Electronic Health Reporter

By Christopher Maiona, M.D., SFHM, chief medical officer, PatientKeeper, Inc.

After all that transpired in 2020, it’s understandable if people are reluctant to make predictions about what will happen in 2021. I suspect some prognosticators retired their crystal balls, or at least are finding the view a bit hazy right now.

And yet, in the healthcare IT domain, I’d argue that the major trends entering 2020 continued – some even accelerated – during the unpredicted chaos of last year. The movements in health IT toward greater mobility, interoperability, and remote care capabilities all manifested themselves in profound ways during the pandemic. Each will remain a priority for provider organizations in 2021, and I predict (warily) will see progress in the coming year.

Mobility Plus

Even as mobile devices have become more commonplace in healthcare settings, provider organizations still face challenges in realizing the full potential of these platforms. While there is utility in the ability to view clinical results or send messages (hopefully HIPAA-compliant ones) to colleagues, the real value is to integrate these features into a larger bundle of capabilities central to common provider workflows. Doing so places the entire technological ecosystem in the palm of a clinician’s hand. I predict we will see continued feature growth in the mobile space to better facilitate a provider’s ability to deliver care in the moment, wherever and whenever that moment may be.

To highlight where this evolution of mobility is leading us, consider this scenario. A provider reviews a concerning test or lab result on their phone. Without waiting to address this on a desktop station, they can utilize CPOE on their mobile device to order a follow-up study, and request a notification be “pushed” to them when the study is completed (or there is no result in timely fashion).  They can query their fully-integrated messaging feature to identify the appropriate specialist on call and immediately send a secure text, which automatically incorporates a link to the patient’s full chart and all relevant data, and offers the user the ability to add a few lines of text to clarify the reason for consultation.  The attending can confirm consult receipt and may further discuss the care plan.  The consultant in turn may enter preliminary orders while the attending can message the larger care team (nurse, case manager, etc.) with an update before dictating a quick note.

With the continued advances in NLP and note automation, I anticipate the provider component of note generation will once again focus on pertinent positives/negatives, thought process and the plan, leaving the more administrative documentation to the system.  Taken together, these advances will help free the provider from the constraints of the desktop terminal and facilitate the advancement of care. I don’t expect all of this to come to fruition in 2021, but we will take initial steps along the path.

Finally, on the mobile front, I would expect to see continued development of virtual assistants, which will one day move us from simple screen navigation to CPOE and touch-free engagement.

Physician Burnout

Sadly, the well-documented problem of physician burnout has been amplified by the pandemic. All providers are under intense stress. And with COVID activity at record highs (and an elevated stock market that is conducive to early retirement), I fear burnout and the associated physician shortage will get worse before it gets better.  Prior to COVID, the American Association of Medical Colleges predicted a physician shortage of 120,000 providers by 2030, which even the so called “Fauci effect” will be unable to mitigate in short order.

As these physicians are taken out of their rotations, bandwidth issues quickly begin to surface. Understaffed programs make everyone’s workload that much heavier, exacerbating the effects of burnout for the physicians who remain. It’s one of the most dangerous types of domino effects in the healthcare system today. In 2021, I expect it will only get worse.

I predict (and hope) that this perfect storm of factors impacting physician burnout will finally provide the impetus to address the EHR’s widely acknowledged role in this crisis. It is encouraging, therefore, that in the PwC Health Research Institute’s most recent survey, 94% of provider executives said “improving the clinician experience is a priority for their organizations as they enter 2021.” I believe hospitals with enlightened leadership will finally take definitive steps to address this pervasive problem, and that solutions which optimize the clinician’s EHR user experience will firmly take root at institutions intent on keeping their providers engaged, loyal and satisfied.

Telehealth Forever

In 2020, telehealth at long last achieved a foothold as a mainstream patient care delivery mechanism. While there may be some retraction in 2021, telehealth will remain stronger and more stable than in pre-pandemic times. The 2021 Physician Fee Schedule final rule issued by CMS last month makes clear that telehealth is here to stay, and is endorsed as a useful tool for chronic disease management. Certainly, more ready access to preventative care should lead to a decrease in hospitalizations, which has long been a systemic goal.

To be clear, telehealth won’t replace the in-person visit. While the goal of preventative care is to decrease unnecessary hospitalizations, the path may include remote intervention as well as office visits.  Even in situations where telehealth is clinically appropriate, some practical realities will continue to limit it. For starters, access to telehealth is uneven geographically and demographically. Also, many patients may desire to be seen in person by their clinician. Established patients in particular may be slower to embrace telehealth. A hybrid model will be the norm for the foreseeable future.  I don’t see a future in the short term (a decade or so) where the in-person office visit becomes unnecessary or is replaced by telehealth.

The technology implications of an increase in telehealth and chronic disease management include more remote monitoring devices and a growing interest in apps and platforms – software that lives between the patient and the provider – that help clinicians manage chronic disease. A significant part of this trend is so-called “wearable” devices, originally popularized by FitBit and the Apple Watch, and now expanding to include wearable ECG and blood glucose monitors. The possibilities seem endless, but providers must be confident in the data accuracy of such devices. Data from them must be verified and included in the patient’s medical record. Also, in an increasingly “remote” healthcare environment, there will be a greater need for more robust, easy-to-use patient portals. I expect these to be areas of focus in healthcare IT in 2021.

It is my sincere hope that 2021 will be a better year than 2020 was. My prediction is that, emerging from the adversity of last year, we will see mobility and interoperability gain more traction in the market. That, driven by these technology enablers, more patients will receive better “care in the moment.” And (fingers crossed) that this new year will be far less unpredictable than the last.