companies, and not end-user providers.Microscript (booth 1331) and AWG (booth 2920) will be showing Appian a new interoperability scheme that integrates the desktop across the enterprise and across the Internet.
Medicomp and Snomed are two such suppliers, as is Citrix. Medispan and Cerner’s Multum drug database companies are samples of drug information middleware vendors. Then there are all of the relational and object-oriented database suppliers. Microsoft (offering the much-streamlined, SQL Version 7), Informix (booth 3760), Sybase (1638), and Oracle (booth 218) will all will be competing for the database portion of the CPR repository. Tremont Medical will be showing its mobile hardware platforms in its own booth (booth 4165), as well as a number of its partners’ booths, including Data General (booth 327). Other hardware platform vendors including Planar Systems (booth 1356) and Carstens (booth 1905).
RF wireless LAN technology
Showing PC Card RF Wireless and other RF solutions will be Aironet (booth 3768), Proxim (booth 2660), Data Critical (booth 2125), the Bells (booths 2030 and 2244), GTE (booth 3756), Nortel (booth 3068), RadioLan (booth 752), Vitalcom (booth 4048) and others. Look for more PC card solutions at 2.4 Ghz., some new 900 MHz. solutions, and some hints about the new 400 MHz. TV UHF (channel 14-43) telemetry systems and networking. There’ll be discussions about new 1.2 Ghz. medical band proposals made to the Federal Commun ications Commission. Hospitals are very interested in all of these new technologies, which will be previewed by these and other vendors at HIMSS.
Monitoring and info systems integration
The world is becoming more integrated, including patient monitoring and clinical information systems technologies, which are coming so close together that the distinction between them is somewhat blurred. Spacelabs will be showing its Ultraview monitoring integrated with its Intesys clinical information systems, and with Web browser enhancements allowing patient data access from anywhere with any Window CE or better device that can run a web browser. This system also has full 12-lead ECG and ST segment capabilities implemented on the bedside monitor. Marquette/GE also will be showing its new Solar 9500 bedside, which hosts the vital signs monitoring, as well as QMI or third-party information system networks.
Watch for more pre-HIMSS news in next week’s issue, including, more on what various vendors will be showing. And be sure to look for copies of Healthcare InfoTech, which will be available at the Atlanta show.
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