Consumerization of EHR
For decades, companies and regulators have been trying to “fix” the EHR. But since the passage of the Health Information Technology for Economic and Clinical Health Act (HITECH) in 2009 — a $30 billion effort to transform healthcare delivery through widespread use of EHR technology — the “next generation” EHR is becoming a reality, and it will be an important focus in 2016 and beyond. There are three macro trends that are driving this: First, “machine-generated” healthcare data from mobile apps, sensors, etc. is growing at an unprecedented rate. Second, healthcare providers are feeling the pressure to cut costs and bring more efficiency into the system. Third, the fundamental shift in the “operating terminal” from a desktop to a smartphone and tablet is forcing healthcare providers to reimagine how patient care data is produced and consumed to deliver better care at a lower cost.
While the technology is there to make it happen today, the key barriers are physician adoption and regulation. Unless the “next generation” EHR is designed around physician workflows and makes it easy for them to produce and consume data, it will not succeed. Making sure it collects just enough data and has proper controls in place to make sure the data can only be accessed by the right people is very important to ensure privacy and safety. On the regulatory side, many of the initiatives around the “meaningful use” program, such as incentivizing physicians to adopt EHR, will help accelerate this effort.
I am personally very excited about this trend as we build out our vision for “smarter operations.” With growing demand for healthcare and a not so growing supply of physicians, we’ve got to do more with less, and EHR sits at the center of innovation. I see more organizations adopting the “app store” model that Kaiser pioneered to open up their platform and inviting developers to build innovative apps on top of it.
Telemedicine has now become mainstream and is clearly showing significant gains in delivering primary care. With more than 50 percent of consumers using mobile phones for monitoring health and more than 50 percent of physicians using or wanting to use mobile phones for monitoring patient health, we will see more adoption of mobile-enabled services for ambulatory and specialty care in 2016 and beyond. Mobile brings three key benefits in those areas: First, it provides “situational awareness” to all stakeholders so they know what’s going on with a patient in an instant and can move the right resources fast with the push of a button. Second, it radically reduces communication overhead, especially when you’re dealing with multiple situations at the same time with urgency, and communication is key. Third, it can significantly improve the patient experience and reduce operating costs. Studies have shown that remote monitoring and mobile post-discharge care can reduce readmissions and unnecessary admissions significantly.
While this is very exciting, the key hurdle is regulatory compliance. There are many apps that can monitor health data, but for that data to be used for delivering care, a lot of controls need to be in place. For example, while mobile can significantly improve appointment scheduling, the notion of auto-dialing 9–1–1 if a phone detects a heart attack can be dangerous if not done right — many controls need to be in place to deal with false positives and false negatives. Plus, again, unless these services are designed around physician workflows and pass regulatory compliance, they are unlikely to succeed.
Every healthcare CIO I talk to is working on or thinking about using mobile to improve situational awareness, improve patient experience and reduce operational overhead.
Internet of Things
The Internet of Things is fast moving from a fantasy to reality with unprecedented advances and adoption across consumer and enterprise areas. While hospitals have been a bit slow in adoption, we’re seeing faster adoption and likely to see bigger strides in 2016 and beyond. There are two key trends shaping this: First, innovation in hardware components (e.g., smaller, faster CPUs at lower cost) is creating cheaper, more advanced medical devices such as a WiFi-enabled blood pressure monitor that can more accurately monitor blood pressure and transmit it to an EHR. Second, general purpose sensors are maturing and becoming more reliable for enterprise use.
However, the biggest barrier is fragmentation. Devices are becoming smart, but making them all work together is painful. It’s good to have bed sensors that talk to the nursing station but unless they become part of a top level “platform” within the hospital, they’re unlikely to add long term value. More sensors mean more data. Without a “backend platform” to collect, process and route it to the right place at the right time and create “holistic” value propositions, the IOT cannot succeed in healthcare.
Big data is one of the hottest industry trends right now. While many industry verticals such as retail have been quick to adopt it and see gains, healthcare has been a bit slow, mainly because the ROI has not been very clear. With more wins both on the clinical side and operational side, that’s clearly changing. Of all the technology gains, big data has the greatest impact both on the clinical side and operational side and will be one of the biggest trends for 2016 and beyond.
There are three issues with big data in the world of healthcare. First, there’s a lot of data, but it’s not easy to access it and not quite primed “or clean” for analysis. So, there’s only so much you can see, and you spend a lot of time cleansing before you do any meaningful analysis. Second, the ROI is not clear in many cases. There are a lot of products or approaches out there that produce 1–2 percent gains — that doesn’t necessarily justify the investment. Third, and most important, there’s the issue of accuracy. It’s easy to build predictive analytics, but if that doesn’t translate to evidence-based decision making, it could be dangerous.
In the last few months, I’ve spoken to hundreds of healthcare leaders at hospitals small and large and am surprised with their willingness to understand and adopt big data products. Everyone outside the industry thinks it’s hard to sell big data to hospitals, but that’s simply not true. As long as you’re solving a real problem and can clearly articulate the ROI, they’re willing to listen and try it out.
Originally published in Becker’s Health IT & CIO Review