By Ken Perez, vice president of healthcare policy, Omnicell, Inc.
Ken Perez
H.R. 1, The Tax Cuts and Jobs Act (TCJA), gained passage in the Senate (by a 51-48 vote) and the House (by a 224-201 vote) on Dec. 20, 2017, and two days later, President Donald Trump signed the bill into law.
The TCJA constitutes the biggest tax reform legislation in three decades for the U.S. and unquestionably the most significant legislative accomplishment of the Trump administration in 2017. Two provisions and one possible pitfall of the TCJA are most relevant to the healthcare industry.
Decrease in the corporate tax rate from 35 percent to 21 percent
This change, excluding other provisions of the TCJA, will clearly benefit for-profit hospitals and health systems, as well as pharmaceutical companies.
Repeal of the Affordable Care Act’s individual mandate
Starting in 2019, the TCJA repeals the ACA individual mandate that requires all Americans under 65 to have health insurance or pay an annual penalty, $695 per person or 2.5 percent of income—whichever is higher.
Per the Congressional Budget Office’s November 2017 analysis, “Repealing the Individual Health Insurance Mandate: An Updated Estimate,” the repeal of the individual mandate in 2019 would increase the number of uninsured Americans—relative to a baseline that assumes continuation of cost-sharing reduction (CSR) subsidies in the ACA marketplaces—by 4 million in 2019, with that figure growing to 13 million in 2025 and remaining at that level thru 2027.
According to the CBO, the 13 million is composed of five million people who would not choose to obtain coverage thru the individual insurance market, five million people who would not enroll in Medicaid—not due to a pullback of the ACA’s Medicaid expansion, as that was not in the TCJA—and three million people who would choose to no longer have employer-sponsored insurance. The CBO admits that its projections are uncertain and states, “The preliminary results of analysis using revised methods indicates that the estimated effects on the budget and health insurance coverage would probably be smaller than the numbers reported in this document.”
Joanna Gorovoy, senior director product and solutions marketing, Axway.
Joanna Gorovoy
To accelerate the shift toward value-based care – organizations across the healthcare ecosystem must find new ways to unlock value from an ever-expanding array of data sources to create data-rich digital services and experiences that improve patient engagement, enable delivery of more personalized healthcare services, and increase clinical collaboration and care coordination across the patient journey. Developers play a key role in accelerating innovation that will shape the future of healthcare and positively impact patient outcomes. But innovating at the speed of digital is challenging in an industry that has long been plagued by interoperability challenges, a prevalence of legacy, siloed systems and applications, and heightened data privacy and security requirements which hinder digital projects. As a result, there are a few key things developers should keep in mind when designing for today’s healthcare market.
You can’t spell interoperability without A-P-I
The frustrations associated with sharing information have burdened the healthcare industry’s digitization efforts for many years. With application programming interfaces (APIs) taking hold, however, data exchange is now easier to accomplish. APIs are revolutionizing data sharing by making it possible to bridge legacy IT systems of record, such as electronic heath records (EHRs), with modern systems of digital engagement, such as mobile apps. Healthcare developers must take an API-first approach and will need to gain knowledge of the latest healthcare interoperability standards – such as FHIR. FHIR (Fast Healthcare Interoperability Resources) is an HL7 standard that simplifies the exchange of healthcare information and promotes the use of APIs to support light-weight integration, facilitating secure data access and interoperability. As healthcare developers increasingly leverage APIs to move beyond some of the challenges associated with secure data sharing and opening up proprietary EHR systems, this will result in faster time to market for innovative digital services and experiences.
Create a sound security strategy
Security must always be top of mind for healthcare developers. Before writing a single line of code, healthcare developers should familiarize themselves with HIPAA regulations that protect all personal health data transactions and impose hefty penalties for violations. As developers design apps that leverage patient health data from a variety of sources, they need to take the time to understand how this law works and must be mindful of how to mitigate security concerns. Adopting a full lifecycle API management solution enables developers to secure and manage FHIR and other healthcare APIs in a unified way across projects and communities, ensure data security and streamline compliance and help reduce the data security burden by using built in, configurable audit trails and reporting.
Inviting external innovation
Healthcare organizations are increasingly looking to invite open innovation into their organizations as they struggle to keep pace with digital transformation. Organizations such as Kaiser Permanente, Johnson and Johnson and Stanford, for example, have hosted developer challenges and hackathons to stimulate innovation and bring in fresh perspectives from developers outside of their organization/industry to help tackle big problems such as healthcare access and affordability. As the industry struggles with IT modernization challenges, developers who have experience working across multiple industries can provide a fresh point of view and can contribute skills and approaches they have gained developing applications for other industries/use cases to provide value to healthcare.
The digitization of healthcare records across the nation over the past several years has created an electronic backbone for patient data that is in the early stages of getting unlocked for value. However, as we have seen in the past couple of years, technology-led change is slow to take hold in healthcare, and the policy uncertainty of the previous year has meant that healthcare enterprises have been cautious with technology investments.
In my latest book “The Big Unlock,” I discuss the competitive forces within the healthcare technology provider landscape, which I have classified into four major categories: The custodians are the dominant electronic health record (EHR) vendors who have the data and the workflow. The enablers have built platforms that they hope will be used by the enterprises as well as other technology providers to develop new digital health experiences. The arbitrageurs are solutions and services firms that rely on global labor pools, and increased automation, to deliver technology-enabled services at lower costs. The innovators are developing new ways to provide healthcare experiences, and are often venture capital funded startups.
These categories are not watertight compartments, but indicate a dominant business model for a particular type of solution provider. Vendors in each of these groups face challenges related to organic growth within their space and competitive pressures from other incumbents as well as new entrants. In response, technology providers in a specific category are also trying to expand into different categories, examples being EHR vendors who are building out advanced analytics and digital capabilities. All incumbents face threats from emerging non-traditional sources of competition: Amazon, with its blockbuster Amazon Web Services (AWS) business, is reportedly considering an entry into the pharmaceuticals distribution space, while Apple is getting deeper into digital health space, leveraging its vast consumer base of iPhone and Apple Watch users. Large healthcare enterprises, such as UPMC and Quest Diagnostics, are getting into the technology solutions space, either by leveraging proprietary data or by investing in startups through innovation programs. Health plan major Cigna’s recent acquisition of digital health firm Brighter is an example of the lines blurring between technology providers and enterprises.
Guest post by Steve Elder, director of communications, STANLEY Healthcare.
Steve Elder
The healthcare industry is in a period of great uncertainty, with major questions looming around how regulations, standards and reimbursements – particularly regarding care quality and interoperability– will be changing for hospitals in the coming year. One thing is clear though: In order to provide the efficient and high-quality care needed to meet patient expectations, hospitals need to focus on the intelligent application of new technologies. Here are four trends that will influence healthcare IT in 2018:
The opioid epidemic will trigger growth in investments around patient and staff safety
The growing opioid epidemic now causes nearly 100 deaths each day, and is projected to cause 500,000 deaths over the next decade, primarily due to overdoses. That is not only putting pressure on hospitals to reevaluate how they use opioid medications and monitor patients once back in the community, but it is also forcing them to address the physical safety of staff and patients. This is because the opioid epidemic has led to an increase in violent crimes in healthcare facilities. Emergency departments in particular are under heavy strain, with more patients presenting with addiction symptoms, compounding wait times and leading to more patient disputes. Hospitals will have to invest significantly more in technologies to protect staff and patients, such as patient monitoring solutions and staff duress systems to prevent potentially dangerous patients from harming themselves or others.
Big data advancements will pave the way for the rise of predictive and prescriptive analytics
Regardless of how the major causes of uncertainty affecting the healthcare industry – such as the future of the Affordable Care Act – resolve themselves, it is certain that there will be no return to the pre-ACA era. As healthcare industry writer and consultant Edgar Wilson has pointed out in the context of primary care, the expansion of insurance coverage did not magically create more capacity. It challenged hospitals to find new ways to serve more patients, more personally, without adding cost. Hospitals will continue to look for practical ways to improve their efficiency by leveraging data to better predict patient care requirements, and demand for medications and equipment needs. The benefits of these predictive analytics capabilities are enormous.
According to a February 2017 report by the Society of Actuaries, 93 percent of healthcare providers said predictive analytics is important to the future of their business, and 57 percent believe predictive analytics will save their organization 15 percent or more over the next five years. In addition to predictive analytics, prescriptive analytics will have a growing impact. Ongoing advancements in the collection, aggregation and analysis of data will provide hospitals with greater operational insights, enabling them to optimize staffing levels and other aspects of operations while enabling staff members to deliver more effective, targeted care.
Staffing shortages combined with rising care expectations will drive adoption of AI and automationContinue Reading
Around the world, there has been a notable shortage of biomedical engineers. From Kenya, to the U.K. and the U.S., healthcare facilities have begun filling positions that require specific training and licensing with underqualified employees, which has not only led to increased risk for health problems within communities, but it also reduces the advancement of medical technology and thwarts the cure of devastating diseases.
Biomedical engineers, while not the face of medical research like physicians and surgeons, are integral professionals within healthcare, and without them, we wouldn’t have most of the medical devices and tools in use today. It is imperative that more students pursue credentials in biomedical engineering, so we can continue to advance our medical knowledge.
What Do Biomedical Engineers Do?
Every industry relies on equipment. In healthcare, that equipment is designed, built, maintained, and sometimes operated by biomedical engineers. Combining typical engineering skills with medical training, biomedical engineers work alongside doctors to generate solutions to pressing medical issues. Like other engineers, biomedical engineers can claim a variety of responsibilities, to include:
Evaluating medical equipment for safety, efficiency and efficacy.
Developing new medical equipment, such as artificial organs and limbs, machines for testing and diagnosis, and devices that treat chronic illness.
Installing, repairing, maintaining, or otherwise providing technical support for medical equipment.
Training personnel for proper use or maintenance of medical equipment.
Undoubtedly, nearly everyone in developed or developing nations has seen the work of biomedical engineers. From MRI machines to prosthetic legs, from pacemakers to laser surgical tools, the most useful and innovative equipment in hospitals exist thanks to biomedical engineers’ efforts.
Less commonly, biomedical engineers might research biological systems, publish reports, and present their findings to scientists, executives, clinicians, hospital administrators, fellow engineers, and the public. These findings may serve as recommendations for the development of new technologies or the adoption of new methods in medical institutions. It is this academic biomedical engineering study that often pushes innovations in the field, but all biomedical engineers contribute to medical advancement — and it is all biomedical engineers that are currently lacking.
How Can Students Enter the Biomedical Engineering Field?Continue Reading
With 2017 in the rear-view mirror, it is time to look forward to 2018 and how healthcare will evolve in this year. The last year has been an eventful one for healthcare, from the uproar in healthcare regulations to potential mega-mergers. Needless to say, it’s a time of transition, and healthcare is in a very fluid state- evolving and expanding. There are certainly going to be new ways to keep healthcare providers and health IT pros stay engaged and excited, and here are our top 10 picks:
The future of the GOP Healthcare bill
The Republican healthcare reform bill gained immense traction this year. In their third attempt at putting a healthcare bill forward, the senators and the White House officials have been working round the clock to gather up votes, but somehow, the reservations persist. The lawmakers have insisted that Americans would not lose their vital insurance protections under their bill, including the guarantee that the plan would protect those with preexisting conditions. However, as it so happens, even these plans have been put to rest. Perhaps sometime in 2018, the GOP may pass a budget setting up reconciliation for tax reform, and then pass tax reform. Then, they would pass a budget setting up reconciliation for Obamacare repeal, and then pass that- it all remains to be seen.
The ongoing shift to value from volume
Despite speculations, healthcare providers, as well as CMS have pushed for more value-based care and payments tied to quality, but it’s been going slow. Although providers have been slightly resistant to take on risk, they do recognize the potential to contain costs and improve quality of care over value-based contracts. And perhaps as data assumes a central role in healthcare, the increasing availability of data and smarter integration of disconnected data systems will make the transition easier and scalable. Notably, with a $3.3 trillion healthcare expenditure this year, there has been slow down the cost growth. 2018 is expected to be much more impactful as it builds on the strong foundation.
Big data and analytics translating data into real health outcomes
Big data and analytics have always brought significant advancements in making healthcare technology-driven. With the help of big data and smart analytics, we are at a point in healthcare we can make a near-certain prediction about possible complications a patient can face, their possible readmission, and the outcomes of a care plan devised for them. Not only it could translate to better health outcomes for the patients, it could also make a difference in improving reimbursements and regulatory compliance.
Blockchain-based systems
Blockchain could arguably be one of the most disruptive technologies in healthcare. It is already being considered as a solution to healthcare’s longstanding challenge of interoperability and data exchange. Bringing blockchain-based systems will definitely require some changes from the ground up, but 2018 will have a glimpse of by innovation centered around blockchain and how it can enhance healthcare data exchange and ensure security.
AI and IoT taking on a central role
2018 can witness a good amount of investment from healthcare leaders in the fields of Artificial Intelligence and Internet of Things. There is going to be a considerable advancement in technology, making the use of technology crucial in healthcare and assist an already unbalanced workforce. AI and IoT will not only prove instrumental in enhancing accuracy in clinical insights, and security, but could also be fruitful in reducing manual redundancy and ensuring fewer errors as we transition to a world of quality in care.
Digital health interventions and virtual care to improve access and treatment
In December 2016, many were suggesting that wearables were dead. Today, wearables are becoming one of the most sought-after innovation when it comes to digital health. And, the market is quickly diversifying as clinical wearables gain importance and as several renowned organizations integrate with each other. Not only wearables- there are several apps and biosensors that can assist providers with remotely tracking patient health, engage patients, interact with them, and streamline care operations. As technology becomes central to healthcare, 2018 will be the year when these apps and wearables boost the patient-physician interaction.
Everywhere you look, smart technology is making exciting leaps in healthcare, changing how people are cared for and their health issues treated. When it comes to teeth, we tend to take them for granted. We might only think about them when we’re in pain with a tooth cavity and need a dentist urgently. And yet, our teeth give us insight into our overall health: what we’re eating, if we’re healthy, and if we’re at risk of disease. Teeth could even reveal bullying, with research published in the Journal of Oral Rehabilitation showing that teens who are the victims of bullying tend to grind their teeth. Smart technology for teeth could help us to better understand the link between our teeth and overall health, completely changing dental care and encouraging healthier lifestyles. Here’s a study worth looking into about smart technology and teeth.
In the study, scientists glued sensors onto eight volunteers’ teeth. The sensors were devices known as accelerometers that can recognize movement in the mouth. They were connected to wires to collect data from the participants’ teeth. The participants of the study were told to drink a bottle of water, cough, read a section of an article, and chew gum. They had to spend less than a minute on each of these tasks, and their actions were recorded.
These activities were important to study because they make the teeth move in different ways, and can therefore shed light on someone’s health, for instance why they’re coughing so much or if they’re chewing their food enough. Coughing could signal a health condition in the body, while not chewing food enough can cause plaque buildup that leads to cavities because not enough saliva is produced in the mouth to eliminate bacteria. Another oral health issue that such smart technology could help to spot is if the teeth aren’t positioned well. This puts a patient at greater risk of experiencing chips and wear and tear, as explained by Vibrant Dentistry. Advancements in smart dental technology could pinpoint issues such as the above, making dental care much easier.
Guest post by Marti Arvin, vice president of audit strategy, CynergisTek.
Marti Arvin
The myriad of regulations associated with clinical research can be daunting. In addition to complex regulations, most research entities have the added challenge of coordinating the process across multiple stakeholders that may be spread across different organizations. One way to begin to get a handle on this is to look at integration between the EHR and other systems used in the process. The research enterprise can leverage the availability of electronic systems to the reduce duplicate effort, increase researcher satisfaction and improve compliance.
By integrating the EHR and the clinical trials management system (CTMS), an organization can create a single source of truth, consolidate efforts in teams that have the appropriate expertise and decrease the overall timeline to get a study up and running. A typical research project has multiple processes that must occur for it to get approval from the Institutional Review Board (IRB), gain appropriate funding from the sponsor, and receive any necessary approvals from committees such as biosafety or radiation safety. Traditionally, the researcher has been responsible for assuring all of the necessary approvals have been obtained, the study is appropriately budgeted and all other steps are completed to help ensure compliance, despite the fact that the researcher is the scientific expert on the project, and is often the least experienced in ensuring the study meets all the regulatory requirements.
Creating a process where the CTMS and the EHR are integrated to capture necessary information at both the study initiation phase and throughout the study can help improve the process and ensure all necessary actions are completed.
System integration
System integration can offer improved efficiency and effectiveness in a number of areas. This discussion will focus on just two examples: Clinical trial billing and HIPAA compliance.
How can system integration help with these two issues?
Clinical Trial Billing
It is necessary to evaluate the proposed budget for the clinical trial to ensure services which can be legitimately billed to the patient/subject’s third-party insurance are identified as such and services that must be covered by another source are identified– also known as the coverage analysis. The rules around what can be billed to insurance, particularly to Medicare, are complex.
The process requires someone with expertise in not only general billing and coding, but the specifics of the rules in this area and the ability to read a study protocol. The language of the study’s informed consent document is also critical. The wrong wording in the informed consent can render a service otherwise billable to third-party insurance non-billable, meaning the cost of the service must be covered by another source and makes the initial coverage analysis extremely important. Equally important is a process to ensure the services are in fact billed in the manner anticipated by the original budget and coverage analysis. This helps ensure the organization does not submit a potential false claim by billing insurance when the study should be covering the cost.
By integrating the systems (CTMS, EHR), a process can be developed to trigger certain steps to happen contemporaneously. The researcher’s initial submission to the IRB system can trigger an alert that the study needs to be established in the CTMS. The establishment of the study in the CTMS then triggers the initiation of the process to develop a coverage analysis. The development of the coverage analysis can be built in to the CTMS so that all services provide to the participant are identified on a structured calendar with the corresponding payer source identified.
In my latest book “The Big Unlock,” I discuss the competitive forces within the healthcare technology provider landscape, which I have classified into four major categories: The custodians are the dominant electronic health record (EHR) vendors who have the data and the workflow. The enablers have built platforms that they hope will be used by the enterprises as well as other technology providers to develop new digital health experiences. The arbitrageurs are solutions and services firms that rely on global labor pools, and increased automation, to deliver technology-enabled services at lower costs. The innovators are developing new ways to provide healthcare experiences, and are often venture capital funded startups.
Around the world, there has been a notable shortage of biomedical engineers. From 
