After years of underinvestment, CIO’s in healthcare may have something to cheer about this year. The biggest trend seems to be the increased focus and investment in IT in healthcare enterprises. With more than $30 billion invested in electronic health record (EHR) systems, and meaningful use (MU) requirements out of the way, we are seeing enterprises turn toward the more strategic aspects of IT in the ongoing transformation of the healthcare sector.
These investments, however, will follow the money. In other words, funding will focus on initiatives that have the biggest impact in terms of revenues, cost avoidance, and transformative potential. A recent survey by technology provider Healthedge suggests that investments among payers will be targeted at selective enhancements to the most critical systems that support business development, and not a wholesale upgrade of IT. Here are a few of the top investment areas across healthcare:
Population Health Management (PHM): Everybody is on board with the concept of PHM as the defining principle in an outcomes-based business model. However, PHM has eluded a consistent definition, other than that its desired impact is to reduce overall costs of patient populations, and improve clinical outcomes. Analytics has been an important aspect of this discussion, however standalone analytics solutions have struggled to demonstrate value, and progress on advanced analytics involving predictive models and cognitive sciences has been slow. This year may change all of that. Many standalone analytics companies are likely to be acquired, and IBM Watson will gain more traction. M & A in healthcare will drive PHM as well.
Information Security: With healthcare data breaches at over 112 million in 2015, including high-profile breaches at Anthem, Premera, and Excellus, IT security is now a CEO level issue. There is no doubt what this means – investments in data security technologies are going to increase. However, there is no guarantee that data breaches will not increase.
Healthcare Consumerism: Changing demographics and unexpected increases in the costs of health insurance are driving the consumerization of healthcare today. Silicon Valley startups, flush with VC money, are coming up with direct-to-consumer approaches that are making traditional healthcare firms sit up and take notice. At the same time, the newly awakened healthcare consumer is also demanding information and price transparency. New York Presbyterian has launched a patient-first marketing strategy aimed at improving engagement with patients through information sharing, and is revamping its website completely. BCBS of NC has already released the cat among the pigeons by publishing price data (and is facing pushback from its provider network). IT investments will now be focused on maximizing the reach and value of the information to empower consumers to make the right choices.
Last year, 2015, was a year of buildup, anticipation, and finally some bold moves to propel healthcare technologies forward, specifically regarding interoperability of data. The Office of the National Coordination, under the auspices of the department of Health and Human Services, released the long-awaited and much-debated meaningful use Stage 3 requirements in October. All the players in the health tech space were awaiting the final verdict on how Application Programming Interface (API) technology was placed into the regulations, and the wait was worth it, regardless of which side of the fence you were on. Before we get into the predictions, though, a little background knowledge about these technologies, and their benefits, will be helpful.
An API is a programmatic method that allows for the exchange of data with an application. Modern APIs are typically web-based and usually take advantage of XML or JSON formats. If you are reading this article, you almost inevitably have used apps that exchange data using an API. For example, an application for your smartphone that collects data from your Facebook account will use an API to obtain this data. Weather apps on phones also utilize an API to collect data.
Next let’s take a look at the history of interoperability of healthcare data. HL7 2.x is a long standing method to exchange healthcare data in a transactional model. The system is based on TCP/IP principles and typically operates with Lower Layer Protocol (LLP) which allows for rapid communication of small delimited messages. The standard defines both the communications protocol and the message content format. No doubt about it, HL7 2.x is incredibly effective for transactional processing of data, but it has been limited in two key areas:
A pioneering developer of a successful HL7 interface engine once said: “Once you have developed one HL7 interface … you have developed one HL7 interface.” The standard exists, but there is nowhere near enough conformity to allow this to be plug-and-play. For example, a patient’s ethnicity is supposed to be in a specific location and there is a defined industry standard list of values (code set) to represent ethnicity. In reality, the ethnicity field is not always populated and if it is, it rarely follows the defined code set.
HL7 is an unsolicited push method, which means when a connection is made, messages simply flow from one system to another. If you are attempting to build a collection of cumulative data over time, this is a mostly sufficient method, but what you cannot do is ask a question and receive a response. Although some query/response methods have existed for years, their adoption has been very sparse in the industry.
2016: Year of the Healthcare API
If you are a physician with an electronic health record (EHR) system and you accept Medicare patients, you likely have gone through the process of becoming meaningful use (MU) certified, which means you have purchased an EHR software solution certified by the ONC. This EHR must follow guidelines of technical features, and physicians must ensure they utilize those features in some manner. In October 2015, the ONC released MU Stage 3 criteria (optional requirement in 2017, mandatory in 2018) which includes this game changer: A patient has a right to their electronic health information via an API.
Guest post by James Carder, CISO of LogRhythm, VP of LogRhythm Labs.
This year’s biggest health data breach victims include insurers Premera and Anthem, where incidents affected nearly 100 million patients combined. It’s clear that healthcare organizations must strengthen their cyber security programs to protect themselves and their patients, or they’ll be targeted again and again. Strategically, healthcare organizations must change the way they have operated for the past 30+ years with regard to their behaviors and their use of IT. Cyber security is now a key business differentiator as both patient care and safety are paramount to a hospital’s ability to remain a trusted provider. The hospital of the future is one that incorporates these protection measures into its business brand, thereby recruiting, retaining and reinvesting in patients.
As we start out 2016, here’s what I think we’ll see going forward:
Healthcare IT security will continue to fall further and further behind the rest of the industry verticals
Healthcare IT security will continue to fall further behind the rest of the industry verticals. Healthcare organizations are focusing on functionality for patient care (rightfully so), and security is an afterthought. Many organizations are overly dependent on antiquated hardware and software, with inherent vulnerabilities, that could inadvertently put patients in danger. There has never been a real investment in information security, so the cost to catch up to industry standards and shed the label of being the hackers’ “low hanging fruit” is that much more expensive. The industry will continue to be targeted by sophisticated and organized attackers until a serious investment is made in both technological and human capital.
The medical record is a relative goldmine of information and, as such, a highly valuable target for all classes of attackers, ranging from financial crime groups to nation state threat actors. The number of items a hacker has access to and the way in which the information can be used is more extensive. Stolen data can be re-used by a hacker over and over again. So, in addition to this general prediction, I also think that at least one of the U.S. News and World Report top 10 hospitals will go public with a breach through outside channels.
Healthcare IT (security) spend will be the highest it has ever been, doubling the spend of 2015
Despite my first prediction, healthcare organizations will invest a lot of money in IT security technology and human resources, doubling the spend of 2015. Although the executives may fund the security department, a security culture might not trickle down to the rest of the organization. The person in charge of security might be accountable for security, but the buy-in must come from the board of directors down through every level of the organization. Staff and the clinicians must understand what they are doing is making the organization a safer place for them and their patients–their effective security behaviors allow clinicians to do their job in treating patients better.
At least one major medical device manufacturer will have to go public with a vulnerability that could fatally affect patients
Medical device vendors and manufacturers have never taken security seriously. They are primarily looking for functionality for patient care and ease of administration and maintenance. A medical device is a computer system with one end attached to the patient, providing critical patient care, and the other end attached to the corporate network or Internet. Just like most devices on the network, a medical device runs a known operating system; vulnerable to the myriad exploits that effect any computer. Based on the risk profile of a medical device, it should be subject to the highest security standards in the industry but unfortunately they are not. If someone can hack into a Windows XP box that is unpatched with exploitable vulnerabilities, someone can hack into an XP-based medical device. I predict that another medical device manufacturer will disclose an easily exploitable vulnerability that could patients at direct risk. I also predict that an attacker will exploit a medical device and use it as a bridge into a company’s corporate network to facilitate a breach.
Guest post by Kirk Larson, national CIO, healthcare, NetApp Inc.
As we start a new year, let’s take a moment and take stock of the past 12 months. Like an annual physical, it gives us a chance to take a pulse check on the industry and see what the next year has in store – the opportunities and the obstacles.
During 2015, we had the opportunity to chat candidly with CIOs, healthcare technology partners and healthcare providers to discuss the big questions affecting the industry:
— What are the big topics the industry will be focused on?
— What changes do you see coming?
— What new challenges lay ahead and what new technologies will help us overcome them?
Based on these discussions, here are some of the key trends healthcare CIOs can expect in 2016:
Electronic Health Record (EHR) Optimization
As healthcare organizations move beyond implementation phase of EHRs, CIOs and IT are refocusing their efforts towards enhancing care workflow and benefits realization by way of optimizing the IT infrastructure. Basically, the status quo on overspending on legacy hardware is no longer being tolerated.
While the high availability, performance and security requirements for IT infrastructure certainly aren’t lessening anytime soon, IT is feeling greater cost pressures to run EHRs more efficiently. As a result, organizations are looking to simplify IT operations for running on-premises data centers with improved data management solutions, with the end-goal of moving toward building their own private clouds.
In addition to greater cost efficiency, we are seeing a growing demand for increased agility of IT services. As such, organizations are looking to advanced analytics capabilities as a means of achieving greater responsiveness. But before they can reap the benefits of employing a population health management system, IT needs to shift from tired legacy IT environments to highly agile IT infrastructure.
Population Health Management
Population health management programs have long been used by healthcare insurers to increase wellness and decrease claims cost. Organizations leverage multiple data sources such as EHRs, pharmaceutical data, insurance claims, etc.; to enhance and preserve wellness, as well as, programs that anticipatory and pre-emptive in design.
Guest post by Jean Van Vuuren, regional vice president, Alfresco.
Hospitals, clinics and other healthcare organizations are constantly evolving due to the proliferation of technology, the increasingly digital workforce and advancing patient expectations. In addition to evaluating the constant flow of new technologies in the healthcare market, they must be nimble to meet the technological needs of healthcare workers and patients. In addition, the increasingly multigenerational workforce has varying requirements when it comes to technology, organizational culture and career progression. Finally, it is becoming more important for healthcare organizations to deliver a consistent patient experience. Today’s patient is better informed, more in sync with their health and expects a superior healthcare experience. To address these somewhat competing forces, healthcare organizations will focus on consolidation, integration and digitization in 2016.
Shared services is a growing model across industries, and healthcare organizations will follow this trend in 2016. This model allows organizations to consolidate tools and processes to meet a number of needs across their organizations. Hospitals, clinics and other healthcare facilities will look to take existing services and the tools that support them, and coalesce them into a more agile and flexible platform for IT solutions that support their entire organizations. For example, hospitals that have a system to manage EHRs and a different system to manage employee records may be able to use one, the other or an entirely new system to address both needs (and, potentially, others across the organization). The latter would obviously involve the decommissioning of legacy applications in favor of more robust tools that are open, have flexible deployment options and support mobility.
Similarly, healthcare facilities will only be able to meet the technological, organizational and clinical needs required today by employing tools that integrate not only with the systems they already have in place, but also with the tools that employees and patients use both personally and professional. And, in 2016, they will focus on integration, bringing in technology that can work with many other tools now and into the future. Using the example above, if a healthcare organization has an EHR system that they plan to keep, but they also want to get another system to manage employee records, they will seek to purchase a tool that integrates with their current EHR system. And for good reason.
Guest post by Robert Williams, MBA/PMP, CEO, goPMO, Inc.
I continue to view 2016 as a shakeup year in healthcare IT. We’ve spent the last five plus years coming to grips with the new normal of meaningful use, HIPAA and EMR adoption, integrated with the desire to transform the healthcare business model from volume to value. After the billions of dollars spent on electronic health records and hospital/provider acquisitions we see our customers looking around and asking how have we really benefited and what is still left to accomplish.
All politics is local
Our healthcare providers are realizing their clinical applications, specifically EMR vendors, are not going to resolve interoperability by themselves. When the interoperability group, CommonWell formed in 2013 much of the market believed the combination of such significant players (Cerner, Allscripts, McKesson, Athenahealth and others) would utilize their strength to accelerate interoperability across systems. Almost three years late CommonWell only has a dozen pilot sites in operation.
Evolving HL7 standards and a whole generation of software applications are allowing individul hospitals to take the task of interoperability away from traditional clinical applications and creating connectivity themselves.
Black Book’s survey published last month, stated that three out of every four hospitals with more than 300 beds are outsourcing IT solutions. Hospitals have been traditionally understaffed to meet the onslaught of federal requirements. Can they evolve into product deployment organizations as well? Across all the expertise they need within the organization? Most are saying no and searching out specialty services organizations to supplement their existing expertise and staff.
Are you going to eat that?
Patient engagement is on fire right now at the federal level (thank you meaningful use Stage 3), in investment dollars and within the provider
community. But to truly manage hospital re-admissions and select chronic diseases (diabetes, obesity and congestive heart failure for example)
providers need data and trend analysis on daily consumer behavior. The rise of wearable technology and the ability to capture data/analyze data from them will be a major focus going forward. These technologies will likely help to make us healthier but with a bit of big brother side affect.
Guest post by Mohan Balachandran, co-founder and president, Catalyze.
As we look back upon 2015, we can reflect, review and based on that and other factors, make some predictions about what next year will bring us. John Halamka had an interesting post that reflect on the bigger challenges, such as ICD-10, the Accountable Care Act and its implications on data analytics, the HIPAA omnibus rule and its impact on cybersecurity and audits and the emergence of the Cloud as a viable option in healthcare. We can expect to see some of these trends continue and grow in 2016. So based on these key learnings from 2015, here are a few predictions for 2016.
Cybersecurity will become even more important
In 2015, insurers and medical device manufacturers got a serious wake up call about the importance and cost of cybersecurity lapses. Healthcare data will increasingly be looked at as strategic data because we can always get a new credit card but since diagnoses cannot change, the possibilities of misuse are significant. Just as the financial industry has settled on PCI as the standard, expect the healthcare industry to get together to define and promote a standard and an associated certification. HITRUST appears to be the leader and recent announcements are likely to further cement it as the healthcare security standard. Given all that, one can safely expect spending on cybersecurity to increase.
IoT will get a dose of reality
The so-called Internet of Things has been undergoing a boom of late. However, the value from it, especially as applied to quantifiable improvement in patient outcomes or improved care has been lacking. Detractors point out that the quantified-self movement while valuable, self selects the healthiest population and doesn’t do much to address the needs of older populations suffering from multiple chronic diseases. Expect to see more targeted IoT solutions such as that offered by those like Propeller Health that focus on specific conditions, have clear value propositions, savings, and offer more than just a device. Expect some moves from Fitbit and others who have raised lots of recent cash in terms of new product announcements and possible acquisitions.
According to PwC’s Health Research Institute (HRI), 2016 will be a year of firsts for players within healthcare as the industry adapts to the main forces driving the New Health Economy: the rise of consumerism, the focus on value, downward pressure on costs, technological innovation and the impact of new entrants.
In its annual report, “Top Health Industry Issues for 2016,” released today, PwC’s HRI highlights the top 10 forces that are expected to have the most impact on the industry in the coming year and looks back at how trends from the past decade have persisted or evolved. Leveraging results from a survey of 1,000 US consumers and interviews with health industry leaders, 10 issues stand out in the year ahead across three key themes:
Innovation:More and more, health technology in the palm of your hands will mean more than just monitoring – it will also mean diagnosis and treatment. Sixty percent of consumers are willing to have a video visit with a physician through their mobile device, while 58 percent of clinicians would rather provide a portion of care virtually. Additionally, new high-tech databases will allow industry players to analyze data from many sources in novel ways, finally unlocking new insights. Shouldering higher deductibles and rising out-of-pocket expenses, consumers expect to begin to manage their health spending like they manage their retirement savings.
Access to care:In 2016, the US health sector is expected to see a new class of products – biosimilars – introduced to the market, bringing potential savings with them. The New Year may also bring renewed attention to behavioral health, long relegated to the industry’s back burner. However, the issue will be access. More than half of US counties have no practicing mental health clinicians. Additionally, with mounting budget pressures, care may move to the community as health systems pursue lower-cost care settings more aggressively and creatively than before.
Troubleshooting issues in the New Health Economy: With 2016 being a presidential election year, industry issues such as drug pricing will be in the spotlight. Additionally, as insurers, consumers and purchasers are demanding better value, providers may be scrambling to unlock the medical cost mystery and calculate the true cost of services. 2016 should also be a year in which the industry is dramatically reshaped by consolidation, as the insurance market should inch closer to being dominated by three major players. Finally, with the rise of health technology comes the rise of cybersecurity Nearly 40 percent of consumers would abandon or hesitate using a health organization if it is hacked. More than 50 percent of consumers would avoid, or be wary of using, a connected medical device if a data breach was reported.
“After more than a decade of identifying the top health industry trends, we are finally starting to see the creation of a New Health Economy – a health system that is more connected, transparent and patient-centric,” said Kelly Barnes, PwC’s US health industries leader. “2016 will be marked by how well the sector balances greater demand with rising costs, and handles trends such as industry consolidation and the increase of consumer technology in healthcare. But there is much more work that needs to be done in forging new ways of receiving, paying for and delivering care, and it will be businesses that prioritize addressing consumer needs and increasing value that should succeed.”
Additional details on the top 10 business issues that HRI identified include:
By Tom Bizzaro, vice president, health policy and industry relations, First Databank
Healthcare delivery is changing drastically. Demographics, technology, economics, societal forces and many other factors are prompting the industry’s transformation as we head into 2016 and beyond. And, while change is always a bit jarring, sometimes it actually makes sense.
Here are eight emerging trends that are changing healthcare for the better:
The move toward telemedicine
Is there anyone out there who can honestly admit they are thrilled about traveling to a provider’s facility for their care? In today’s world, time has value and patients are much less willing to spend their time waiting for care. Now, in some cases, it is critical to be face-to-face with your caregiver. However, in many cases, it is just an inconvenience. I am pretty sure that surgery and treating a broken bone won’t lend themselves to a virtual visit, but think about all those things that do. Using Skype for virtual doctor visits; reading medical images taken in Indianapolis by a physician in Australia; and using a kiosk to get access to a nurse consultation have become commonplace — and much more is expected as telemedicine continues to expand.
The adoption of evolving electronic communication tools
I read recently that people under the age of 25 prefer texting as a means of communication with their doctors. It seems that phone calls and even emails are too intrusive and time consuming. In a world where email is too slow, where people are cutting the cord to cable TV, and newspapers are the last place young people get their news, healthcare organizations must stay on top of their constituents’ constantly changing communication preferences.
The return of home care
While patients are pushing healthcare providers to adopt the latest technologies, at the same time “what is old is new again.” Home healthcare services are growing as aging Americans want to stay in their homes as long as possible. Pharmacists are making home visits to the most at-risk patients to manage medication therapy. Doctors are making house calls to help improve care and decrease hospital readmissions. Nurses are performing all types of infusion therapy in patients’ homes.
Telemedicine technologies are evolving rapidly, enabling better care, greater patient access and the promise of bending the healthcare cost curve. Telemedicine has evolved dramatically over the past few years, and providers have come to realize the profound ways in which it can improve patient care. With this evolution has also come the increasing sophistication of telemedicine practitioners. Doctors, nurses and administrators now desire easier integration, clinical adaptability and configurability, support for multiple specialties on a single comprehensive platform, and robust data collection and analytics.
REACH Health, a leading provider of enterprise telemedicine solutions, has identified five key technology trends for the coming year, each promising benefits for providers and patients. These trends for 2016 include:
Obsolescence of Proprietary Hardware and Networks: Although proprietary hardware and networks were standard in the early generations of telemedicine technology, healthcare providers now desire affordable, flexible solutions. Effective telemedicine programs are increasingly powered by off-the-shelf PC components, standard, low-cost cameras and emerging networking standards such as WebRTC. These open, standardized products allow providers to choose the most appropriate end-point for the clinical need; whether it be a high performance cart, a PC or a mobile device such as an iPad, Android or Surface tablet. Providers also now increasingly seek specialty-specific telemedicine software applications that are deployable across these commodity hardware devices using open networks.
The Rise of the Software Platform: Healthcare systems now seek enterprise-wide telemedicine solutions that can be scaled to support multiple service lines and a variety of delivery models, all on one common platform. Just as single-function “dumb phones” have been rendered obsolete by multi-purpose “smart phones,” providers want a single platform to accommodate all their telemedicine needs. They expect a simple, effective solution that supports varied telemedicine requirements across the continuum of care and works wherever it is needed, on a variety of devices. These platforms must also be designed with an open architecture, providing the ease of plug-and-play connectivity with specialized, interoperable components such as high quality peripherals.