December 2015

The Shape of Things to Come
By Dale Kivi, MBA
For The Record
Vol. 27 No. 12 P. 10

The dynamics of the exhibit floor at this year's AHIMA conference offered clues about the direction of the HIM industry.

Things didn't seem the same at the 2015 annual AHIMA meeting in New Orleans. The long-awaited shift to ICD-10 on the last day of the show was expected to prevent many from attending, and for the most part, those predictions proved to be true. There's no question member attendance was down, but it also seemed like the size of the exhibit floor was smaller as well. It was perplexing to attendees and exhibitors alike. Even AHIMA admits that the vendor roster was down slightly—about 10%—compared with previous years. The perception on the show floor, however, was that the decline was more precipitous.

So what happened? Were vendor numbers fairly consistent with the past, as reported by AHIMA, but the exhibit spaces were smaller? Were the wider-than-normal aisles required to accommodate New Orleans' unique facility needs to blame for the perceived drop, as suggested by show organizers? Did some vendors decide to sacrifice this year's show and save money due to the expected lower attendance? Are some companies shifting focus to non-HIM prospects and spending their exhibit budgets elsewhere? Have others merged or simply gone out of business?

While all these factors may have been in play, there's no need to panic. Such changes to the vendor landscape should be expected, especially in an industry as dynamic as HIM.

Before exploring who's gone, who is left, and why, it's important to note who was new, who's growing, and why this temporary dip is no cause for long-term concern. This year, anyone who attended couldn't turn around without bumping into coding service vendors. From the small 10 ft x 10 ft inline booths to larger island exhibits, they were everywhere. Some were recognizable names; others recently added coding to more established product lines, while most were firms previously limited to regional markets that took advantage of this year's show to launch onto the national stage.

And although coding services were clearly the most popular topic on the exhibit floor (thanks to ICD-10), there were other new areas of focus as well. Recently, clinical documentation improvement (CDI) and information governance have dominated the conference's education sessions. In response, vendors have either developed targeted solutions or crafted positioning statements to highlight how their ancillary offerings help improve performance in those disciplines. Since these emerging topics expect ongoing attention, vendor development efforts to address those opportunities will certainly lead to more committed exhibit space in the years to come.

But where did everyone go?

Comparing this year's exhibit hall map against the past eight years or so, two significant categories jump out as missing in action: EHR platforms and medical transcription service organizations (MTSOs). As recently as five years ago, these categories ruled the larger booth spaces. Multiple EHR vendors exhibited with large island booths and one MTSO even gave away a new car. Together, they pretty much dominated the show floor.

Although both segments were certainly still present in New Orleans, their days of domination seem long gone.

Refocused EHR Vendors
Absent EHR vendors such as Cerner, McKesson, and Siemens were seen as longstanding cornerstones of the AHIMA exhibit hall. Then, when terms such as meaningful use and certified EHR became part of health care's vocabulary, seemingly dozens of lesser-known vendors and new start-ups emerged, convinced their stage 1 certifications were golden tickets to long-term business success.

But it didn't take long before the wannabes ran out of venture capital money and disappeared from existence, while many that did survive completely shifted their focus to the IT audience, turning their back on HIM participants who were no longer seen as the primary decision makers or even (in their minds) effective influencers. Then, as relative newcomer epic seized market control, even some of the veteran players, such as Siemens, chose to sell off and exit the market.

The refocus of the EHR vendors away from the AHIMA fold was self-justified by thinking such purchasing decisions would be driven by IT and the CFO, which often was true. Some vendors actively fanned the flames of traditional hospital politics, aggressively pitching their products to IT as cost-effective eliminators of transcription and coding labor, thus treating HIM objections to their new meaningful use workflow strategies as obsolete and unwelcome hurdles to their inevitable success.

Although many are gone while others are significantly smaller on the show floor, what we've learned is that even though initial sales were indeed made through IT, it's HIM's responsibility to make these systems work on a day-to-day basis. And now that stage 3 of meaningful use has pushed out further than the long-awaited ICD-10 adoption, and certified EHR incentives (or nonadoption penalties) can be measured against well-documented total operating costs, again it's the HIM department that, in large part, will determine who stays and who goes as those initial contracts expire. It will be interesting to see these dynamics play out and watch which EHR vendors ultimately decide to recommit to AHIMA.

Disappearing MTSOs
Arguably, the largest impact to the AHIMA exhibit floor has been caused by the departure of MTSO vendors. Inherently tied to the rise in EHR technology designed to shift report creation efforts solely to physicians, today's transcription market is significantly smaller than its former self.

Early EHR implementations at major hospital chains such as Kaiser and Catholic Health West had a huge impact on MTSOs that drew large percentages of their revenue from this deeper end of the industry pool. To replace this significant lost income, a few large venture capital-backed firms shifted to merger acquisition mode to keep their top line revenue numbers up for Wall Street, gobbling up scores of small to medium-sized industry players that still had their business volumes intact but lacked the in-house technology to compete in an EHR-driven marketplace.

Consequently, familiar MTSO exhibitors at AHIMA such as CBay Systems (the one that gave away the car), Spheris, Transcend, and WebMedx don't exist anymore. Even the once formidable Medical Transcription Industry Association, which boasted paid membership from several hundred vendors, closed its doors a few years ago when it no longer had enough members to remain viable.

Unfortunately, a few former large island booth vendors that are still very much alive in the marketplace simply decided against exhibiting at all this year. Adding insult to injury, a longstanding major exhibitor and the largest MTSO not only dropped support of AHIMA by staying off the show floor but also crept into town and hosted a competing event at a nearby hotel, drawing conference visitors away from vendors who remained loyal to the association. Of course, members can influence the proliferation of such attendee-hijacking events by not attending anything hosted by nonexhibitors, which, given the lost show revenue such tactics represent, certainly would be the preference of conference organizers.

What's Next?
Looking forward to next year's show in Baltimore and beyond, medical coding service organizations (MCSOs) should continue to flourish and demand a greater percentage of the exhibit floor. Many industry insiders predict that, similar to the emerging stages of the MTSO marketplace, mergers and acquisitions are inevitable and will be driven by technology that allows labor forces to be consolidated onto a common third-party platform, regardless of the client's existing EHR and encoder configurations. Until then, MCSOs are basically labor shops with dedicated pools restricted by their client's platform choices, limiting their ability to scale.

Once such technology is developed, those vendors will grow their exhibits, as did the transcription industry players of the past. Consequently, larger MCSO and coding technology vendor booths are sure to follow.

Also, the information governance and CDI special interest segments will continue to scale. In a data-driven, certified EHR environment, data analytics tools and measurement functions are the future. Vendors that can bridge the gap between meaningful use of clinical data and actionable business intelligence will find an enthusiastic HIM audience to drive the industry forward. Such applications and best practices are just starting to emerge and are sure to gain additional momentum in the education sessions and vendor arena as well.

Finally, expect to see a quick resurgence of both EHR and MTSO vendors on the show floor as HIM professionals reassert themselves as the strategic buying decision influencers they truly are. After all, they're the ones with all the data and often the only ones who truly understand how everything fits together. Any industry player that turns its back on them could be making a big mistake.

— Dale Kivi, MBA, is vice president of business development for FutureNet Technologies Corporation and has exhibited at more than 300 state and national conferences. He is a former Medical Transcription Industry Association board member who has served on numerous AHIMA state and national committees.