Five healthcare predictions for this year
Work related to ICD-10, Meaningful Use and electronic health record (EHR) implementation has taken up considerable bandwidth in 2015, limiting what hospitals could implement beyond these.
By contrast, 2016 will provide healthcare professionals with the opportunity to leverage data to optimize decision-making and communication. Value-based care is gaining momentum, and hospitals must act now, or face the consequences.
Here are our five predictions for 2016:
- Fast Healthcare Interoperability Resources (FHIR) will be adopted as the preferred method to lower the barrier to interoperability and liberate ‘the data’-the EHR information required to deliver value. Many believe FHIR could be the ‘trump card’ in the ongoing battle against proprietary data formats, questionable information blocking practices and other persistent barriers to health information exchange.
Recognizing FHIR’s potential, several prominent healthcare organizations are currently exploring the use of this technology to create the next wave of patient-centered, fully interoperable population health programs. If all goes as planned in the upcoming year, FHIR should become the widely-implemented standard, creating considerable new opportunities to create value from EHR data.
- HIT will drive culture change and transparency. Health information technology (HIT) will move beyond management of transactions and towards promoting the culture change embodied in the “fee-for-value” phase. Patients will demand, and have, access to their own records. Clinicians will embrace tools that promote more data-driven decision-making, appropriate use of medical resources and shared decision-making with patients.
In fact, a customer we work with has rolled out a program that exemplifies this idea, using software that helps clinicians quickly assess whether a surgical procedure that has been ordered is appropriate for a given patient. As part of the decision-making process, the patient and clinician can sit down together at a dashboard and review all of the pertinent information, including the patient’s individualized risk factors from the intervention. The conversation is supported by the information generated by the tool. With this data in hand, truly informed and truly shared decision-making is happening. A culture shift is occurring, where the patient is no longer a bystander in his or her own health, and can actively choose the most ‘appropriate’ care path. In this way, HIT has become more than a tool for clinicians; instead, it actively connects the patient and physician.
- Data will become actionable. Providers will look beyond the mandates and use the systems developed for reporting and compliance to achieve positive improvement in care delivery. The initial federal quality mandates-and the metrics they entail-are really just the first phase in the measurement and optimization of care. The grander vision calls for broader incorporation of measurement and data-driven optimization in care delivery. HIT tools-especially those touching the EHR-will evolve to support that cultural shift. Hospitals who fail to adjust will bear the brunt of mismatched revenue and cost in the capitated environment. Case in point: Tools that capture mandated quality metrics retrospectively – such as PQRS for physicians who care for Medicare patients – will be used to affect change in clinical practice, not just to fulfill mandated reporting requirements and avoid penalties.
- Cost cutting will drive the train. Let’s face it, ours is still an expensive, sub-optimal healthcare system. To see clear evidence of this, check out the Commonwealth Fund’s latest study, which reports that we spent more per person on health than 12 other high-income countries in 2013, but among this group had the lowest life expectancy and some of the poorest outcomes.1
To remedy this, hospitals will have to evaluate and potentially redesign each aspect of their operations to optimize cost and quality. As we move further into value-based care, the answer won’t be to add more bodies or staff to solve a particular problem, rather technology and “lean” business practices will be relied on to streamline processes and ultimately, create cost-effective healthcare delivery systems.
- We finally realize EHRs are not the Holy Grail. The ongoing spending on EHRs and the high hopes that one system will provide a complete solution to every problem will finally fade away. However, sad to say, no groundbreaking, disruptive and completely interoperable solutions are in sight for 2016 that will become the new Holy Grail, either. Instead, hospitals will have to optimize the capabilities of the infrastructure and applications they already invested in. We will operate under a more mature perspective that considers the EHR as the transactional chassis upon which healthcare data and actions take place. That chassis will become substantially more open and interoperable, permitting new forms of value innovation to leverage that digital foundation.
Interoperability and the cultural changes outlined above will drive adoption of specific technologies to optimize the data in the EHR such as natural language processing (NLP) and more sophisticated tools such as QPID Health’s clinical reasoning platform. It’s possible to use all the data in the EHR to help overburdened administrators and clinicians with tasks that traditionally have required manual labor. Processes such as medical necessity reviews for appropriate use, population of clinical data registries and quality reporting can be vastly accelerated with these technologies, and 2016 is the year where this will become apparent.
- “US Spends More on Health Care Than Other High-Income Nations But Has Lower Life Expectancy, Worse Health.” Available at: http://www.commonwealthfund.org/publications/press-releases/2015/oct/us-spends-more-on-health-care-than-other-nations