Clay Shirkey wrote the book, Here Comes Everybody, and yesterday he focused his theme on ‘Here Comes Every Patient.’ Shirkey’s theme is that “everybody” — from my 12 year old daughter and her Gen X/Gen Y mentors, to the 80-year old grandma who Googles — is pressuring institutions and organizations to deal with them on their terms. The implications for the health system here are huge.

What’s encouraging from the institutional standpoint were some observations made by two hospital CIOs during the HIMSS press conference covering this year’s annual survey of hospital CIOs. Denni McColm of the rural Missouri Citizens Memorial Hopsital, and Tim Zoph of the large urban Northwestern Medical Center both said they are hopeful about “new partnerships” coming out of the bad economy and the economic stimulus program for HIT. While cash flow and the liquidity crisis are hitting hospitals and providers very hard, those who already have HIT infrastructure are figuring out how to optimize what they’ve got. In McColm’s case, her small hospital with fewer than 100 beds is part of a larger community system with long-term care and other service assets — and, they are wired up. So for them, as well as for Northwestern, it’s about getting more out of what they have, which is a full employment act for the service providers in HIT.

I ended my day with a private one-on-one with a large service provider (systems integrator and consultancy) whose evangelist on the New HIT World quoted from Shirkey and believes that the Gen X/Gen Y cohort collectively will force change on the health system.

While demographics are sometimes destiny, I agreed, I suggested that following the money and incentives in the system determines health care organizational design and workflow. “Nudging” works in many ways: what drives one stakeholder isn’t what motivates another’s behaviors. So how to align?

Health Populi’s Hot Points: A Big Question emerged for me by the end of Day 2 @ HIMSS: how will information be exchanged in communities who can’t yet get along? While Shirkey’s “Everybody” is pressing for change from the grassroots — and taking on more health and health information responsibilities like maintaining PHRs and paging Dr. Google with long-tail searches — there remains a chasm. It’s not just the IOM Quality Chasm I’m talking about; it’s the chasm between what people want and what health institutions provide. George Halverson spoke forcefully about our broken health system in the morning. We need to build a bridge over this chasm that’s what Everybody Wants, and what Health Providers and Vendors are providing.

Remember that the subtext of Shirkey’s thesis is, “organizing without organizations.” So there is the threat of dis-intermediation of traditional health stakeholders that is the undercurrent here at HIMSS which many people are missing in the glitz and kitsch of the convention floor, from the Blue Man Group-type mimes to the cheerleading chicks at another vendor booth.

One bright light is the theme of “open:” opening the kimono, open source, open-ness. I heard some of that, too, on Day 2 at HIMSS. I will explore more of that aspect today as I search for more consumer-targeted applications for “Everybody.”