The pages of HMT cover a wide variety of topics, from healthcare policy to EMRs, to wearable devices and trendy health gizmos. As such, our look at HIT going into 2016 – and beyond – features a diverse assortment of perspectives from experts across the space. Here we feature voices from providers and vendors alike, each lending insights from their particular area of expertise.
Telemedicine adoption rates will continue to climb
As a physician practicing in the modern world of medicine, it is abundantly clear to me that technology is a major driving force behind the future direction and success of healthcare. One major trend that has impacted healthcare this past year was the continuing adoption of telemedicine – an industry that, according to Forbes, will become a nearly $2 billion market by 2018.1 While telehealth has been around since the 1960s, technological advancements of recent years have made remote medicine more viable and valuable than ever before. As we approach 2016 – and as more physicians begin to adopt telemedicine into their practices – we will quickly reach a tipping point of adoption and implementation.
Innovative healthcare professionals are turning to telemedicine as an added way to serve patients more effectively and expediently. The convenience offered by this technology allows physicians to provide treatment, diagnosis, and professional advice for patients when a virtual visit is appropriate. Often, patients
are not able to come into a doctor’s physical office for a variety of reasons, including a lack of mobility, geographic separation from the doctor’s office, or work or family obligations. Telemedicine creates a more timely and convenient way to treat and assist patients that might not require an in-person appointment.
Beyond time savings and improved access to care, telemedicine also opens up a new revenue stream for physicians, allowing them to bill for virtual appointments, without increasing physical traffic in their office. Finally, the ability to manage common care issues remotely allows physicians to spend more time and focus on complex cases or patients with atypical symptoms.
While physicians have to carefully research and understand new technologies like telemedicine before adopting and implementing them in their practices, there are clear and significant advantages.
Telemedicine provides a unique opportunity for physicians to increase patient care access through technology, and I expect that we will continue to see advancements and subsequent adoption rates in 2016 and beyond.
Wearables will show their true colors
The current wearables landscape, overall, is not unlike Gartner’s Hype Cycle. Consumers are out buying wearables and are either sitting at the edge of the Peak of Inflated Expectations, pumped that their new wristbands will be helpful in some way, or have already fallen into the Trough of Disillusionment, recognizing that they only collect finite information that really doesn’t help them plan or behave differently, as it relates to overall health and wellness.
Today’s wearables market has created a confusing data deluge that will actually slow progress. This can only be changed if devices are architected in ways that permit them to absorb, analyze, and create workflows in real time, based on the user’s information. The lack of definition regarding how wearables should actually help consumers and providers – and compounding the issue, the lack of integration with overall care management platforms and processes – has relegated the devices, for now, to mere novelties.
Where there’s opportunity for wearables to actually be effective is with those in need of chronic care management, and for these devices to capture data that aligns with the workflows of their care management strategies. Only when health systems and providers determine what information will be useful – and how it fits into overall care management strategies – will the wearables landscape start pulling up toward the Slope of Enlightenment, moving closer to a true Plateau of Productivity. This transition will only begin once care managers and health systems really understand which data sets are needed from these devices to strengthen population health management and make consumer collaboration central to care.
In a perfect world, wearables would be developed in ways that capture and share truly useful data, transforming it into workflows for consumers and providers. Today, the data is just a nuisance –
and consumers are being scammed.
Mobile advancements will push personalized medicine
YouPlus Health
I believe that 2016 will be the year of personalization in healthcare. Consumers are tired of counting calories and looking at large quantities of data to help them improve their health. History has proven this method is not sustainable, and people are finally beginning to realize that. Consumers are also sick of being stuck in the one-size-fits-all approach of the healthcare system, and they have started to demand the same level of customization from healthcare that they receive from other industries. This is the year we will begin to see consumers get what they want.
Technology, and more specifically health applications, will drive this level of personalization. Although there are over 165,000 health apps right now, few focus on people as individuals. In order to help create meaningful behavior change, we have to provide consumers with personalized feedback that adds context around their data and actions. A high level of personalization can be created by providing people with specific information based on their lifestyle and background, as well as understanding what motivates them and what sets them back when guiding them to their best overall health.
As a physician, I find that it is absolutely critical for me to treat each of my patients as individuals. I understand the importance of knowing my patients on a personal level and treating them based on this. The same is true with a health application. In order for people to find success with this platform, they must be able to trust that it is providing them with the best solution for them as an individual.
Now is the time to shift to value-based care
Every eight seconds a boomer enters Medicare. In 2016, this trend will continue as the more than 76 million members of the baby boomer generation continue to leave the workforce and move into retirement. At 65 or older, and often presenting one or more chronic diseases, this population requires increased medical care and is directed to Medicare as their primary health insurance coverage.
With more than one-third of the U.S. population having left, or on its way to leaving, the private insurance network, the increased move to Medicare is tightening margins for payers across the board. As much as 45 percent of this population is noncompliant with their healthy lifestyle recommendations and live with unmanaged chronic diseases, such as diabetes, obesity, and cardiovascular disease, which also leads to higher out-of-pocket costs for patients as well as a decrease in payer revenue.
To compensate for these shifts, 2016 will be a tipping point in the move from a fee-for-service model to preventive medicine with compensation based on outcomes. The transition to value-based care is not easy considering less than half of providers are aware of value-based programs related to chronic care management (CCM) and transitions of care management (TCM). Additionally, it will require more advanced analytical, care-coordination and patient-engagement tools and services. Putting actionable insights into providers’ hands, these tools enable practices to reconcile patient data, stratify risk, streamline revenue, track quality compliance, drive patient engagement, and facilitate personalized remote care. Essentially, the right tools can make value-based care not only possible, but profitable.
Practices and providers should take advantage of the opportunity to opt in and get ahead of the curve. Beyond deeper engagement with patients, value-based programs offer financial benefits and can be particularly attractive to primary and ambulatory care providers that deal with preventable chronic diseases on a daily basis. With the right tools in place, 2016 is the year to embrace value-based medicine – making an impact on the cost of healthcare, improving patient outcomes, and strengthening your bottom line.
LTPAC will finally embrace e-prescribing
While use of EHR and e-prescribing technologies is commonplace within many hospitals and health systems, the long-term and post-acute care (LTPAC) market is just beginning to dip its toes in the information technology pool – and 2016 promises to be a good year for swimming.
As it relates to use of these technologies within our organization – for example, if a member of the medical staff gets a call and needs to write an order – he or she has access to the patient’s entire medical record at a glance via our automated e-prescribing program provided by SigmaCare. Physicians can remotely access our e-prescribing system on their phones, tablets, and computers and directly communicate with the pharmacy. Not only does this expedite the prescribing process, it prevents transcription errors, dosing issues, and other safety lapses and cultivates a more symbiotic and collaborative relationship between clinicians and pharmacists at our facilities.
In terms of the future for the industry as a whole in the coming year, LTPAC organizations face many challenges that technology-enabled solutions can address. To remain competitive in this increasingly crowded market, organizations will need to find ways to enhance value and outcomes for patients – something that electronic systems are designed to do. At the same time, tightening reimbursements will mean these organizations will be called on to do more with less, pushing them to improve efficiency and prioritize cost-saving initiatives. Reporting requirements are also skyrocketing, and organizations that don’t adopt an integrated EHR and financial system may quickly get overwhelmed.
With the advent of a new year, LTPAC organizations stand on the edge of opportunity. The coming year will certainly see some changes as providers begin to join their hospital and health system peers in embracing technology and initiate exploration and adoption of specific processes, like e-prescribing.
Smooth sailing for the ICD-10 transition
Overall, the ICD-10 transition went exceptionally well. Providers were more prepared than initially anticipated, which is evident from the low number of diagnosis-related denials from payers since Oct. 1. Payers were also prepared, with few syntax errors, indicating their systems were ready to at least receive the new format. This success must be in part due to the 24-month delay in implementation, as healthcare organizations were able to properly educate physicians and coders to ensure a successful transition.
In these first few months, we have seen a significant increase in medical necessity-related denials, as some payers are still updating their benefit tables. For example, these specific denial types, such as CARC 50, spiked from 3 percent of overall denials in September to 4.7 percent in October. Many of those denials were processed by Medicare, as Medicare is currently still in the process of updating their NCDs. The good news is that those denials decreased in November as payer organizations continue to improve ICD-10 benefit-level rules.
Looking ahead to 2016, our biggest piece of advice to providers is to be sure that they are reviewing denials very carefully and not assuming the payer is correct when it comes to diagnosis-related denials. Providers also need to incorporate available technologies to quickly analyze and determine the root cause for denials – it is a never-ending process. In addition, it will be crucial to appeal denials that are properly coded and were previously allowed under similar ICD-9 procedure to code diagnostic combinations. We know the level of specificity has increased substantially, but this should not cause more denials if coded correctly. The process of appealing questionable denials and requesting documentation from payers will ensure continual process improvement in the coming year.
Over time, the high level of detail and specificity in ICD-10 codes will make it easier for payers to reimburse providers, since the codes present a clear picture of the exact medical service delivered. Healthcare organizations should continue educating their staff on ICD-10 documentation as well as the new changes rolling out in the New Year, ensuring regulatory requirements are being met now and in the future.
A paradigm shift is coming in the approach to security
As we move into 2016, the healthcare industry is beginning to think of security as more than just checking boxes. Hopefully, healthcare IT executives will realize that security is not only a compliance issue but also an assurance issue, and non-IT executives will begin to understand that security is a people issue, not a technology issue. Computers don’t click links, steal critical data, or social engineer – people do. And it’s people who can stop breaches from occurring.
We must also recognize that biomedical devices represent a huge security gap to providers and patients. However, biomedical devices are a special case – and healthcare IT executives need to stop worrying so much about the traditional IT devices – PCs, laptops, smartphones – and start protecting the most important things: patient data and identities. With this mindset, the healthcare IT industry can begin investing in long-term strategies rather than thinking of security as a short-term necessary cost, and begin to see that security must be part of a holistic, comprehensive digital strategy, not a series of unconnected point solutions.
Finally, implementing information governance will also shift the focus from technology to the people and policies that generate, use, and manage the data and information required for care and related processes. And, as with all technology, we’ll recognize that fancy, expensive tools will not fix security. This isn’t about tools; it is about educating employees and encouraging a workplace culture focused on enhancing security. To do this, security leaders and their teams will stop trying to do security manually. Instead, executives and staff will automate security to the greatest degree possible in their organization or use services to enhance it. And to top it all off, they will learn to better communicate with management to help them understand what is happening and the risks involved, so they can be actively engaged in security decisions.
Independent practices are likely to rebound
I’ve been in private practice as a primary care provider for over 20 years. I’ve been watching the news over the years suggesting that more and more physicians are seeking employment with larger health systems and hospitals. For several years the trend seemed to be growing at a steady pace. But recently it appears to have slowed. Today, the number of doctors who are employed by a hospital is a little over 30 percent, according to the American Medical Association, while just over 50 percent say they are owners in their own practice.
As I talk to my colleagues now, I hear many saying that they’d prefer to stay independent – or go back to private practice – and they are seeking ways to do that and be successful. They ask me how I’ve done it. Honestly, the first thing I say is that I have tried to be open to trying new things, and I have chosen technology that can support me no matter what path I take.
I believe that physicians and patients are more satisfied when doctors control their own destiny without too much interference. There are more solutions and support for the independent provider today, and it is possible to thrive despite the challenges. I predict that the independent doctor will be something we will see more of – not less – in the coming years.
Epic will continue to dominate, Optum will regain market share
Epic will continue its dominance of the EMR market in large hospital systems. Epic signed up over 100 new clients in 2015. Continued merger and acquisition activity coupled with strong sales will lead to more and more hospitals using Epic. Love them or hate them, Epic is universally recognized as the best-in-class vendor for large hospitals. “Best of breed” doesn’t work with enterprise-wide systems. Ask anyone who came from the ERP (enterprise resource planning) space. Hospitals need technology to seamlessly integrate so the people in IT aren’t doing data entry all day. The easiest way to integrate is to use the same vendor for as many areas as possible, even if that vendor isn’t best of breed in every area. Epic does not let implementations fail and is the best and most integrated EMR system. The war is over, and Epic has won.
Hospitals will continue to struggle with ICD-10. While some of the largest hospital systems adequately prepared and trained their people, many hospitals were expecting ICD-10 to be delayed indefinitely and did not prepare nearly enough. ICD-10 is significantly more complex than ICD-9, and most coders cannot yet code effectively. Productivity is down across the board, consulting rates are through the roof, and there is a massive talent shortage. Outpatient coders are having a harder time adjusting than inpatient coders. The scores on our ICD-10 coding tests are bad for inpatient and absolutely horrible for outpatient. I believe this is because outpatient coders need a much deeper knowledge of the human anatomy to code correctly in ICD-10. It is going to be years before things stabilize.
I also think Optum 360 gains back market share from 3M in the coming year. Optum 360 is significantly easier to use, and clients are seeing a much smaller drop in productivity than 3M clients. Sorry 3M, but Optum has a better product.
Clinical documentation improvement is going to be huge as hospitals attempt to retrain every doctor on how to write their charts to maximize reimbursements. HIM departments have been so focused on making sure they code correctly that they have not had time to train the doctors. This changes in 2016.
2016: The year of open EHR platforms
2016 will be the year of open platforms. Most hospitals and health systems run legacy technology that was never designed for the Internet age or to let information flow beyond a health system’s walls. Counterintuitively, our institutions are fighting to hold onto their old, conveniently outdated platforms. But market forces are pushing healthcare to open up, expose its APIs, and let innovators in. Closed health information systems will have a harder time surviving as the hospital moves farther away from the epicenter of care. Patients are becoming the healthcare consumers they were born to be, seeking care from retail clinics, telemedicine, and urgent-care chains.
These patterns, coupled with the emergence of value-based reimbursement, are placing more pressure on hospitals to share information and coordinate care. It’s now crucial for institutions using different health IT platforms to share clinical data and deliver seamless care in order to achieve – and get paid for – high-quality outcomes. This paradigm shift is going to open the interoperability floodgates. Fortunately, there is a new class of cloud-based technology that allows health information to flow.
No institution can be all things to all patients. Most hospitals can’t offer the convenience of a retail brand. Retail clinics will never do brain surgery as well as an academic medical center. To remain viable, institutions need to become “focus factories” and specialize in the slice of the healthcare market where they can have the best outcomes, lowest costs, and offer the most convenient services. Under this model, information sharing, not information hoarding, will be a health systems’ greatest asset and comparative advantage.
REFERENCE:
1. Japsen, Bruce. “ObamaCare, Doctor Shortage To Spur $2 Billion Telehealth Market.” Forbes. Forbes Magazine, 22 Dec. 2013.
AMA, CHIME focus on interoperability
American Medical Association (AMA)
We must improve the interoperability of health information systems, and 2016 is shaping up to be an inflection point for the seamless exchange of data throughout the healthcare system. A redesigned Stage 3 is needed in the coming year to shift the conversation away from the prescriptive mandates of Meaningful Use and toward a flexible approach with a focus on achieving better clinical outcomes. That means we must see an end to the fixation on electronic health records as the only digital health tool at our disposal. EHRs don’t change patient behavior or improve engagement.
To enhance the patient-physician relationship, we need policies in 2016 that encourage a choice from the broad pallet of digital health tools. Telemedicine, mobile apps, and other digital health tools can play a greater supportive role in team-based care, preventive services, and individual wellness. Prerequisites for this patient-centered approach are interoperability and usability.
College of Healthcare Information Management Executives (CHIME)
Since enactment of the HITECH Act in 2009, the nation’s healthcare providers have made significant strides in implementing electronic health records. The adoption of robust health IT systems will better enable providers to achieve the Triple Aim of better care, an improved patient experience, and reduced costs. However, we still face some significant challenges – not the least of which is being able to exchange patient information across the care continuum. What’s needed now is a laser-like focus on interoperability. Providers, vendors, and government officials must make interoperability a priority in 2016.
Ensuring that providers can exchange patient information is key as we continue to see the development of accountable care organizations and population health management. Because patients are more mobile than ever before, we need to make sure that their medical records are accessible wherever and whenever they seek care. We believe that a national patient identification system is an essential building block to achieving interoperability.
We’ll also see a greater emphasis on cybersecurity in 2016. Healthcare CIOs are tasked with the daunting job of protecting patient information in a highly digital environment. Threats are evolving, and there’s no respite on the horizon. Working across the industry and with other stakeholders, including the federal government, we must continue monitoring for cyber threats and establish best practices for minimizing the risk of a cyberattack.
