Every year, we editors at Healthcare Informatics share with our readers our compendium of the Top Ten Tech Trends—our look at some of the most important trends shaping U.S. healthcare right now.
Of course, it is virtually never the case that a trend important enough for us to consider as one of our “top ten” will have emerged completely out of the blue in the past few months. The healthcare system isn’t that wildly unpredictable. Instead, inevitably, many of the trends we describe this year connect to previous “Top Ten” trends or center around new sets of developments in the same or related areas.
But what is true is that things are accelerating rapidly these days across U.S. healthcare. Certainly, in the several years since the passage of the HITECH (Healthcare Information Technology for Economic and Clinical Health) Act in 2009 (as part of the American Recovery and Reinvestment Act, or ARRA) and of the Affordable Care Act (ACA) in 2010, U.S. healthcare has moved head rapidly with regard to internal health system reform. Value-based purchasing and readmissions reduction, mandated areas of activity under the ACA, as well as the accountable care organization (ACO) and bundled payment contract development provisions of the act, together with the meaningful use program under HITECH, have been pushing the leaders of hospitals, medical groups, and health systems, forward with a sense of urgency. And that urgency has been compounded by the countless initiatives by private health insurers to establish value-based purchasing, ACO, and bundled-payment programs, as well as many others. Meanwhile, the passage by Congress last year of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), a law that repealed the Sustainable Growth Rate (SGR) formula for Medicare physician payment, only added to what is becoming a full-out push on the part of the federal government towards compelling providers (in that case, physicians participating in the Medicare program) forward into value-based purchasing.
So along the policy dimension, there is now a level of clarity that didn’t exist seven years ago. And that has made all the difference.
Meanwhile, data security continues to leap ahead as a first-tier concern, with data breaches and ransomware becoming day-to-day realities for patient care organization leaders, while advances in genomic research and in connecting research-based information and insights to clinical care, are moving forward daily. And of course, the core information technologies supporting patient care and care management, as well as hospital, medical group and health system operations, are rapidly becoming more capable and sophisticated.
Naturally also, there continues to be a strong—and complex—interplay between advancing information and other technologies, and progress in crafting new models of care delivery, care management, etc. So, for example, connected health—connecting patients/consumers to caregivers and information, via mobile devices and other technologies—is something that continues to move forward via a consistently iterative pattern of advancement on both the process and technology sides. The same reality of an interplay of phenomena is true with regard to the growing phenomenon of integrated health system leaders choosing to leverage their internal resources, in partnership with commercial vendors, to come together to develop a variety of healthcare IT solutions that can be commercialized and shared with the industry.
Complex dynamics of interplay certainly are at work when it comes to physician documentation reform, which sits at the nexus of a number of diverse phenomena—from the need to get obtain more and more data, and deeper levels, from individual patient records, to support population health, care management, and other initiatives by patient care organizations—to the need to relieve practicing physicians from the effects of note bloat and time-suck.
Thus, the interconnectedness of our Top Ten Tech Trends this year. In no particular order, they are:
HL7’s FHIR Standard and its Growing Traction in the Marketplace
The Challenges of Making Vendor Interoperability Real
Healthcare IT Leaders: Time to Prepare their Physicians for MIPS
Bring Cybersecurity to the Next Level in the Face of New Threats
The IT Challenges of Moving More Deeply Into Risk-Based Contracting
Extending Care with Connected Health Strategies, Via Mobile Technology
OpenNotes and Consumerism as a Spur to Physician Documentation Reform
The National Patient ID Movement as a Private-Sector Initiative
Personalized Medicine: Forward-Thinking Connectedness
Patient Care Organizations Nurturing Digital Health Startups
Each of these trends is having a big impact on its own. But taken together, they provide a clear and convincing snapshot of a moment in time in the U.S. healthcare system, one that is compelling patient care organization leaders forward as never before.
Some of the trends have a clear urgency associated with them. As Managing Editor Rajiv Leventhal noted in his Cybersecurity Trend, “A recent survey from the Darwin Deason Institute for Cyber Security at Southern Methodist University in Dallas found that 88 percent of CISOs and CIOs report that their security budgets have increased in response to high-profile data breaches, while 81 percent reported that their upper-level management is supportive of their cybersecurity efforts, with 85 percent reporting increasing levels of support.” And yet, as Mac McMillan, CEO of the Austin, Texas.-based consulting firm CynergisTek, noted recently, most IT leaders of patient care organizations are still going about data security as a compliance-driven set of tasks, when in reality, keeping one step ahead of cybercriminals is quickly now requiring a for proactive approach.
And certainly, when it comes to preparing their organizations’ salaried and affiliated physicians with the IT infrastructure and IT-facilitated processes to work under the new MIPS (Merit-based Incentive Payment System) going into effect next year and mandated by the MACRA legislation, time will be of the essence.
As Leslie Kriegstein, vice president of public policy at the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME) told Leventhal, there remains substantial confusion throughout the industry regarding the bill’s implications. “This is a fundamental payment overhaul,” Kriegstein said in her interview. “Folks are pointing to 2019, but that’s the first payment year. As things stand today, we are rapidly approaching the first program year of 2017. There is no rulemaking yet, and it’s still going to be a very expedited timeframe by the time we respond to those proposals and see them finalized. Folks will have to put the pedal to the metal after that.”
Other trends will necessarily play out over time—though there remains less time than anyone probably believes. Such is certainly the case with regard to the IT leaders at provider organizations that are quickly taking on more and more financial risk. In that area, it has become clear already that CIOs and other healthcare IT leaders will have to get used to having the proverbial “one foot in the boat and one on the shore,” or deck, for a while, meaning that they will need to continue leverage information systems to support fee-for-service-driven operations as well as the emerging risk-based operations. The reality, says Jeffery Spight, president of the White Plains, N.Y.-based Collaborative Health Systems consulting group, is that one doesn’t actually need to boil the ocean to make some needed adjustments to align information systems better with needed risk-based contracting processes. “There’s got to be a process that says, Mary Jane just showed up in the hospital tonight,” with an alert being triggered, he told me. Among the capabilities needed, he believes, are patient registries and real-time lab value alerts. “It’s about collectively harnessing as much valuable information as possible to help physicians do the right thing,” he added.
Fortunately, pioneers are moving forward on all fronts to try to make progress. For example, in his Trend on the rapid rise of the FHIR (Fast Healthcare Interoperability Resources) standard, Senior Contributing Editor David Raths noted that the Danville, Pa.-based Geisinger Health System has proven to be “one of the pioneers in creating FHIR-based apps. In less than a month,” he notes, “it took a rheumatology app it had embedded within its Epic system and FHIR-enabled it to run across Cerner’s and athenahealth’s systems without having to be re-written. Although they proved the feasibility of doing that, Erskine did have a word of caution: As health systems try to deploy the app in other settings, the EHR vendors don’t yet support all the FHIR resources that the rheumatology app needs, so they have to find some adapter or middleware between the EHR and the app.”
Pioneering is happening everywhere, in fact. As Assistant Editor Heather Landi notes in her Connected Health Trend, “Connected health technology, including the use of mobile devices and apps, sensors, wearables and remote patient monitoring, has the potential to transform healthcare delivery, by enabling providers to track and care for patients outside the four walls of hospitals and physicians’ offices. The ability to tie mobility around care is especially promising when caring for patients with chronic illnesses. From wireless blood pressure cuffs to blood glucose monitors and wellness apps, these technologies enable providers to reach into patients’ homes and daily lives, and capture patient-generated health data.”
She goes on to note that “The most successful mHealth initiatives to date have been implemented by health systems, hospitals and physician practices with a clear, strategic vision about the role that mHealth plays in the overall patient care strategy.” And she goes on to describe encouraging initiatives in that area taking place at the UPMC health system in Pittsburgh and at Partners Healthcare in Boston.
So for every set of challenges present in the current operating environment of U.S. healthcare, there are pioneers pushing the envelope and laying the groundwork for real healthcare system-wide progress.
It was a great pleasure and privilege to bring you, our readers, the Healthcare Informatics Top Ten Tech Trends for this year. Personally, I can’t wait to see how these trends will play out over the next year, and what new or newly morphed trends make their appearance at this same time next year. 2016 certainly promises to be as interesting a year as any, in U.S. healthcare.
