Healthcare Trends and Predictions for 2016

Reviewing the multitude of healthcare articles and blogs that discuss trends and offer predictions is one of my favorite things to do at the beginning of each year. I know that may sound a little boring, but I like to keep up on what is happening in the healthcare industry and where it may be going in the near future. Since I spent the time to review the articles, I thought I would summarize them here for you.

2016 Technology Trends and Predictions

The following are the trends and predictions related to technology.

The Size of Digital Technology. The size of the cloud is getting to be enormous. In 2015, the world produced data equal to 120,000 times the total of all previously written words in history! This data will be stored in the "cloud" and accessible to a growing range of devices.

The Electronic Health Record (EHR). The transition to the EHRs continues to be a major trend in healthcare. While we are making good progress, it is obviously a tremendous task and it will take time to complete. There is slower integration in smaller organizations, but it is encouraging that we continue to move toward the goal of computerized records. Most large healthcare systems have already set their long-term EHR strategy and many have implemented a system. Others are still looking, or in some cases, already replacing their original EHR, because it did not meet their needs, as expected.

Care Management Medical Record/Care Coordination Record Needed. The EHR/EMR record excels at capturing in-person encounters. However, as care expands beyond those encounters, the EHR/EMR does not work as well to capture and track what happens between visits. Trying to make it "fit" just doesn’t work and not all members of the extended care team have access to the EHR/EMR. Clinicians are asking for a Care Management/Care Coordination system that is available to all team members, whether in the healthcare system or out in the community, to manage a patient’s care plan, track action steps, and enhance team coordination. This coordination and collaboration is essential to succeeding in a value-based world. Expect to see Care Management/Care Coordination Record systems start to become even more popular in 2016.

Better User Experience for Software Users. Software users are becoming more savvy and want products that are easy to use and provide a good user experience, instead of those that are hard to use and not intuitive. Some vendors build their products for ultimate buyer (the C-suite executive), who is not the user. In 2016, you’ll see more buyers and clinicians begin to value products that are easy to use and provide good end-user experiences. This will push vendors into working more closely with end-users to make the end-user experience easier and more efficient. If vendors are building clinical products, they should have clinical input into the design, workflows, and processes.

The lack of interoperability continues to be a top issue with these systems. Over $28 Billion has been spent on implementing health information technology, particularly Electronic Health Record (EHR) Systems, yet they are not interoperable (information does not flow seamlessly between systems). Many health systems and networks are developing workarounds to exchange clinical information. Experts warn Epic and Cerner, the two of the largest client-server (non-cloud) EHRs, to take note or they will become less relevant. (Remember what happened to the Blackberry in 2007?). 60% of hospitals and health systems expect interoperability to be one of the top three data-related challenges over the next three years.

Cloud-based Health Record Systems. While organizations started with the larger client-server enterprise systems, like Epic and Cerner, the cloud-based systemsseem to be more popular. They are more agile, adaptable, and flexible than traditional enterprise systems and make all charts immediately accessible to all healthcare professionals in real-time, thereby providing better care coordination and transitions of care. Some cloud-based systems also interface with business and information services, while many enterprise systems do not.

Security and Privacy. The potential for loss of data or a breach in security are key issues that tend to keep CIOs up at night. In the past two years, 90% of healthcare organizations have had at least one data breach and healthcare breaches topped the ITRC 2015 Breach Listwith 35.5%. 2015 was the year of the large healthcare data breaches. As a result, federal fines increased and will likely continue to increase in 2016. There is also increasing concern about the vulnerability of new wearable and connected medical devices. These concerns have made IT security a CEO-level issue in healthcare organizations. Analyst firms, such as IDC and Forrester,predictthat old-school CIOs will need to rise to the occasion or be left behind. Expect to see greater vigilance in trying to prevent hacking and loss of data, and expect to see more opportunities for healthcare IT security positions.

Wearable Patient Technology. Another area of security concern is the use of wearable technology- devices, clothing, or accessories embedded with electronics, software, sensors, and network connectivity that enable the exchange of data without human intervention. Patients want to be able tomanage their own health and well-being. Researchers predict that more than 32 million Americans will track their own health and fitness online or by using their smartphones in 2016. Twenty percent of Americans already own some type of wearable device and that number will increase. The prevalence of these tech-enabled add-ons is growing into an industry of its own with trade shows, events, and new entrepreneurial companies springing up. Examples include: Smartwatches, FitBits, activity trackers, rings that tracks sleep and rest, heart rate monitors, blood-glucose and blood pressure monitoring, hydration and fall detection, vasovagal response detection, and automatic alerts to first-responder services. See 8 Hot Wearable Devices to Get You Healthy In 2016.

Some wearables produce immediate effects, such as the artificial pancreas software that detects low glucose levels and sends out personalized, appropriate, immediate, remedial and automatic actions, such as a prescribed insulin dose. Others, such as devices that monitor sleeping, eating, and exercise routines, offer more long-term healthcare solutions. Wearables give patients greater control over their own health; financial and time savings; and a better overall healthcare experience. Wearables are a huge $6 billion market. Currently, healthcare wearables primarily involve monitoring technologies, but the new generation of "medical" or "clinical wearables" will be equipped with more sophisticated sensing, capture, and analytical functionalities, making them much more actionable. Within the next five years, sensors will not only be incorporated into accessories and clothing, but into our bodies, such as pacemakers for heart arrhythmias or dosage compliance for chemotherapy. Companies will be exploring strategic acquisitions of early stage wearable companies. IT staff are worried about how they are going to handle security and privacy issues, due to the large number of devices and the fact that they are outside their firewall.

Telemedicine. Telemedicine is the use of telecommunications and information technologies (internet, wireless, satellite, and telephone media) that provide remote delivery of healthcare. It helps eliminate distance barriers, expand capacity, reduce costs, and improve access to medical services that would often not be consistently available in distant rural communities. It is also used incritical care and emergency situations. Telemedicine is especially beneficial for patients who have chronic conditions that require continuous home monitoring and regular physician follow-up. Telemedicine is already available. More than10 million people used telemedicine options in 2014. APriceWaterhouseCooper (PwC) study found that 60% of consumers are willing to participate in a video visit on their mobile device and 58% of clinicians would rather provide a portion of care virtually. The usage numbers could have even been higher except for some political and insurance barriers that prevented organizations from getting reimbursed for the visits. These are being worked out, so expect to see increased legislative activity to support Telemedicine in 2016. Once these are resolved, we just need to raise awareness.

Virtual Healthcare. Virtual healthcare refers to carrying out healthcare processes and services by means of a computer. Examples include telemedicine and other remote monitoring devices in the hospital and the home. It also includes programs such as the eICU, which remotely monitors patients in an ICU. It sounds scary to have someone monitoring multiple critical patients from 100 miles away, but it has been working in some areas for about 10 years. There are about 5 million ICU patients each year, who account for at least 13.4% of hospital costs and 4.1% of the national healthcare costs. Managing these patients is very resource intensive at a time when the supply of skilled critical care clinicians is low. The e-ICU solution adds sophisticated technology to monitor ventilator, cardiac, and vital signs data. A remote ICU physician can actually respond faster to a critical event than if they were physically present in the unit. A study done at St. Mary’s Health Center in Jefferson City, MO in 2006, produced the following remarkable outcomes, which are still being achieved. Expect to see more eICU units in 2016.

ICU mortality was down 24% after one year
Cardiac arrests dropped by 69%
ICU patient total length of stay dropped by 14%

The "Internet of Things" (IoT). Currently one of the hottest buzzwords, the IoTconsists of a network of physical objects, devices, vehicles, buildings and other items that are embedded with electronics, software, sensors, and network connectivity. The technology enables these objects to collect and exchange data.Over 8 million hospital medications will be tracked using the IoT in 2016. Experts estimate that the IoT will consist of almost 50 billion objects by 2020! Examples include: privacy, security, interoperability, infrastructure updates, technical standards, regulations, and how to incorporate the data into the healthcare process. Are they a fad? Will patients want to wear them after the novelty wears off? We need determine how they are to be evaluated, monitored, maintained, regulated, and integrated into the healthcare process. The sheer volume alone for wearables and IoT devices is a scary thought for IT executives. That is why experts are predicting a new type of non-CIO executive will be created to lead the deployment of these agile, consumer-facing, cloud-based, scalable, and dynamic IT applications. The McKinsey consulting firm refers to this as the 2-speed IT model and the Gartner analyst firm refers to it as bi-modal IT. It will be a huge undertaking and there are a lot of issues to be resolved before they are ready for wide-scale deployment, but they also hold a lot of potential.

Social Media Engagement. The healthcare industryhas typically shied away from social media, but more than 40% of patients polled said thatsocial mediaaffects the way they handle their health. They feel comfortable using social media networks, like Facebook, as a source of information. They also belong to online communities that share ideas, create content, and use content and suggestions from others. Social networks will start to be used more and more by healthcare organizations and providers to alert groups of patients about potential health crises, share signs of illnesses, and provide general treatment tips. Of course privacy issues are critically important, but if social media is something patients want and it engages and empowers them, then healthcare organizations should figure out how to use it. The benefits of social media can outweigh the negatives, if used correctly.

Big Data Analytics. This is the process of having large data sets containing a variety of data types, algorithms and other powerful analytic, digital technologies at the point of care to identify and uncover hidden patterns, known correlations, trends, customer preferences, and other health insights. The process is used in Population Health Management (PHM) programs to analyze the data for optimum results and target patient outreach and access. Newer high-tech, predictive databases and analytic technologies will enable deeper data analysis by identifying customized insights and using them to determine personalized treatments and cures, thereby improving patient care and consumer health. Big data analytics is available now, but it continues to struggle to prove its value as more connected devices are implemented and new data sources, such as wearables and social media, gain acceptance. Big data assumes that all data sources are readily accessible, complete and accurate, and can be easily integrated into standardized data sets that can run sophisticated predictive modeling algorithms. In reality, this is not true. At present, the focus for most analytic systems still seems to be for operational performance metrics that allow administrators to revise, improve, and streamline workflows thereby reducing costs, improving quality of care, reducing admissions, and improving patient satisfaction levels.

3-D Printing. Three-dimensional (3D) printing is a manufacturing method in which objects are made by fusing or depositing materials, such as plastic, metal, ceramics, powders, liquids, or even living cells, in layers to produce a 3D object.3D printing is expected to revolutionize medicine and other fields, not unlike the way the printing press transformed publishing. It is currently used to create dental implants, hearing aids, and even customized prosthetic limbs, as well as visualize and practice complex surgical procedures, decreasing the chances for error and reducing operating times. As technology improves, 3-D printing has become more effective and useful. Experts are already working on using 3-D technology to build replacement organs and tissues, which will completely transform the healthcare field.

This completes the technology trends and predictions. The technology sector has numerous large and important areas of focus. While the work looks somewhat daunting, as a nurse, who is also a "technology geek", I am encouraged by the changes in our health care systems that are being driven by rapid advances in health information technology, mobile platforms and social media. However, I have to admit that the overwhelming number of applications on the IoT scares me. How are we ever going to evaluate them for quality and outcomes, monitor their use, and keep them updated and maintained? I don’t know, but I’m sure we will figure it out. The value and benefit they can bring will be amazing. We are living in a time like no other. I can’t even imagine what healthcare and technology will be like in 10 years. Can you?

2016 Healthcare Trends and Predictions

Now let’s take a look at the trends and predictions related to healthcare in general.

The consulting firm, PriceWaterhouseCooper (PwC), published a report on the "Top Health Industry Issues for 2016". It provides a look at the forces that will have the most impact on the healthcare industry in 2016, while also looking back at key trends from the past 10 years. According to PwC, the factors listed in the report will drive, what they are calling, "the new health economy". They describe it as a health system that is more connected, transparent and patient-centric. It includes: the rise of consumerism, a focus on value, downward pressures on costs, technological innovation, and the impact of new entrants (industry consolidation). The challenges are to balance greater demand with rising costs, handle consolidations and consumer technology, and find new ways to receive, pay for, and deliver care. They stress that businesses that are able to prioritize consumer needs and increase value will succeed.

The PwC publication also cites the following emerging healthcare trends

Merger Mania. Continued high profile mergers, acquisitions, and consolidations make the healthcare industry closer to be dominated by three major insurers.

Escalating Drug Prices. The need to find a fair drug pricing formula.

Biosimilar Drugs. A new class of drugs, created under the Affordable Care Act (ACA), which allows an abbreviated pathway for licensure for drugs that are interchangeable with an already approved FDA-licensed product. They are near substitutes for the original brand, with no clinically meaningful differences in safety or effectiveness, yet they provide significant price discounts.

Technology Gives More Power to Consumers. The use of smartphone apps doubled from 2013-2015 (16% to 32%). Changes in technology and financial incentives are moving care decisions and power to the consumer.

Access to Behavioral Healthcare. The healthcare industry is finally beginning to recognize the importance of mental health and its close relationship with a person’s physical health. According to the PwC report, 20% of American adults experience a mental illness every year, costing businesses more than $440 billion each year. Yet more than 50% of U.S. counties have no practicing mental health clinicians. Hopefully we will see an increase mental health services and programs. Managing behavioral health issues will help reduce costs, increase productivity, and improve overall health.

Care Moves to Community Settings. Value-based payment models, technological advances, and powerful database tools are being used to promote the use of lower-cost outpatient and community settings. An increase in telemedicine virtual care visits are also going to be seen.

Consumers Become ‘Money Managers’. Due to higher deductibles and co-insurance, new tools and services need to be created to help consumers manage their healthcare spending like they manage their retirement savings.

Cost of Care: Healthcare systems need to determine the ‘true cost of services’, which will then allow them to improve efficiency, as well as care.

Other general healthcare trends for 2016 include:

A Shift toward Personalization. Consumers want customized, personalized interactions that meet their specific needs, just like they have in their shopping experiences.

Consumerism will gain ground. The lack of affordable insurance on ACA exchanges, low price transparency of healthcare costs, and increasing financial burdens on consumers will drive the shift towards consumerism. A report by McKinseysuggests that consumers expect the same level of customer experiences from healthcare as they do in other industries. Insurers will have to provide better communication and more real-time interactions.

"Care Coordination" and "Patient Engagement". These are key concepts in most programs, but they are being over-used and losing their meaning. They are too important to be just terms "in name only". We need to insist that companies are actually able to deliver on these promises and make them an integral part of their program.

Population Health Management (PHM). PHM drives over $50 billion in healthcare mergers and acquisitions. Long term corporate strategy aligned with PHM opportunities is expected to drive decision-making for corporate restructuring, mergers and acquisitions, spin-offs, research and development spending, and venture investments. The new healthcare paradigm ties compensation to outcomes. Requirements for PHM tools are forcing companies to consider acquisition strategies leading to companies in adjacent or complimentary markets. A survey found that 69% of the respondents indicated a commitment to some form of a PHM program. We expect to see more activity in ACOs, as all entities involved really want the concept to work. However, data silos, lack of interoperability, and the scarcity of data analysts are cited for the low adoption rates.

Value-Based Payment Models. Organizations will become more serious about implementing value-based payment models in order to meet Medicare’s goal of having 90% of fee-for-service payments replaced by value-based payments by 2018.

Healthcare startups will be reviewed by regulators. Several startups came under scrutiny for unsavory practices in 2015. The FDA will be going after mobile medical apps that claim to provide "scientifically proven" benefits, yet can’t prove it. CIO’s and healthcare executives will need to start looking more closely at their current relationships to assure their reliability.

Retail care goes mainstream with 35% expansion of in-store clinic footprint. Retailers in 2015 expanded their clinical footprint significantly, acquiring new tools and forming unique partnerships with healthcare companies. 2016 should see retailers fully executing their strategies for becoming the front line of primary care services.

Less expensive and faster point of care (POC) testing, which will enable new diagnostic care models? New platforms are able to drastically improve turnaround times (5 to15 minutes) and allow testing services to be performed in settings previously not feasible.

Healthcare IoT solutions spur $10 billion in venture capital investments for start-ups. Numerous early stage companies are looking to bring their IoT expertise to healthcare. They want to tear down outmoded forms of care delivery and implement new approaches using innovative tools and technologies.

Free preventative care services available to over 90% in the U.S. To mitigate the cost and burden of care for late-stage chronic diseases, a wide range of technology and wellness enabled preventative services will be offered free of charge. However, it remains to be seen how engaged consumers will be in leveraging those services.

Hospitals invest heavily in overhauling and retooling outdated facilities to avoid closure. Hospital closures and consolidations are forcing hospitals to rethink everything from hospital layouts to resource utilization in order to adapt to new forms of care delivery that emphasize efficiency and patient satisfaction.

The global regenerative medicine market will reach $30 billion. The regenerative market is expected to see growth rates 22.4% above those of 2015. Favorable legislative policies and an increasing number of cell therapy marketed products will provide new competitors vying for a market.

Final Thoughts

Healthcare is an industry of constant discovery, progress, and invention. It also elicits skepticism from patients and providers alike. Some are skeptical about the role that technology should play in healthcare. They do not feel that tools like the internet, mobile technologies, or social networks should be used in healthcare. This type of skepticism is not new. A prediction in the 1834 edition of the Times of London said: "That it will ever come into general use, notwithstanding its value, is extremely doubtful because it’s beneficial application requires much time and gives a good bit of trouble." What were they describing? The newly invented stethoscope! And it is still a foundational tool of our industry 182 years later. Given the skepticism over a stethoscope, you can see why some would be skeptical about today’s far-reaching, complex technological innovations.

I find the role of technology and the significant changes that have occurred in the past few decades astonishing. My first role with computers was back in 1987, when I implemented an Ask-A-Nurse triage program. It was strange. Nurses not working in a clinical setting? Just answering phones and using a computer? Really? Yet that was the beginning of a whole new era in healthcare. Healthcare technology has grown dramatically since then and it will continue to change healthcare even more dramatically over the next decade. Are you ready?