Jeff Lew, vice president of product management, Nextech.
The dawn of a new year brings anticipation for things to come—and this certainly holds true regarding health information technology. Electronic health records (EHRs) continue to evolve, and the next 12 months should provide some excitement as new developments emerge. In particular, there are three trends worth watching.
The inescapable shift to the cloud
More and more healthcare organizations are seeking cloud-based EHR and practice management systems, and it appears this trend will continue throughout the coming year. One of the primary reasons for moving to the cloud is the economics of these solutions. An organization does not have to maintain costly hardware and software or allocate resources for upgrades and other technology management functions. Instead, the system is housed remotely and kept constantly up-to-date by the vendor. Users can access the software with any device that has an internet connection, including laptops, tablets and, in some cases, smartphones. A cloud solution is especially cost effective for those organizations that have multiple facilities. Gone are the days of a server in each site—users can bring their laptops or tablets with them as they travel from location to location, logging in to the system from anywhere. Not only can this keep costs in check, it can also promote greater user satisfaction because the tool offers the flexibility to work from anyplace at any time.
Security and protecting an organization’s IT from threats will continue to make headlines like it has in the past year. It is a real and present risk that organizations must be acutely aware of and ensure relevant preventative measures are established and continuously maintained. This requires not just the relevant knowledge and skills, but also focus and resources, that many organizations may not have.
Ultimately, most—if not all healthcare providers—will shift to cloud-based solutions at some point. Although the move may not occur immediately for every organization, 2018 will see many healthcare entities take steps in that direction.
Complying with MACRA
This past November, the Centers for Medicare & Medicaid Services (CMS) released the final rule governing 2018 MACRA participation. The rule introduced several changes that stand to impact physician practices and other healthcare organizations. Here are a few key aspects of the rule of which to be aware for the coming year:
The exclusion thresholds have changed, and this may allow more specialty practices and other smaller organizations to exempt themselves. Note that CMS is now including Medicare Part B drug reimbursement in the calculations for exclusions, which may skew applicability for certain entities. If a physician practice uses a lot of Part B medications, for example, it may increase its revenue amounts and thus preclude the practice from exclusion.
For the first time, practices must submit cost measures, and these will represent 10 percent of an organization’s MIPS score. That percentage will rise to 30 percent in 2019. Since organizations will need to demonstrate cost performance, they may want to review that performance and see how it relates to their peers as well as the quality of care they deliver. Even if cost numbers are high, if they can be tied to good quality, then they are likely justifiable.
Organizations must start submitting cost and quality measures on January 1 and submit for the entire calendar year. They also must achieve a composite score of at least 15 out of 100, which is up from last year’s three out of 100.
As president and COO of a leading electronic health record (EHR) and practice management (PM) provider, part of my job is to be in constant communication with providers about health IT. They tell me and my team what works for them and what doesn’t work; what brings joy to their practice and what keeps them up at night. All this insight helps polish my crystal ball, making it clear what we can expect to see in 2016:
EHR system will pivot from regulatory compliance to physician productivity. EHRs are generally blamed for fueling the professional dissatisfaction of physician. A few software vendors are looking at the problem-oriented medical record (POMR), a more intuitive approach that works similarly to the way a doctor thinks. It organizes clinical records and practice workflows around specific patient problems, making it faster and more satisfying for physicians to use.
The problem list not only delivers a “table of contents” to clinically relevant issues, but also gives a provider a longitudinal view of a patient’s healthcare over time. This intuitive method of information organization makes it easier for provider and patient to set the agenda at the start of the exam. During the exam, the POMR supports the nonlinear nature of a patient encounter.
The POMR also helps reduce cognitive overload, which can lead to medical mistakes such as misdiagnosis and other potentially life-threatening errors. Providers can see “bits” of data like lab results associated with a specific problem, thus easing the number of mental connections required to make sound medical decisions.
Chronic care management (CCM) will grow quickly because it makes sense for both patients and providers. Our healthcare system is changing to address the needs of an aging population with chronic illnesses like hypertension, diabetes, heart disease, and more. To promote the effective care coordination and management of patients with multiple chronic illnesses, the Centers for Medicare and Medicaid Services (CMS) introduced CPT code 99490. This code reimburses providers for remote, inter-visit outreach, such as telephone conversations, medication reconciliation, and coordination among caregivers.
The reimbursement for CCM services is an average of $42 per month for Medicare beneficiaries. New levels of technology integration will enable clinicians to complete CCM reporting of remote care from inside their EHR system.
Anyone who grew up playing video games ought to have a greater appreciation for the future of healthcare.
When they moved out of the arcade halls and into living rooms, video games became more accessible to more people. And when a wave of fitness-related console titles were released in the late 1990s and early 2000s — Dance Dance Revolution, EyeToy: Kinetic, and Yourself!Fitness/My Fitness Coach — women joined in the fun. By 2014, a study by the Entertainment Software Association revealed that women represented 48 percent of the gaming population in the United States, and the addition of this untapped market allowed the gaming industry to make the pivot that would eventually merge gaming with healthcare.
The title character of My Fitness Coach was Maya, a virtual personal trainer. Maya was the agent who coached couch potatoes and weekend warriors alike to reach whatever fitness goals they might have. A doctor, similarly, knows what’s best for patients and has a reason behind every instruction — and the difference between the virtual video game trainer and the Ph.D. isn’t the vast ocean it once was.
With innovations from FitBit and Jawbone for wearables, Biosensing to Augmedix and Entrada for electronic health records (EHRs) and clinical workflow apps, as well as direct competitors such as Doctors on Demand and TeleDocs, traditional healthcare institutions are facing consumer-direct competitors whose products and services are almost exclusively based on the use of self-care technology. A new wave of innovation is coming soon. Venture funding of digital health companies surpassed $4 billion in 2014, nearly equivalent to the previous three years combined.
So, what’s next?
Self-care apps like FitBit, RespondWell, Caremerge and others that feed a patient’s data into a cloud have the potential to enrich clinical observations in ways that the occasional hospital visit cannot. If you have a device producing conclusive data that says “your heart rate is higher than it should be,” “you’re taking too many pills,” or “you’re walking with a gait,” a physician can say with confidence “something bad is going to happen to you.” Predicting a person’s proclivity for injury and illness is more of a science than ever.
Guest post by Torben Nielsen, senior vice president product and strategy, HealthSparq.
The past few years have seen record investments in digital health. More than $12 billion have been poured into digital health companies in 2014 and 2015 alone, according to Rock Health, and there’s no indication of any slowing in 2016. Here are my predictions for what’s in store for health care in the New Year:
#1: Fragmented and disparate data sets turning into relevant and comprehensive information sets
Healthcare data sources have been siloed and fragmented for years. Data in electronic health records (EHRs) have worked within the hospital setting (to some degree), but not across systems, or for the consumer. Patient portals have attempted to bring data together, but with limited adoption due to sporadic data, old interfaces and no clear use model. With new data standards, APIs, and open source developments, data will become more fluid and accessible. We will finally start to see data portability and data integration in ways not witnessed before. This will be to the benefit of the consumer, who will be able to share and embed data from different sources into their preferred view. This will ultimately create a more relevant and engaged experience for the healthcare consumer.
#2 Continuous and team-based care on the rise
Along with a deeper and more portable experience of one’s own healthcare information (both from the healthcare system and via patient-driven data) comes a more continuous and streamlined patient-doctor experience. Interaction between the patient and the system will happen via Wi-Fi enabled technology and smart devices allowing for a continuous stream of data and information. This will benefit the doctor, who will be able to interact and react much faster. It will also do away with the “information black-outs” that often occurs between the time a patient visits their physician, all the way until their next scheduled visit. The patient will also be able to better track their condition. Furthermore, much of this information can be shared with the patient’s broader care team such as significant others, children, specialists, etc. This will ultimately benefit the care provider, the patient and the overall system.
#3 Millennials will be the catalysts for the healthcare consumer revolution
One of the most over-used buzzwords in the healthcare industry today is “consumer/patient engagement.” Everyone seems to have a solution for driving up engagement for the masses. However, it’s a fallacy to believe that anyone or everyone will engage in a particular system, process or technology. As is the case with most products, an early-adopter segment needs to be identified to successfully scale and ramp up sales. For healthcare, millennials will be a great catalyst for change and the movement towards consumerism. This generation has grown up with Uber, Amazon, Instagram and Facetime. They will demand a much more efficient and technology driven healthcare experience. They will push for a seamless and personalized experience, and their voice will become stronger and stronger over the years as they start consuming healthcare to a greater extent.
Guest post by Ben Weber, managing director, Greythorn.
This is the time of year when people are looking into their crystal ball, and telling all of us what they see happening in the next 12 months. Some of these predictions will be wild (aliens will cure cancer!) and some will be obvious (more health apps in 2016!). But how many will be helpful?
As I gaze into my own crystal ball, I have to admit I’m also peeking at my email (I like to multi-task). I can’t really say if it’s inspired by the swirling lights of the magic orb on my desk, or if it’s because of the inquiries from clients, messages from my management team and RFPs from various hospital systems … but I also have a prediction for the New Year: 2016 will be the year of migration for Epic and Cerner consultants.
The United States healthcare industry has made great progress in EHR implementation—to the point where implementation is no longer the primary conversation we’re having. Now we’re discussing interoperability, if we’re using ICD-10 codes correctly, how and if we should integrate the data collected from wearable fitness technology, and more. Those discussions—and the decisions made as a result—will continue to require human intelligence and power, but in 2016 there will be a decreased demand for consultants on these projects. Healthcare IT professionals who have grown accustomed to this kind of work will either have to settle into full-time employment—or turn their nomadic hearts north to Canada.
Our neighbors on the other side of the 49th parallel are ramping up their EHR implementations, which is good news for consultants interested in using their passports. Implementations in the US are slowing down, and while there is still work available, it is not as constant and may not command the same hourly rates as in years past. Meanwhile, several leading Canadian healthcare IT organizations have already warned of a looming talent shortage in their country (source), the effects of which are beginning to be felt.
Epic and Cerner specialists are particularly in demand, as there is a dearth of experienced talent. Out of the Canadian healthcare IT professionals who have worked with an EMR, 28 percent report familiarity with MEDITECH, 13 percent with Cerner, and 7 percent with McKesson. Only 4 percent have worked with Epic, according to the 2015 Canadian Healthcare HI & IT Market Report.
This article is part of the “Think Further” series sponsored by Fred Alger Management. For more “Think Further” content, please visit www.thinkfurtheralger.com.
There is almost nothing I’m certain of except that life is an uncertain thing and that it seems to change a lot. Even in the most predictable of settings, even the minutest changes in detail can have a lasting and overwhelming effect on nearly everything in its atmosphere. In healthcare, a space seemingly immune to the status quo, things seem to get a whole lot more complicated. The same can be said of life and death, health and well-being. On their own, they are not so difficult to understand and often, in most cases, predictable and redundant; until the final days, of course, then things begin to get a little more complicated. When we’re fine, we’re fine. Life is good and most of our concerns seem trivial.
Then health gets involved and the minutest change in detail can send our lives in a spiral so much so that we barely recognize our place in it let alone who we are and where we belong. When such an occurrence arises, we begin to rely on beeps and buttons, software and technology in ways never before imagined for the intersection of our lives.
Clearly, the health IT landscape will be completely different five years from now. From where we stand today to where we’re headed, we’ll likely look back on this moment and wonder how we survived such archaic times. Just a couple years removed from the age of the electronic health records, technology that already seems dated and antiquated, is no longer monolithic and domineering to the space as it likely seemed in 2010.
Our future selves might stand on the threshold of 2020 and say that we were being single minded. The technology — EHRs were supposed to save healthcare and are now nothing but foundational. The technology was supposed to simply aggregate information collection, provide for the ability to quickly share information system wide and around the world; and give us the capability accessing all of a patient’s information at the tips of the proverbial finger.
When the promise of those solutions faded (yes, their stars have faded) and as our attention forced us into new technologies (primarily because of consumers’ desire) we are now seeing developments in technology creating touch points that impact patients “where they live” and has become the new force behind healthcare technology.
Consumers will drive healthcare’s future. Probably not a secret at this point, but a point that is hard for the old guard. They’ve had enough of being left out of the ownership process regarding their own health. They’re tired of being locked out of their own records, and kept access to their own information. Such data would not exist without those helping produce it. New consumer technologies have and will further level the field. Consumer tech will continue to spur innovation, at light speeds. Data will flow between healthcare parties and its consumers; HIPAA protections will be waived and open access for the social good will become the norm. Standard and traditional approaches when dealing with patients, in a generation or so, will be completely different and far less segmented, as they are now.
Guest post by Deanne Kasim, IDC research director, payer health IT.
Part of the role of being a research director is to analyze current industry trends, developments and policies and help clients navigate these IT, market, economic and regulatory changes. A post-health reform environment has accelerated the rate of change in all these areas. I recently developed a discussion of the top 10 areas of change payers need to focus on for the next 12 to 18 months (http://www.idc.com/getdoc.jsp?containerId=HI253579). The following is a brief discussion of the top three predictions.
Payers need to develop greater understanding of who their consumers are and adopt more of an omni-channel approach for reaching and meaningfully engaging different population segments.
Consumers understand how to assess the concept of value in other areas of their lives, such as researching information to purchase a new car, a major appliance, or a house. But they do not have nearly as good of an understanding on the way health insurance works, how to necessarily use it, or how to define value in insurance benefits and care choices. Health reform has forever changed the business model of health insurance and placed consumers front and center in the equation. This increased emphasis on the consumer needed to happen a long time ago and now payers are challenged to radically change how they develop, market, and administer health insurance benefits accordingly. IT tools and applications are quickly evolving to better support the consumer’s purchase decisions and use of insurance benefits, and payers are continuing to realize the potential and importance of this developing product area.
According to IDC Health Insights’ 2014 Payer Survey, payers were split between increasing the 2014 budget for consumer engagement strategies (49 percent) and keeping the budget the same (51 percent). I fully anticipate these numbers will be higher in this year’s survey, as more payers commit additional resources to the development and support of thoughtful consumer engagement strategies, processes and IT applications.
As the industry moves from pay-for-volume to pay-for-value payers need to form more “win-win” relationships with providers and this requires leadership, trust and the IT applications and analytics to support this.
The longtime practice of paying for volume is changing rapidly to pay for value, and the U.S. Centers for Medicare & Medicaid Services (CMS) continues to lead developments in pay for value methods, including a variety of value-based reimbursement (VBR) practices, pay-for-performance (P4P) and global or episodic payments. The establishment of patient centered medical home (PCMH) and accountable care organization (ACO) models, combined with the reduced reimbursement realities under the ACA, has incentivized more providers and payers to explore new, mutually beneficial reimbursement arrangements. Providers and payers will have an increasing need for analytics applications to help predict and monitor clinical quality outcomes and financial performance measures in order to make VBR arrangements work for all involved stakeholders. In addition, as payers continue to employ narrow networks as part of their public HIX business line strategy, VBR arrangements with the contracted providers can enhance the performance of both payers and participating providers.
Guest post by: Lauren Fifield, senior health policy advisor, Practice Fusion
Many HIT vendors will be largely focused on major development efforts to meet 2014 edition certification requirements for meaningful use. However, as Stage 2 measures aim at improving patient engagement, quality and interoperability, we may be surprised by the new technologies that existing and new companies develop to meet the requirements:
Patient health records or portals allowing for access to and transmission of health information
Consumer applications to provide patient education and communication with providers
Exchange platforms to share clinical information like immunizations, diseases and more
Clinical decision support tools for medical professionals to improve their quality of care
We’ll also see new industry movement toward improved patient safety through provider training, reporting and other efforts. Thanks to the successful collaboration between vendors and the agencies that help providers achieve meaningful use, we expect the Food and Drug Administration to work with the Office of the National Coordinator for Health IT (ONC) and the Federal Communications Commission (FCC) to engage key stakeholders by addressing the 18-month study mandated in the FDA Safety and Innovation Act of June 2012.
Given the continued and ever-growing provider outcry to address the broken payment system, the Department of Health and Human Services (HHS) may finally develop plans to move to a reimbursement system that relies on quality and outcomes. With the recent announcement of more than 106 new ACO contracts, growing provider participation in new payment models, and the new possibilities opened up by technology vendors, it may at last be time to put this broken system behind us.
Though much of the 2013 transformation is fueled by government initiatives, the healthcare industry is at a tipping point regardless of any push on Uncle Sam’s part. Patients will soon be expected to pay for more of their care, making consumer health tools, telehealth and personalized medicine more appealing and important. Providers tired of the payment system will partner with technologists and private payers to try alternative models and cash-based business. And big data might just find a home amid all these new patient, provider and health system innovations.