While the COVID-19 pandemic forced healthcare into a reactionary crisis state in 2020, 2021 offered an opportunity to rethink traditional care delivery models. Divergent views on vaccines, powerful COVID-19 variants and ongoing capacity issues have shown that providers, and the technology companies that support them, will need to continue to evolve in order to serve patients effectively.
As we look towards 2022, experts at Wolters Kluwer Health, a clinical technology and evidence-based solutions provider, outlined their predictions for next year and what they think it will take to properly equip providers to deliver the best care everywhere.
Building trust in an age of digital information overload
Digital health investment in 2021 has focused mostly on technology innovation and workflow improvements. What I’m seeing in the digital health space is akin to the implementation of EMRs, which really focused on the technology itself and not the content inside, which creates the experience for both clinical users and consumers. What’s missing from digital health strategy, and what providers will need to focus on in 2022, is increasing access to high-quality, evidence-based health content that consumers and providers alike can trust and understand. This ease of access is crucially important to overcome the infodemic of COVID-19, with an influx of misleading and rapidly evolving information we’ve seen expand across all areas of healthcare. Effective, engaging digital health requires more than the right technology, but a full-fledged experience that informs and motivates consumers towards evidence-based action.
Jason Burum, general manager, Healthcare Provider Segment, Clinical Effectiveness, at Wolters Kluwer, Health
More compliance, less burden
The pressures of COVID-19 spurred USP to issue interim guidance that provided flexibility for compounding pharmacies, but 2022 is likely to represent a return to stricter compliance. In September, USP issued a Notice of Intent to Revise (NITR) for both USP <797> and USP <795>. With COVID-19 cases continuing to surge across the country, I anticipate hospitals and pharmacy staff in 2022 will increasingly rely on expert solutions and technology to automate and standardize compounding operations in accordance with best practices and the latest compliance requirements. Burnout and technician shortages are happening in pharmacies too and software tools will help alleviate burdens pharmacy staff face right now.
Annie Lambert, PharmD, BCSCP, Clinical Program Manager for Compliance Solutions for Clinical Surveillance & Compliance, Wolters Kluwer, Health
Pitting AI against HAIs
Data show that while hospitals have allocated more resources to infection prevention and control efforts to contain the spread of COVID-19, it has largely come at the expense of controlling other far too common healthcare-associated infections (HAIs). It’s true that a larger volume of sicker patients at higher risk of infection and sepsis have been admitted to the hospital over the last year, but the CDC concluded that 2020 increases in HAIs were also a result of lacking surge capacity and other operational challenges. Looking ahead to 2022, as hospitals take aim at controlling all HAIs in addition to COVID-19 with more resilient care teams, they will be looking more closely than ever at AI-powered technology to support proactive and real-time monitoring of patients to empower staff with quick risk identification abilities and opportunities for earlier clinical intervention.
Mackenzie Weise, MPH, CIC, Infection Prevention Clinical Program Manager for Clinical Surveillance & Compliance, Wolters Kluwer, Health
Telemedicine grows up
Contrary to some news stories, telemedicine will prove resilient well past the pandemic and will establish itself as a permanent, significant fixture in the healthcare ecosystem. In 2022, I expect healthcare providers themselves will strengthen and formalize training to research and promote telehealth best practices to their clinicians. It’s already happening, and I expect to see specialties like mental health and urgent care shifting to a predominantly virtual model in 2022. Ultimately, I believe that the rise of telehealth will drive more dialogue around modes of access as an issue not only of tech but also equity in the years to come. This in turn will have big impacts in the future of medical practice.
Vikram Savkar, vice president and general manager, Medicine Segment of Health Learning, Research & Practice
Telemedicine – the practice of providing consultations and medical assistance to patients through video calls – should be a lasting way of administering health care, according to the American Medical Association, particularly for patients with chronic health conditions. It promises to free up doctors’ offices and reduce the amount of time that individuals spend on waiting lists.
From around 2012 onwards, the number of people using telemedicine increased globally, year-on-year. Technology made it possible for patients to connect with their doctors remotely, skipping the need to travel to offices for consultations. However, despite the feasibility of such systems, coverage was patchy, right up until 2020.
Once the pandemic hit, though, things began to change. Social distancing meant that medical practitioners had no choice but to shut their doors and administer patient care online. According to the AMA, COVID-19 changed everything. Early on in the crisis, the Trump administration removed many of the regulatory barriers to telemedicine, freeing up providers. The moves made it easy for patients to pay for their care while remaining safely in their homes.
One of the greatest health concerns of modern society is nursing shortages in different states across the world. The prevalence and impacts of the recent Covid-19 pandemic have taught the world that professional nurses and physicians are pertinent to providing quality healthcare services. As the pandemic continued to expand, it became evident that frontline nurses suffered the most, causing an unpredictable shortage of professional healthcare workers at such a poor timing in history. Predictions indicate that by 2030, there will be a shortage of more than 50,000 nurses in certain states.
This trend explains why nursing programs and professionals embrace technology to help in the ideal recruitment, retaining, and monitoring process. Here is how technology helps to counter nurses’ shortages in the healthcare system.
Specialty Preference Over Facility
Gone are the days when nursing and other healthcare job vacancies filled the print media pages. Around a decade ago, influential healthcare policymakers decided that the system would evolve from print journals, specialty publications, and newspapers to social media, website optimization, and email marketing. This strategy would facilitate analytical and metrical monitoring to promote nursing by specialty rather than a facility.
Many nursing training processes take place virtually. Several nurses get assigned to different shifts based on their competence skills and preference areas. Electronic scheduling helps solve the nursing shortage challenge by facilitating trading shifts among professional healthcare workers and establishing a stable balance between work and personal lives.
The medical profession has come a long way from the days when doctors made house calls carrying little black bags with everything they needed for their trade. Changes have occured to the medical profession that have greatly improved the overall health care that patients have access to. Advances in technology have been able to both help improve health outcomes and wellbeing. Technology allows doctors to gain real time data about how their patients are doing. While there are many areas where technology helps patient outcomes, four that should be highlighted include telemedicine, decreasing financial burdens, improving patients’ access to care, and allowing patients to take more control over their own health and wellbeing.
Telehealth, telemedicine, and virtual care are often used interchangeably to describe remote healthcare visits. But virtual care means something much more than just telehealth or telemedicine. In fact, virtual care is in a category all its own. It is the logical, necessary next step in providing access to healthcare for all.
Telemedicine is Evolving
Remote monitoring and telehealth are nothing new. For decades, doctors have been able to monitor patients remotely or provide medical consults over the phone. Anxious parents have called in to 24-7 nurse hotlines to get advice about childhood illnesses and accidents. More recently, with the advancement of smart phones and web cams, new business models were created to connect patients with doctors over the internet.
However, most people still preferred to visit their doctors in person, and most doctors and healthcare centers weren’t considering a major shift to video any time soon.
Then COVID hit. It accelerated peoples’ desire for virtual healthcare visits and helped them feel more comfortable using video conferencing technology. Zoom, FaceTime, Google Meet and Skype became the go-to solutions for clinics large and small that didn’t yet have telehealth in place.
Video conferencing did good things for healthcare:
• Prevented even higher rates of delayed care
• Enabled providers to triage patients from a distance
• Gave quarantined providers a way to treat patients remotely
• Kept more clinics open and providers working
• Improved access to care for more patients
And while these video conference technologies solved an immediate problem, they quickly showed their limitations. These bandage solutions solved one issue while encountering (and even creating) many more problems.
Rapid expansion of video conferencing for healthcare exposed its weaknesses from HIPAA compliance issues, non-secure connections, the inability to bring a third party onto the call, wasted time as patients and/or doctors wait for the other party to join, limited number of users, concurrent calls, and call minutes and even the limited length of calls. The pandemic accelerated everything, even the “bad habits” of telemedicine.
An increasing number of entrepreneurs and innovators are tackling challenges in healthcare, but many of these solutions will never make it to market. It is critical to lay the right foundation by applying the principles of discovery and validation early in the process of innovation in healthcare technology.
Understanding the Basics of Discovery and Validation
Innovation thought leaders like Steve Blank have lauded the importance of discovery and validation. During the discovery phase, innovators gather data to substantiate market needs by talking to potential customers and other stakeholders. This data forms the first iteration of a business model.
Despite being informed by data, the business model also contains numerous assumptions. During validation, experiments are designed to test assumptions and reduce uncertainty. Often, experiments yield new insights and inform business model pivots while requiring innovators to conduct additional discovery. Innovators must collect enough data to feel confident about their assumptions without getting caught in an endless loop of testing.
This constant churn of trying to make sense of data helps get early stage healthcare innovations off the ground. For those in the healthcare field, the experience can be taxing. So-called “innovation fatigue” can set in fast, particularly for team members who don’t realize they’re embarking on a marathon instead of a sprint.
The pressures on healthcare organizations and employees make them even more susceptible to fatigue. Is it any wonder so many of them skip validation altogether? It might be tempting to make definitive decisions after an involved discovery excursion, but that won’t help stakeholders in the long run. Not testing after gathering insights can lead teams down an expensive road by building a solution and going to market prematurely.
Still, plenty of well-meaning healthcare innovators believe validation is not essential. Sometimes, it’s because they believe in the mythos of overnight success; they underestimate the time and resources required to explore and de-risk early stage opportunities, ultimately failing to anticipate the iterative nature of discovery and validation. Other times, they become overly confident in what they’ve seen and achieved during discovery and think no further iteration or learning is necessary.
To be sure, discovery gives healthcare innovation teams the knowledge to extract and shape a preliminary idea and begin to identify underlying risk quickly. Nevertheless, discovery alone means very little in practice. Validation is required if healthcare technology innovators really want to design experiments that will help resolve uncertainties, reduce risks, and pinpoint whether a hypothesized solution should persist, pivot, or perish.
Ultimately, organizations that lack a clear bridge from discovery to validation will see high-potential opportunities linger in their innovation pipelines. They never move because no one’s sure what to do with them. Eventually, these opportunities may fade away — meaning the healthcare system (and the people it serves) suffers.
The challenges and tragedies of the past year are well-known, but amidst the hardships of 2020 some hopeful signals have emerged in healthcare. Patients and the people and systems who care for them have been forced to do things differently this year, and many of these experiments will be with us to stay. These are some trends that will strengthen and take shape in 2021.
#1 Stakeholders embrace asynchronous
Payors, providers and other industry stakeholders who may have been reluctant to engage with async models in the past have been won over in 2020. The pandemic accelerated the understanding that async can safely and efficiently care for patients at scale. Providers who waded into async out of necessity during Covid have found that it allows for less rushed, more direct communication with patients that in many cases results in better care, while increasing provider flexibility and quality of life. Payors are realizing telehealth offers smart savings compared to legacy systems. State laws are coming along too — in May Maryland changed legislation allowing for asynchronous telemedicine to be accepted, and we expect more states to modernize in this way.
#2 Decrease of PCP as gatekeeper
Today’s young adults were already less likely than those of previous generations to have a primary care provider, and this trend will grow as PCPs close practices and people grow accustomed to a la carte care. Circumstances of 2020 have led people to get care formerly channeled through a primary provider directly, in a diverse array of settings. Covid swabs at drive-through clinics, flu shots at supermarket pharmacies, and prescription medications through telehealth, combined with increased utilization of home monitoring devices and wearables, have transformed patients (for better or worse) into their own care coordinators.
By John Danaher, MD, president, global clinical solutions, Elsevier.
At the beginning of last year, we all had our own thoughts on how the year would unfold. However, a few months into 2020, we realized that the year would be quite different than we previously imagined because of the COVID-19 pandemic. With 2021 underway, we will continue to witness the digital transformation of the healthcare industry that was accelerated by the COVID-19 pandemic.
Clinicians were quick to embrace different types of innovative technology, such as telemedicine platforms and non-contact solutions to track patient vitals, that allowed them to provide patient care remotely. I believe that in 2021, we will continue to see an evolution of technology to assist clinicians and widespread adoption of digital health services. I also expect the industry will take key learnings with them as we move towards the future, such as the importance of building more trust in science and data.
Investments in AI are paying off
We have seen the impact of AI in the fight against COVID-19, specifically in the diagnosis and tracking of cases, predicting future outbreaks and assisting in selecting treatment plans.
I hope to see more infections decline as populations receive access to the COVID-19 vaccines and I see a renewed focus in how AI can help healthcare systems recover from the pandemic. Artificial Intelligence will be paramount in aiding many healthcare systems’ return to their regular operations as they were pre-pandemic. Artificial intelligence helps systems work faster to address the backlog of patient cases across other diseases and conditions that were postponed due to the pandemic, and deal with the financial strains caused by the virus. These tools can be used in revenue cycle management to assist with staffing, bed and device management, and provide a better understanding of patient utilization.
Artificial intelligence will continue to play a larger role as telemedicine tools and solutions rise in popularity.
Widespread use of telemedicine
One of the longest lasting effects of this pandemic is how clinicians have adjusted their delivery of care. The use of telemedicine applications is now a widely used practice, with the U.S. seeing an increase of 154% in telehealth visits in March 2020, compared to the same time period in 2019. There’s no doubt that the rise in the usage of telehealth services have benefited both healthcare providers and patients.
Mainly, the adoption of services has decreased the number of patients in medical offices seeking non-emergency care and ultimately minimizing the risk of exposure to COVID-19. While telemedicine will not replace in-person care, it will remain a necessity in 2021 and beyond. As patients are now more accustomed to the convenient delivery of care services, they will be more inclined to expect these remote services, along with other services, such as drive through testing sites and at-home delivery of prescription medications that do not require in-person visits.
Across the country, well over 100,000 Americans are currently hospitalized with COVID-19, and these numbers continue to climb along with rising positivity rates. Similar to the earliest days of the pandemic, this surge in patients is filling hospitals to capacity and beyond.
The resulting shortage of beds and clinicians threatens to compromise quality of patient care and even raise the specter of rationing care in some hard-hit communities.
Increasingly, hospitals are recognizing that telemedicine provides a powerful tool for stretching limited resources by preventing and better managing overcrowding.
Telemedicine can make a critical difference in three key ways:
Telemedicine enables rural hospitals to treat patients with complex needs, reducing or eliminating the need for transfers. For critical access hospitals without specialists such as cardiologists or pulmonologists on staff, managing patients with complex or high-risk medical needs – whether COVID-19 related or not – typically requires transferring them to a tertiary facility. By providing virtual access to experienced board-certified specialists as needed, telemedicine allows rural hospitals to diagnose and treat many of these patients right in their own facility.
For example, consider a patient admitted to a rural hospital presenting with elevated biomarker levels. Through telemedicine, a cardiologist can remotely evaluate whether the patient is having a heart attack or displaying COVID-related organ stress. The specialist can then collaborate with on-site care providers to determine if the patient can successfully be cared for internally.
Telemedicine can also play a valuable role in critical access facilities when patients admitted with COVID-19 begin to suffer increased respiratory stress. A pulmonologist can remotely evaluate whether intubation is required. If it is not, the specialist can also help continue to treat the patient safely in place, avoiding the need for transfer.
In addition, telemedicine can provide or supplement hospitalist services, including rounding and admission coverage, for rural hospitals. This capability stretches limited resources and supports local physicians’ ability to provide quality care for all patients in-house.
Remember Instagram’s “Ten Year Challenge”? When ‘grammars were posting pictures of themselves from a decade before, next to one from the present day? Now we’re seeing the “2020 Challenge” — and this time, it’s a picture from March next to a present day picture.
Telemedicine was the finger in the dyke at the beginning of pandemic panic, with healthcare providers grabbing whatever came to hand — encouraged by relaxed HIPAA regulations — to keep the dam from breaking. But as the dust settles, telemedicine is emerging as the commodity that it is, and value-add services are going to be the differentiating factors in an increasingly competitive marketplace. Offerings like remote patient monitoring and asynchronous communication, initially considered as “nice-to-haves,” are becoming standard offerings as healthcare providers see their value for continuous care beyond COVID.