HIMSS: Part of the solution, or part of the problem?

The Washington Post has published a couple of articles within the last few days shining a spotlight on the obvious influence that HIMSS exercised in drafting the HITECH Act and the HIT components of ARRA. The reports drew attention to the web of connections between HIMSS, CCHIT, CITL, the Administration, Congress and the ARRA.

The uninitiated wouldn’t be blamed for coming away with the impression that there was a conspiracy of powerful insiders who manipulated Congress into funneling billions to big healthcare IT vendors.

I think that a little perspective might come in handy.

For the sake of full disclosure, let me say up front that I am a member of HIMSS. Through the years I’ve volunteered for various committees and workgroups. I’ve tried to attend the national and state chapter meetings regularly, and consider HIMSS to be my most important professional organization.

With that established, the fact that I feel as strong an association with the organization as I do is a small piece of evidence contradicting the contention that HIMSS is a “vendor dominated” organization. From where I sit, it feels as if HIMSS has made a concerted effort to represent the interests of all the constituents that make up the HIT industry.

Does that include vendors? Sure. And I’m not so naïve as to think that the funding provided by the vendors isn’t a dominant portion of the organization’s budget.

But HIMSS constituents also include hospitals, the military, public health organizations, ambulatory healthcare organizations like mine, and a lot of individual members like me. I think that HIMSS leadership has recognized the necessity of navigating a middle road among these groups in order to maintain credibility with any of them.

HIMSS claims about 20,000 individual members. Most of them are individuals who have toiled in the backwater of HIT for years, battling constrained budgets, clueless administrators, reticent users, and immature systems. They’ve been motivated by faith in the promise of IT to improve the delivery of healthcare- not just in this country, but around the world. They’ve felt as if they were doing the Lord’s work.

20,000 members sounds like a lot, but trust me, the HIT world is a very small one. Most of us have been doing this for a while; we attend the same meetings, read the same articles, and share many of the same problems. There are considerably less than six degrees of separation between those of us who are tucked away in Appalachia and the Mark Leavitts of the world.

How does that 20,000 HIMSS members compare to other professional organizations?

Here, culled from their respective websites, are some examples…

As a small community, it’s not particularly surprising that the same people keep popping up doing different jobs.

Truth is there is a web of interrelationships- between customers and customers, vendors and vendors, vendors and customers, consultants and vendors, and any other permutations you’d like to define. I’ve often described some of the vendor relationships as “incestuous”. (Rather indelicately, now that I think about it.) Unfortunately, the adjective fits a lot of these other connections as well.

The term “lobbyist” is not a popular one these days. Does HIMSS participate in that enterprise? Yes they do. Are they masters of the Machiavellian art? I’m not convinced yet.

Anyone who took the time to read through the “Call to Action” that HIMSS published in December could not help but be impressed (or appalled, depending on your viewpoint) at the similarity to much of the language that made its way into the final versions of HITECH and ARRA. Most of it did not read to me like vendor boilerplate, however.

It appears that that document was the product of an open process that solicited, received, and utilized input from across the spectrum of HIMSS membership, not just what the vendors were touting. (I’ve already pointed out that many of us share a brain anyway.)

What had been HIMSS’s greatest advocacy accomplishment before HITECH? That “computerizing health records” line in Bush’s 2004 State of the Union.

I’m not sure that the NRA needs to worry about the HIT guys diluting their clout anytime soon.

I know this is a radical suggestion- but perhaps the lawmakers gave credence to HIMSS’s suggestions because they realized that they were well-considered and made some degree of sense.

(That raises the issue of when lobbying may actually serve the public good, but I’ll leave that rabbit hole for someone else to climb down.)

Should the leadership of HIMSS pay no attention to the criticism? Not at all.

As Mark Hagland and his commenters have noted, HIMSS has wanted to play in the big leagues, and now it looks as if they may be doing just that. It’s time to start paying attention to how some of these relationships look when they are spelled out (and diagrammed) by a major news organization. People seem to be especially sensitive to any hint of impropriety right now. HIMSS would do well to avoid the appearance of conflict of interest to the extent possible.

They could start by moderating their stance on CCHIT’s role in the official certification required for ARRA funding, as several in this blog space have suggested.

Finally, it’s worth noting that everyone has an axe to grind in the coming healthcare reform debate. And all the constituents are well represented.

• The hospitals have the AHA and state chapters.
• The insurers have AHIP.
• The pharmaceutical industry has PhRMA.
• Employers have the Chamber of Commerce and the Republican Party.
• Doctors have the AMA, AMGA, MGMA, state organizations, and dozens of specialty societies. (I wonder why those guys have problems communicating a unified message?)
• Patients have… I’ll have to get back to you on that one.

Maybe it’s just me, but considering the competition, I’d rank HIMSS relatively low on both the Powerful Scale and the Sinister Scale.

I encourage HIMSS to continue carrying its message to whoever will listen. I’ll do my part to influence the content of that message however I can.