By JOHN IRVINE & MATTHEW HOLT

This years HIMSS drew the largest crowd in history (31,000). That should be a tip off that something is going on. That something is the national drive for health IT launched by the Obama administration with a whole boatload of ARRA stimulus money being paid out starting this year.

Health Information Exchange (HIE)

While the evolving meaningful use standards for Electronic medical records remained a logical focus for many vendors and the subject of a mindblowing number of panels, there is a sense that the conversation is moving to the world of health information exchanges (HIE). As always, there is spirited disagreement about exactly how the term of the hour should be defined (see the debate over just what exactly the term Health 2.0 means for an example of a good controversy). Is health information exchange a central database, kind of like the old Community Health Information Network. Is it a new peer to peer network, linking hospitals and health systems in a more useful and fundamentally practical way?  Or is it about a new economic model, based on the business models that go along with the free flow of clinical data. We heard the term Accountable Care Organization a lot! Or – more likely – a little bit of all of the above? See Mark Frisse’s excellent blog post on THCB for an in depth look.

Innovation

Sure, nobody has yet come up with the world changing, completely disruptive, industry transforming Facebook for doctors that some pundits had predicted, but there are signs we’re getting closer. Lots of people are trying and social network-ish features are everywhere, with vendors giving their systems the ability to communicate with the outside world. That includes some of the “traditional” EMR vendors like Allscripts that are now linking their users.

New usability rules announced (or at least proposed for Meaningful Use stage 2 & 3) by ONC at the event mean that electronic medical record vendors with clunky, difficult-to-drive products (a major source of frustration for physicians) will be forced to address their shortcomings. You can expect things to be significantly different for next year’s conference with vendors rolling out lots of new features designed to address the flaws in the current generation.

Blumenthal Departure

It was widely noted that last week’s conference marked one of the last official appearances for HHS HIT Czar David Blumenthal, who returns to academic life at Harvard this spring. With the administration’s push for adoption still a priority, expect an announcement on a replacement soon, with the smart money betting on an insider who can unify vendors and help encourage adoption. Predictably, rumors abounded. A traditional choice would be a major CIO like ex Partners CIO (now at Siemens) John Glaser, or Blumenthal’s current deputy Farzad Mostashari But perhaps it shouldn’t be a physician? Maybe former athenahealth founder and current HHS CTO Todd Park could be considered an outside choice by many observers for his enthusiasm and support for innovation.

Health 2.0

Health 2.0 applications remained a focus, although the emphasis of development is shifting from first generation consumer tools and online communities to boots on the ground applications – with a near frenzy of activity surrounding apps, unplatforms (that’s mHealth to the uninitiated) and analytics. We’re seeing a whole number of vendors (like SAP & Oracle) trying to lay down the conditions for an ecosystem in which smaller Health 2.0 vendors can provide applications to fit in. Welldoc is one example of a consumer diabetes management system on the iPhone, but even eClinicalWorks’ customer friendly kiosk which (like that of Phreesia) to the physicians’ system is a harbinger of things to come

Enter the Cloud

Even more than at least year’s event, cloud based applications continued to fascinate. Health 2.0 vendors aiming squarely at the smaller physician practice market (including Practice Fusion, Carecloud, ClearPractice, VitalHealth, athenahealth and many more) were on hand talking up the advantages of their flexible, light weight, web-based alternatives to the land-locked old guard. Also note many of that “old guard” have already bought a SaaS based system (GE) or are just doing so (ADP bought AdvancedMD Monday 28 Feb). The land rush for the meaningful use dollars held up in those parts of the market where there is no Epic is truly on. Expect the debate between the two schools to escalate in 2011, with the old guard citing privacy and reliability concerns, and the new kids arguing for the economic advantages of their systems (they’re cheap – Practice Fusion is free.)

People are watching:

Either way, as Allscripts’ Glen Tullman and Cleveland Clinic’s Martin Harris both told TCHB separately, this is a big year. The rubber is meeting the road and all those promises of the benefits of Health ITneed to be kept. Jonathan Hare of Resilient Network Systems told us “neither the nation nor this Congress has the patience for a 10 year project.” We’ll be watching but we think he might be right.

This article brought to you by Xerox Corporation: http://bit.ly/f7vdh8.

John Irvine is Editor-in-Chief of The Health Care Blog. Matthew Holt is founder of Health 2.0 and The Health Care Blog.