Health Trends for 2015: The Rise of the ePatient

Pat Stricker, RN, MEd, Senior Vice President, TCS Healthcare Technologies

The New Year always generates a multitude of articles and blogs discussing health care trends and predictions for the coming year, so I thought I would contribute mine also. Throughout 2014, population health management, value-based purchasing and other advancements in health information systems accelerated the pace of change. As health content moves to mobile devices and the availability of internet-enabled care, case managers and patients are poised to benefit from the rise of the ePatient in 2015.

Digital health futurist Fard Johnmar and author Rohit Bhargava explore how technology, history and culture are fundamentally altering health care in their book ePatient 2015: 15 Surprising Trends Changing Healthcare". I found their three overarching themes describing the greatest impacts on health care today, as well as their predictions for 2015, to be right on target. Here are a few examples from their book:

I’m not sure I see health care as being "hyper efficient" in the near future; however, they contend that "innovations in computing are changing the way health information is recorded and delivered between patients and providers. Electronic health records (EHRs), clinical documentation tools and telemedicine devices are shifting the way providers collect and consume health information regarding their patients." As a result, this is leading to the "humanization of technological interfaces and raises concerns over protecting patients’ digital health information." They see another theme also, which they call "Predictive Psychohistory" – a fancy term for the process of taking the "data collected by these documentation tools to make large scale predictions regarding population health." This concept of predictive modeling is certainly not new, but with the advent of more and more interoperable systems, it does make it much more definitive, and hopefully even more predictive than in the past.

They also see a movement towards the increase of personal health treatment due to the increased number of "genetic, behavioral and digital tools designed to monitor and manage personal health." In fact, eight of the 15 trends in their book are related to this theme, which could provide future patients with a lot more treatment options and information. They continue to explain that, "While this theme holds great promise for health care, it is also responsible for some of the most problematic trends emerging for e-patient. One such trend is the Over-Quantified Self, which exposes the frustration and confusion associated with the array of wearable health devices and applications now at the e-patient’s disposal. As some studies suggest, patients may avoid or discontinue using these devices if they prove to be too complex or if the results are negative or continually discouraging." Are we moving too fast and providing too many of these "gadgets" so that the patients will eventually say "enough" and stop using them?

Johnmar and Bhargava feel that "web, mobile and social technologies are converging to help patients and caregivers navigate the new health insurance landscape, select providers, research treatment options and seek out avenues of social interaction and support".As a result, they suggest that "Care Hacking" may be emerging as a trend to empower patients. They describe Care Hacking as re-defining the patient-doctor relationship, because caregivers and patients can now use digital tools to "hack the health system while seeking and accessing better care". E-Patients are using these tools to better understand their care, communicate with their physicians, and attain better care. Johnmar and Bhargava contend that "While there is still debate on whether the internet is more helpful than harmful when it comes to health care, the evidence that it’s empowering patients to be more proactive about their health is very encouraging".

Clearly, the themes listed above are a very positive view of how technology can improve clinical outcomes. However, not everything related to technology is positive. Experts note that society still needs to address the emerging challenge often referred to as the Digital Divide. While one may think technology is creating a bridge over socioeconomic disparities, barriers still exist to placing the necessary tools or information within the reach of all patients.

While there are certainly areas of the country and world where access to computers and the internet seems to be thought of as a "given right," that access does not exist everywhere. Minorities, the elderly and low-income individuals are more likely to have limited access. This can also be an issue for physicians. Some providers do not have access to EHRs or the latest and greatest medical devices. So, while technology is helping us to improve in so many areas, disparity and cultural issues still exist and we need to address these things before technology can help us reach our highest potential.

Keeping Johnmar and Bhargava’s themes in mind, here are 10 additional observations about the future of medicine and health information technology applications that impact case managers and their patients (in no particular order of importance):

1. Interoperability Challenges. While EHRs and other applications will improve transparency, process efficiencies and patient safety, we need to have better integration and interoperability. Patients also will want access to more seamless and intuitive interactions when leveraging IT systems to support their treatment or health care needs.

2. Better Care Coordination. Coordinating care for patients with complex health conditions who see multiple physicians will be improved with better interoperable IT systems. There will be continued efforts to move key, actionable information to that patient level.

3. Move to Mobile Devices. As referenced above, but worth noting again, health interactions and content are moving to mobile devices and internet-enabled care, which are benefiting patients and providers.

4. Social Media on the Rise. Social media will continue to take strides to promote health and improve how communities connect. The rise of cancer support groups via the web and Facebook are just two of many examples. Another example is the stream of tweets related to a major health conference or world events, such as the Ebola outbreak last year.

5. Evidence-based Medicine. In 2015, health IT will enable providers seeking to build on the success of evidence-based models to measure the programs and provide implementation teams with a feedback loop that will ensure continuous improvement.[1]

6. Cloud Hosting. Storing data and running applications from the cloud will continue to expand in 2015. The ePatient will ask for and demand seamless access to their data and applications.

7. Integrated Delivery. Health IT systems, along with data analytic tools, will continue to promote integrated delivery systems, such as accountable care organizations (ACOs) and other initiatives that merge the provider and payer functions. The Amazon-type experience will give rise to the e-patient who wants more convenient access to satisfy their health care needs.

8. Advanced Clinical Pathways. Advancements in care management software applications will continue to promote complex, condition management strategies where treatment plans are developed and maintained for patients with a range of co-morbidities. In addition, consumers will rely more regularly on molecular profiling and genetic testing to promote more targeted and DNA-based treatments.

9. Value-based Purchasing and Outcomes. Generally, health care and IT will continue to be influenced by the next generation of value-based purchasing and comparative effectiveness requirements. Patients will become more cost and quality conscious as they sign up for large deductible health plans in a post-Affordable Care Act environment. Transparency of patient results can support incentives, so that payers, providers, suppliers and patients all work toward the same goal, making it possible for the market to effectively manage the trade-offs between cost and quality.[2]

10. Telemedicine and Virtual Medicine. Non-face to face interactions between patients and their providers will continue to grow in popularity. These emerging forms of communications will expand, as patients expect greater connectivity to providers and better access to national experts (e.g., remote consultations and surgeons).

As a nurse, who is also a "technology geek," I am encouraged by the changes in our health care system that are being driven by rapid advances in health information technology, mobile platforms and social media. As a result, case managers and health care providers need to start looking at how their interactions with e-patients of the future are going to change the patient-nurse relationship. Innovation isn't just changing health care from an IT perspective; it’s changing it from the patient and the nurse perspectives as well. I hope you have a Happy 2015!!

[1] http://www.hitechanswers.net/2015-healthcare-technology-trends/

[2] http://thehiringsite.careerbuilder.com/2014/10/28/aha-environment-scan-health-care-trends-2015/