It was supposed to be a coming out party for the digital health industry after a huge year of business. But one of the sector’s biggest annual gatherings is shaping up to be a microcosm of another distressing moment in the pandemic, when an overwhelming desire for normalcy is again clashing with an imperative for caution.
The conference of the Health Information Management Systems Society (HIMSS) is scheduled to begin Monday in Las Vegas. But the weeklong event, to be held in person, is unfolding against the backdrop of a rising wave of Covid-19 cases and fear over the spread of the especially contagious Delta variant of the virus.
The run-up to the conference, which is coming after a record year for digital health adoption and investment, has been marked by cancellations, strengthened mitigation measures, and persistent second-guessing of plans. Organizers have provided an option to attend virtually and are requiring all in-person attendees to present proof of vaccination. Nevada authorities have also mandated mask-wearing indoors in public places.
Even still, many of the biggest players — from Amazon to Mayo Clinic to Amwell — have either canceled, scaled down their plans, or fallen silent about in-person participation in the show. And while HIMSS is far from the only large gathering happening this summer, its organizers are confronting a vexing question: Should physicians and technology entrepreneurs who share a mission to advance human health be attending an event that could unintentionally undermine it?
The situation recalls the uncertainty about individual and community-level risk that individuals and event organizers faced at the beginning of the United States’ first pandemic surge. “We’re again in this situation, and it’s actually really disturbing,” said William Hanage, an epidemiologist at the Harvard T.H. Chan School of Public Health. “Because the fact is there are a lot of people who are really sort of poised on the cusp of normal life, and yet the sort of superspreading opportunities that Delta is going to take advantage of is what is standing between us and that normal life.”
The public health concerns threaten to overshadow an event that promises to explore some of the most pressing issues in health care technology, including the expanded use of telehealth and artificial intelligence tools adopted during the pandemic. The conference will also feature advances in cloud computing services, remote patient monitoring devices, and security software designed to guard against a wave of ransomware attacks that have hit health systems in the past year.
During conference calls and interviews leading up the show, HIMSS organizers have acknowledged the national rise in Covid-19 infections and emphasized that their top priority is to ensure that exhibitors and attendees can safely participate in person.
“We put everything in line to ensure and maximize safety,” HIMSS CEO Hal Wolf told STAT in an interview in mid-July. In addition to requiring proof of vaccination, the organization has ordered thousands of masks and redesigned the conference layout to create more personal space for attendees. In a typical year, HIMSS is a sea of humanity, with more than 40,000 attendees packing conference rooms and milling through concourses that resemble four-lane highways at rush hour. The exhibit floor is a daylong circus, with crowds massing unpredictably at various points of interest.
But this year promises to be more spread out and tightly controlled.
“We have been working in designing the aisleways and all of the sessions so that there’s appropriate spacing wherever we can, and we’re fully recognizing all of the protocols that we’ll continue to follow locally as well,” Wolf said.
In the past few weeks, however, Covid cases have continued to rise in Las Vegas, causing officials to impose a statewide mask mandate. What began as a slight uptick in mid-June to about 200 cases per day has now escalated into a third wave, with 936 cases reported on Aug. 5.
The vise grip is achingly familiar to the organizers of HIMSS. In March 2020, they canceled the show just days before it was scheduled to take place as the coronavirus first took hold in the U.S. They then moved it from Orlando to Las Vegas, set a date for August 2021, and put in place requirements and technical infrastructure to require all attendees to submit proof of vaccination.
HIMSS could bring as many as 20,000 people to Las Vegas between Monday and Friday, although the final numbers are uncertain given the rise in Covid cases. Many participants, including public health experts, were planning to attend the event in person as of late last week, while others publicly canceled. The electronic health record vendor athenahealth said it decided against in-person attendance after concluding it presented an avoidable risk.
“This was not an easy decision, but our number-one priority is to protect the health and safety of our employees and their families, as well as our communities and customers,” Bob Segert, chairman and chief executive officer of athenahealth, said in a statement posted on the company’s website. “We remain committed to supporting HIMSS and partnering with them in the future.”
Others that have canceled include Amwell and Olive, a maker of AI software for health care providers. Several other companies and providers, such as the voice communications company Nuance, have pulled out of in-person events, product demonstrations, or panel discussions. An Amazon spokesperson said Friday that “HIMSS presents important programming that advances the healthcare industry, so we will be participating in a reduced capacity.”
The event is taking place amid an information vacuum in which both the Delta variant, and the fears and politics surrounding it, are outrunning the ability of science to provide clear answers about the risks. As the variant has spread in the U.S., the CDC has said it is highly contagious and transmissible by vaccinated people. The agency has updated its guidance to encourage fully vaccinated people to wear masks at indoor public spaces in areas of “substantial or high transmission.”
But such cautions are often difficult to apply to real-life decisions, which contain multiple layers of risk and potential impacts. “We’re human beings; we’re genuinely kind of useless at thinking about risk,” said Hanage, the Harvard epidemiologist. “And when it comes to navigating the next few months of the pandemic, that’s going to be acute because we have a few uncertainties here. We don’t know exactly how dangerous Delta is. And even if we have a pretty good sense that it’s not going to be that dangerous to us if we are vaccinated, there’s still a risk to our communities.”
In Clark County, Nevada, about 44% of the population is vaccinated, according to county data. People are expected to fly into the conference from all over the world, and visit local restaurants and other attractions, before returning home to their communities.
HIMSS organizers leave it to exhibitors to decide whether to publicly disclose cancellations, and many have decided not to share that information, which makes it difficult for attendees to gauge what they’ll get out of in-person participation. The conference offers a separate virtual attendance option, but some speeches and many other attractions are not available through the event’s digital program.
Paddy Padmanabhan, chief executive of Damo Consulting, a health technology advisory firm, said he decided not to attend in person after he got word that several of the executives he’d planned to meet with had canceled their travel plans.
“If the people I want to meet are not going to be there, then what do I really do at the event?” he asked. “Even my speaking sessions — I was supposed to speak at two events — everyone decided to go virtual, so we just decided to do it all virtually.”
The last-minute shuffling means that many attendees may arrive to find that some of the in-person panel discussions and demonstrations they had planned to attend are instead being led by speakers participating remotely. However, a HIMSS spokesperson said in a statement Friday that the conference will offer a full program for in-person attendees. “Those who choose to engage in-person should expect an in-person experience with their education sessions at HIMSS,” said the spokesperson, Karen Groppe. “We are anticipating the majority of our speakers, who were accepted as HIMSS21 speakers, will be in attendance.”
The size and scope of the normally jam-packed exhibit floor— typically the central attraction for attendees — remains uncertain, and many after-hours events and dinner gatherings are canceled or restricted to smaller groups.
But the biggest question, and perhaps the hardest to answer in advance, is what will happen on the ground in Las Vegas during the event, and in the communities attendees return to afterward.
“You know for a fact that transmission is going to happen there,” said Hanage. “And the very difficult question we now have to handle is how much of that transmission are we able to live with?”
Katie Palmer contributed reporting.