We have the data. 2018 is the year we will put it to work.
Healthcare is now on a fully digital platform, with nine out of 10 physician offices using an electronic health record (EHR). Allscripts is continuing to build an ecosystem around this data to make it truly actionable, so we can deliver better care and more value by focusing on the following:
Consumerism and interoperability
Health IT should always be about the patient, and this will be the year that consumer-centric solutions start to pull away from the pack. More than ever before, consumers expect mobile, consumer-friendly technologies that give them both access to their health information and control over it. Consumerism has also triggered an industry-wide call for open health data exchange through Application Programming Interfaces (APIs), which are the key to true interoperability.
Post-acute care coordination
People are living longer, creating more demand for post-acute services than ever before. Rehabilitation, skilled nursing, and behavioral health facilities must be fully integrated with traditional hospitals and clinics to achieve the value-based care goal of healthy communities and populations. Allscripts will continue to invest in solutions for venues of care outside the four walls of the clinic. Coordination is important to care for the whole patient—meeting not just physical care needs—but mental and social needs, too.
As we shift to value-based care, we must be able to draw insights from ever-increasing amounts of information. Big data can lead to big thinking, and more predictive models of care. That’s why the Allscripts Analytics division has extrapolated data from more than 48 million de-identified patient records. We’re combining that information with other types of data, including claims, consumer and environmental information, to gain insights into diabetes, opioid use, and other public health crises. In 2018, we look forward to sharing key findings and introducing client-facing tools.
The American Health Information Management Association’s (AHIMA) focus on providing expertise to ensure trusted information for healthcare is reflected throughout our goals as we move into 2018. As big data, interoperability, and the ever-changing healthcare environment create both challenges and opportunities, AHIMA will provide the industry with resources to prepare high-quality professionals to lead the way. Health information management (HIM) professionals are positioned to take leadership roles in informatics, data analytics, information governance, and other related roles, while creating health intelligence that can be used to lower costs and improve the quality of patient care. In order to accomplish this in 2018, AHIMA and the profession will focus on four major objectives that align with the industry trajectory:
1. Prepare HIM professionals for future roles
by advancing education, competencies, and skills. AHIMA offers a multitude of products and resources to help advance HIM professionals in their careers. We will continue to add products and resources to equip these professionals for the evolving needs in revenue cycle management, healthcare quality improvement, clinical documentation improvement, coding, and privacy and security.
2. Recognize the growing need for informatics
by increasing the number of current members and new members with informatics as their primary job role. AHIMA introduced a new specialty credential in late 2016 to recognize experts in health informatics—the Certified Professional in Health Informatics (CPHI). With the continuing advancements in technology and the increased demand for using healthcare information to foster better collaboration among patient providers, the informatics credential will appropriately recognize individuals who practice in this area, encouraging the growth of knowledge and expertise in health informatics.
3. Encourage growth in data analytics
by increasing the number of current members and new members with expertise in this area. Many HIM professionals are working in the field of data analytics, possessing the knowledge to acquire, manage, analyze, interpret, and transform data into accurate, consistent, and timely information, while balancing the “big picture” strategic vision with day-to-day details. AHIMA’s Certified Health Data Analyst (CHDA) credential recognizes experts in health data analytics. The credential will ensure that the professionals in this area keep up with the growth of the field.
4. Champion Information Governance (IG)
by increasing its adoption through the use of AHIMA’s IG Adoption Model (IGAM), tools, and expertise. Both information governance and information management are necessary to meet the existing and new requirements of an increasingly complex healthcare ecosystem.
At Colquitt Regional Medical Center in rural Moultrie, Georgia, there are a couple of areas of focus for the coming year, the first being consolidation of multiple ambulatory EMR solutions to the Meditech Web Ambulatory product. This project is underway right now and will allow us to focus on more efficient patient care throughout the practices, integrate directly in the acute EMR (Meditech), as well as easing burden of federal reporting requirements. One EMR for both acute and ambulatory settings will allow a seamless integration of data benefiting patients, doctors, nursing … everyone. In my opinion, this one item will allow reduction of costs, increased employee satisfaction as well as better care for the patients that choose to use our facilities.
The second and equally important item is continued security for the network here at the hospital. Security will remain on the forefront to protect patient information and general information concerning the Medical Center. I have seen a steady increase in attempted attacks on our network. Along with securing the network, we will have a focus on employee behavior to help mitigate opportunists from attacking the network. Security is definitely the key item that keeps me up at night.
Along with the our major focus areas for the Medical Center this year is the everyday work to maximize EMR use, troubleshoot PC problems, support clinicians and keep the network up to date with critical patches. The day to day grind is what keeps the facilities running.
One of the most important, and somewhat hidden area of focus every year is to produce more with less, from an information technology standpoint. At the end of the day, technology must foster improvements and reduce costs. In many cases, this is purchasing new technology and in others it is making changes to use current technology to full potential. This is an endless struggle from my vantage point, as we incur costs to integrate and protect data across the continuum of care. We continually work to remain profitable while catering to an emerging workforce that has grown up with technology in their hands.
In 2018 we will continue to see new technology increasingly adopted by healthcare organizations to enable better care, which will impact how IT is implemented and leveraged. However, the adoption of new technology will be done with minimal-to-no attention paid to security or privacy—which will raise costs when security and privacy issues arise, and erode the patient trust required to provide and deliver healthcare services. Here are a few modest examples:
- The use of mobile technology—which is largely driven by consumers, not regulation—will enhance patient engagement and enable patients, providers, and others on the continuum of care to better communicate and create information pathways. But expanded use of mobile devices also broadens the attack surface and creates new social engineering opportunities for the ill-intended.
- Internet of Things (IoT) will play a leading role in healthcare, due to its capability to improve operations ranging from inventory management to patient care to human resource management. Two major concerns arise as these devices become more ubiquitous. First, they are becoming more complex, given their abilities, and complexity is the enemy of security. Second, these devices are only desirable at a low price and with increased functionality. That usually means security is sacrificed for ease of use, features, and cost-saving. Another concern, which is rarely discussed, is that IoT devices can actually be used in attacks against companies and the Internet itself, as the devices can be organized into botnets and used as they were in the 2016 Dyn denial-of-service (DDoS) cyberattack.
- Driven by mobility and IoT, the amount of patient-reported data will continue to increase as patients become partners in their own care. The patient-generated data will become vital to care but will create security and privacy concerns about how data is collected, transmitted, stored, accessed, and used.
- The next major attack vector is network-connected medical devices. Some predict that within three years, we will see our first $100 million class-action suit against a medical device maker for negligence, resulting from a cyberattack. On top of medical devices, there are a number of other connected devices in healthcare that may not get the attention of the CISO: Printers, faxes, multifunction devices. All connected, all unsecured.
- It appears telehealth is not only here to stay but will be coming on strong, especially if anticipated legislation that allows for reimbursement of telemedicine services is passed.
- Blockchain. While there is great potential for blockchain in healthcare, blockchain is not a security technology, but rather a secure technology for creating and managing immutable records. It runs on computers with an operating system that interacts with applications and is used by people. For an industry that has an abysmal record of life-cycle management, patching, updating systems, and training—it’s critical to closely watch and monitor this technology.
As U.S. health organizations continue their march toward value-driven care, it’s readily apparent that improving clinical outcomes will require greater collaboration between providers and patients. The year ahead holds real opportunity for participatory health ecosystems, as data-driven technologies continue to enable better provider/patient engagement. At EY, we see three key elements in the data and analytics sphere driving the integrated, participatory health ecosystem of 2018.
1. Curation and navigation technologies
Participatory care marks a revolutionary change in the patient/provider dynamic where individuals are compelled to partner with their health care team through a variety of interconnected channels such as mobile devices, social media, and wearables. Curation and navigation technologies, the frameworks that enable these connections, are set to expand in 2018 as more channels continue to converge.
A core piece of participatory care, curation and navigation technologies create distinct pathways and coordinate resources that help individuals make the right care decisions both in the moment and long term. These passive systems can also provide patients with the subtle behavioral “nudges” that encourage a more holistic approach to their health.
Additionally, curation and navigation interfaces can automate routine tasks to enhance the work of health professionals, freeing them to focus on more complex patients to drive better outcomes and higher reliability in the care model. Concurrently, navigation can improve communication and coordination of high-risk patients, who typically have multiple chronic conditions and are working with multiple health care providers.
2. Data fusion systems
Data fusion systems are the adhesive that holds the whole system together. Vast flows of data—organized through curation and navigation, then fused with artificial intelligence (AI) and analytics—form the backbone of a truly integrated, digital, patient-mediated health delivery model. Data fusion aggregates patient data from a variety of inputs, including clinical, environmental, and social sources.
This wealth of data consolidated in one setting can be leveraged into valuable insights for care management, risk stratification, performance, and care gaps to improve clinical outcomes. Through data mining, learning and predictions from this fusion, the digital platform can then organize, monitor, and support the user by generating risk alerts and recommending services. We see data fusion systems gaining steam in 2018 as more data inputs from wearables and IoT-enabled devices are incorporated into the data pool.
3. Expanding ecosystem of peer value creation
Digital platforms will evolve on both a regional and global scale to create care models that meet the consumer’s goal of convenient, affordable, comprehensible, and effective support for lifelong wellness. But this will require and enable a multi-stakeholder approach to clinical care. As such, a global ecosystem of peer value creation that goes beyond the traditional health space will continue to gain steam. This ecosystem includes retailers, venture investors, large integrated networks, and global technology companies.
At EY, we call these ecosystems “supra-systems,” and believe they will attract new sets of players in 2018 as adjacent sources of expertise are shown to improve clinical outcomes. This pooled innovation will be increasingly anchored around virtual delivery, consumer engagement, and an integrative and long-term orientation that’s able to evolve and adapt over time.
Prediction 1: Advances in immunotherapy
Newer types of immune treatments are now being studied, and in oncology treatment. Advances in immunotherapy and targeted genome editing such as CRISPR/Cas9 are racing forward in parallel with unprecedented opportunities. It’s time for clinicians and healthcare delivery systems to have the proper tools to utilize this knowledge. By defining the challenges and opportunities that exist in this evolving field of medicine, we can work together to overcome these barriers so genetic information can be integrated meaningfully into everyday practice.
Prediction 2: Gene therapy
For years, the idea of altering our genetic destiny has been a dream. As we move into 2018, we’ll see more treatment using gene therapy, an experimental technique that uses genes to treat or prevent disease.
Very soon, this technique will allow doctors to treat a disorder by inserting a gene into a patient’s cells instead of using drugs or surgery, according to the National Institute of Health.
Prediction 3: Continued discovery
Clinicians must be prepared to answer challenging questions, and they will need support in dealing with patient demand for confirmatory tests. Education alone will not be sufficient. We will require improvements in information technology that bring relevant genomic and phenotypic data together in an appropriate format so that it can be utilized at the point of care. This will serve as a prerequisite for new types of clinical decision support. Similarly, current initiatives focused on quality, analytics, and population health will need to incorporate these new patient-supplied data points.
Prediction 4: Use of genomics becomes widespread
As diagnostics moves away from individual tests and panels to full exome or even full genome, providers will need to understand and deal with the huge number of incidental Variants of Unknown Significance (VUS). As science progresses and some of these variants become known, what are the technical and ethical issues involved in informing clinicians and patients of potential new risk factors? Cloud-based repositories of genomic data will be essential. Continual updates of these data sets along with tools to notify providers and patients will be crucial.
Prediction 5: Exponential growth of information
We will also see much information derived from the larger umbrella of omics. It includes the evolving fields of proteomics, epigenetics, viromics and the impact of the microbiome. There is much work to be done in describing phenotype as we compare it a patient’s known genetic makeup. Phenotype is formally defined as the set of observable characteristics of an individual resulting from the interaction of its genotype with the environment. This will demand better tools for collecting and modeling other types of information such as family history, psychosocial factors, occupational, and environmental exposures.
Prediction 6: Cost of genetic testing
15 years ago, the first whole human genome was sequenced for about $3 billion. Today, there is talk of a test for less than $1,000. 23andMe recently announced a genetic health risk and wellness report for around $200. Browse the internet, and you will see consumer-facing companies offering genetic insights into what are the best foods to eat, what type of exercise is most effective, cancer screening, and many more.
We are witnessing one of the first times in modern healthcare that a meteoric descent in cost is accompanied by an exponential increase in knowledge. Physicians and an already burdened healthcare system will struggle to keep up. Imagine the demand if consumers could afford a home MRI study for about the cost of their monthly cable TV bill. We hope to see the costs of genetic tests continue to drop within 2018, but we must be vigilant in setting expectations.
In 2018, healthcare organizations will have the opportunity to innovate and respond to several trends that began years ago but are now reaching critical mass: Skyrocketing patient responsibility, healthcare consumerism, and data-driven decision making. More than ever, patients define their healthcare experience by how healthcare organizations interact with them. Patients are highly attuned to how organizations use technology to improve their entire experience—not only their care, but also their administrative and financial experiences. They more actively seek information regarding their care costs, as well as a greater variety of user-friendly payment methods. In addition, data analytics has evolved, enabling healthcare organizations to better understand their revenue cycle from broad trends to a single patient’s propensity to pay. Organizations can leverage technology to address each of these three trends and become more successful in the upcoming year:
1) Skyrocketing patient responsibility.
As the number of employers offering high-deductible health plans continues to rise, more patients are choosing this option in an effort to control costs. When they require care, however, they’re often faced with higher bills than they’re accustomed to paying. In many cases, they struggle to meet their responsibilities. In response, many healthcare providers are finding ways to help patients understand what they owe earlier in the encounter, use payment plans, and include a variety of payment options to help avoid uncompensated care.
2) Healthcare consumerism.
In an era when consumers can find a nanny, valuable artwork, or even their new home online, patients have new expectations about their healthcare. They want greater transparency and more thorough information around healthcare costs. They’ve come to expect easy, convenient payment options and recurring payment plans—just as they have in other areas of their lives. Organizations offering payment plans and options can reach dual goals, increasing collections while also improving patient satisfaction.
3) Data analytics.
Many organizations have collected data and monitored key performance indicators (KPIs) for years, but can now begin to take analysis to the next level. Forward-thinking organizations are using predictive analytics to parse through large data sets and extract common themes, building detailed models that pinpoint potential problems or uncover opportunities. This technology allows organizations to be more proactive, anticipating issues instead of always reacting to them.
Our current regulatory environment is pushing organizations to take costs out of the system while sustaining value—a worthwhile but daunting goal. Emerging technologies can help organizations achieve this goal by giving patients the experience, transparency and consumer-friendly options they want. While greater technological capabilities often meant greater complexity in past years, healthcare organizations can now find technology that creates a more seamless experience.
This upcoming year, the newly combined Navicure/ZirMed company’s primary goal is to help healthcare organizations thrive amid these key trends. By focusing on integration and easing patient payment processes across all stakeholders, we plan to help our clients increase profitability while creating a better experience for patients. Healthcare is innately more complex than other industries; therefore, creating a more patient-friendly payment experience will have its challenges. We are here to help organizations overcome these challenges and achieve RCM improvements so they can ultimately achieve greater success in the upcoming year.
This year was one for the books for widespread, high-impact and malicious ransomware, and other cyberattacks. From WannaCry to Petya to Locky, healthcare organizations saw how serious these kinds of attacks can be and how wide their impact can reach, ranging from systems and networks to impact on care delivery, business partners, and supply chain. We have to assume that in 2018, the stakes will be raised yet again, and that in response, healthcare providers will have to continue to strengthen their cyber defenses.
Here are some trends we expect to see in the new year:
- Continued exposure to malicious attacks, including ransomware, as campaigns are becoming increasingly sophisticated, targeted, and widespread, as well as financially motivated.
- As activists and nation states are pursuing their political goals, cyber campaigns will become more complex, blending attacks on devices, information, and institutions with the objective to disrupt economies and societies, as well as manipulate public opinion.
- In response, healthcare organizations will need to improve their security posture and shift their security strategy from focusing on protecting data (confidentiality and integrity) to also protecting hospital operations and care delivery (availability), as well as their reputation.
- Governments will increase pressure on industry stakeholders to improve security, resulting in new legislation and mandates.
- All of the above will lead to the need for a more comprehensive cybersecurity strategy and efficient response, inclusive of all at-risk assets like medical devices and operational IT systems like HVAC or building security.
With the threat landscape becoming more dangerous, and cyber adversaries recognizing the attractiveness and vulnerability of healthcare information, the industry has reached an inflection point. We will see the elevation of security from a tactical practice to the business level, hopefully resulting in a strategic and increased investment in security budgets and staffing. In addition, information sharing and coordination across the industry will be necessary to thwart cyber threats.
At Symantec, we will continue to work with our healthcare customers and help them address these evolving threats as well as support education on security frameworks and best practices, both from a strategic and technology perspective.
2018 will be a watershed year for the healthcare industry. Following the numerous attempts to “repeal and replace the Affordable Care Act (ACA)” that have not succeeded, but managed to slow down Healthcare IT (HIT) investments, we will potentially see some of the pent-up demand for technology innovation drive to fruition.
Here are some of the key trends in healthcare from our perspective:
1. AI and Machine Learning will enhance analyst efficiencies:
The advent and maturity of AI, Machine Learning, and predictive analytics in specific business processes like population health stratification, risk-based wellness and disease management, care coordination etc. will complement descriptive analytics models and frameworks in place. This will empower analysts, physicians, clinicians, and nurses with forward-looking insights re: which patients present the most risk and demand appropriate attention and care protocols.
2. The rise of the “Empowered Clinician Analyst”:
Physicians, clinicians, and nurses empowered by flexible, easy to learn self-service visual analytics tools are driving a paradigm shift in insights-driven decision making at the point-of-care (POC). Emergency department physicians, frustrated with the limitations of legacy BI tools, are “taking matters into their own hands”—leveraging self-service visual analytics to monitor sedation in newly born infants with cardiovascular birth defects, ensuring accurate dosage and superior outcomes, to identifying $ MMs in sub-optimal revenue leakage that the CFO’s office did not.
3. Analytics will drive “Accountability” in Accountable Care Organizations (ACOs):
Lack of analytics platforms that can aggregate data from multiple disconnected healthcare IT (HIT) systems has been a barrier to enabling accurate, real-time visibility needed to monitor, measure, analyze and improve performance. Self-service visual analytics is enabling CXOs to embrace strategic management frameworks like the Balanced Scorecard, which enable cascading of metrics across the enterprise in a spirit of transparency, to drive the desired organizational behavior- and incentives-aligned performance. Physician performance (utilization, patient satisfaction etc.) is now being monitored, measured, and analyzed via Physician Scorecards, which is spurring healthy competition and measurable improvements in productivity and performance.
4. Genomics and analytics in the cloud as enablers of precision medicine:
The ability to capture genomics data from newborn infants and their parents, store these cost-effectively in the cloud, and then analyze the genomic data for variances using self-service visual analytics will enable physicians and surgeons to proactively detect and manage life-threatening disorders in these infants, enabling superior patient outcomes. If scaled over time, this has had far-reaching implications for bending the cost curve, through delivery of proactive, preventive care at a lower cost.
As health systems are faced with increasing financial pressures, while simultaneously looking to expand their reach to a more engaged patient population, virtual healthcare delivery is playing a leading role in transforming the way quality care is delivered. 2017 was a momentum-building year for telehealth, as health systems increasingly added and expanded use cases to deliver on their operational objectives.
In 2018, we will most certainly see health systems embrace telehealth at scale. Telehealth will be a key long-term solution for health systems to build their competitive market positioning and reduce financial risks. It’s no surprise that 76% of health systems have or will be implementing consumer telehealth in some capacity by December 20181.
Another top trend for 2018 will be that mental health will certainly be a growing part of the conversation, as stigmas are being reduced, and those in need are increasingly open to asking for help. That said, approximately 96.5 million Americans live in areas where there are shortages of mental health providers. Telebehavioral health solves that, enabling consumers to get help and on the path to wellness sooner. In 2018, continued advances in the virtual delivery of behavioral healthcare, will help to overcome geographical and societal barriers to quality care.
Data security will no doubt remain front and center, particularly as connected care accelerates. The new year will see an even greater need for strong third-party validation of health tech companies’ ability—particularly with the growing use of telehealth—to meet healthcare regulations and requirements for securing sensitive protected healthcare information. As smart phones and connected devices increasingly make healthcare data portable, data security and integration have never been more important or high profile.
While hospitals and health systems will be addressing other priorities in 2018, Artificial intelligence (AI) will continue to advance. Considering that it is estimated to take 29 hours per workday to stay up-to-date with the latest medical literature, advancements in AI can no doubt provide quality decision support, but will only have true success when married to medical excellence, and not used as a commodity. The results of using AI to help guide healthcare decisions continue to dictate that medical excellence and quality must be foundational components of such a program.
The year ahead should help us realize that now is the time for health systems to provide new ways to access quality care. As Teladoc achieved a greater than 100% increase in hospital and health systems in 2017, a new level of value, access and quality are being realized through virtual care delivery. The key to transforming healthcare is to make access to quality care convenient and easy. Virtual health uses technology, analytics, and convenience to empower patients and overcome major barriers to care.