This was my 18th consecutive annual meeting, but the first one I left feeling demoralized and despondent instead of uplifted and enthusiastic. The usual exuberance and “jump-start” I get each year was simply not there and I am fairly sure it was not just me. One person’s hyperbolic statement described it as “the nadir of medical informatics.”
In the past we discussed ideas and progress relative to improvements in care quality, safety and efficiency such as the “rights” of medication administration and the clinical decision support enabled with CPOE. Big, small and medium data used to impact workflow were the fodder of our professional careers.
There seemed to be more talk this year of how to upgrade systems quickly—not for better functionality or care quality, but to get Meaningful Use (MU) revenue that was budgeted years before. We ruminated on how to succeed (and I use that term loosely) with ICD-10, not because it could provide better data or diagnostic specificity, but to be sure our organization doesn’t suffer catastrophic financial losses.
We talked in hushed and consoling tones about the medical informatics departments being dissolved and the informaticists being let go. After all, the implementation is done. The MU dollars are rolling in and there are other priorities. We are horrified to think that all we have helped to create could be left to stagnate and devolve. Have we invested all our hard work to watch clinical informaticists evolve from enthusiastic nerds to resigned wonks? I certainly hope not.
But there were some bright spots—they were just much harder to find than in the past. I was involved with the Intelligent Hospital Pavilion and watched 30,000 sq. ft. of exhibit floor be well utilized primarily for education, with selling relegated to a secondary activity. Multiple otherwise competing technologies worked together to provide a higher quality and safer environment. Most impressively, dozens of vendors worked together to showcase their own technologies while enabling their competitors.
I had the opportunity to meet in a group with the new national coordinator of health IT, Karen DeSalvo, MD, MPH, MSc. She has inherited the MU beehive and while we all hope and believe there is some incredibly good honey deep inside, there are an awful lot of stingers flying around. I think I speak for much of AMDIS in saying that we desperately wish for her success and want to be allies in the endeavor. But, it is not going to be easy.
The high point for me was watching almost 100 AMDIS members and supporters spend two hours talking about how we could not let all that is going on derail us from the work we all set out to do. We may need to vent and share some whine, but we can still come together to recognize and prioritize the work we need to do in order to continue to be successful, even in the face of adversity. This may truly be a nadir for our field, but that means the only place to go is up.
Howard M. Landa, MD, is CMIO of Alameda County Medical Center in Oakland, Calif.