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

 

Happy New Year! I hope you had a wonderful Holiday Season and that 2017 will be a great year for you.

At this time of year I find myself looking at healthcare trends for the New Year. While it is usually difficult for experts to make these predictions, due to the fact that healthcare is an ever-changing environment, this year seems to be even more challenging based on the uncertain political situation. The Affordable Care Act (ACA) could be dismantled or drastically revised this year by President-elect Trump and the 115^th Congress, requiring some trends and initiatives to be reduced in scope or eliminated altogether. Hopefully the ACA will just be revised to improve the system, make it work more seamlessly, and be more affordable. So, let’s take a look at what experts and surveys have to say about the 2017 healthcare industry and technology trends.

2017 Health Industry Issues and Trends

The Health Research Institute (HRI) commissioned an online survey that included 1,750 U.S. adults and dozens of interviews with health industry leaders to find out what they felt were the "Top Health Industry Issues of 2017". The following are the top 10 forces that are expected to have the most impact on the healthcare industry in 2017:

1.The fate of the ACA remains unclear. If the ACA is repealed and replaced with tax credits, health savings accounts, high-risk pools, state Medicaid block grants, and a transfer of regulatory control from the federal government to the states, that would mean we would need to start over and design, build, and implement an entirely new system. This would result in a lot of extra time, resources, and money (estimated at $137 B), which would delay or eliminate other initiatives from getting completed.

2.Value-based Care (VBC) continues to dominate care delivery. Many of the top 2017 issues highlight how the shift to VBC is occurring and how organizations are responding to it. VBC requires population data in order to control expenses, enhance quality, and improve workflows.

3. VBC is causing a realignment of incentives where doctors are paid for wellness and quality, as opposed to quantity. Risk arrangements for providers will begin to change from the upside risk that has occurred with the new programs and payment models, to providers sharing in more of the downside risk as well.

4.Consumerism will develop new partnerships between pharmaceutical companies and patients. Consumerism, changes in reimbursement, and the regulatory environments will tend to make the pharmaceutical companies engage more readily with patients in order to show more value, justify prices, and improve satisfaction. The new Trump administration may also add additional pressure on pharmaceutical pricing and access to medications.

5.Dialing back drug prices. Three years of pressure on drug pricing practices could result in pricing restrictions led by President-elect Trump’s new administration, industry trade organizations, or pharmaceutical executives, rather than regulators.

6.Modernization of secure payment options for patients. According to an HRI survey, one in four consumers in poor or fair health felt their hospital billing and payment experiences damaged their opinions of the organizations. Low-risk and low-complexity payment options are needed to provide better consumer-centered experiences. Credit cards account for five percent of the providers’ revenue today, but that is expected to double by 2020.

7.Emerging technologies will generate major change. The healthcare industry has lagged behind other industries in the use of emerging technologies, e.g., artificial intelligence (AI) and machine learning, virtual reality, 3D printing, Smart Medical wearable devices from the Internet of Things (IoT), and prescriptive analytics. However, in 2017, these technologies will be used more in healthcare business models, operations, and education.

8.The battle against infectious disease sparks invention. Increased efforts to fight infectious disease and antimicrobial resistance will lead to greater collaboration and investment from public health agencies and private industry to develop new ways to combat these threats.

9.Nutrition: A tool for public health. VBC is providing a focus on diet and nutrition to prevent costly medical problems and improve overall health. This population health trend is validated by a recent HRI survey that showed consumers want more nutritional advice, especially from their healthcare resources.This will spur creation of new programs and collaborations.

10. A year of new partnerships and collaborations. Consolidations through mergers and acquisitions will likely continue in 2017. In addition, joint ventures, partnerships, strategic alliances and clinical affiliations will also increase.

11.Preparing medical students for work in a value-based world. Medical schools and residency programs require more innovative training programs to prepare students for the changing landscape and change in the provider’s role. A 2015 HRI survey found that physicians believe within the next 10 years, they will spend more time on leading teams and coordinating care.

Additional trends cited by other experts include:

1. Online and technology-related education is becoming more popular. Online training programs, continuing education courses, and healthcare degree programs are increasing. Medical schools are also offering virtual reality training programs to make the curriculum more realistic and meaningful to the students.

2. Home Health Care (HHC) continues to be an essential component. The cost of HHC is estimated to be 40 percent to 50 percent less than the same care given in an institution. The number of nurse practitioners will also increase to manage this growing area of care.

3. Patient-Centered Care is still the preferred approach to providing care. President-elect Trump has expressed a desire to move to a patient-centered healthcare system that promotes choice, quality and affordability, as well as patient satisfaction and engagement. Providers are looking for new ways to use social media to communicate and build relationships with their patients. Patients will begin to shop for healthcare, the same way they shop for other services — searching the internet, comparing providers, reviewing providers’ quality scores and consumer reviews, and comparing prices.

4.Collaboration will remain a key concept. To provide successful outcomes, all members of the patient’s care team need to have access to the healthcare record and plan of care, including community and ancillary outpatient service team members. This is becoming more of a reality, but collaboration also depends on good working processes.

2017 Health Information Technology (HIT) Trends

HIT experts see the following ten technology trends increasing in influence for provider organizations.

1.Artificial Intelligence (AI) is an emerging area. AI is defined as an area of computer science that deals with giving machines the ability to seem like they have human intelligence; the power of a machine to copy intelligent human behavior. Another definition describes it as the capacity of a computer to perform operations analogous to learning and decision making in humans. AI is used in key business processes and gets better the more it is used.

2.Blockchain is being evaluated to determine its future role. This new concept is being looked at to see how it can be used and what impact it may have. It is effectively an independent, transparent, and permanent database coexisting in multiple locations and shared by a community (a shared — and continually reconciled — database). This has obvious benefits: (1) the database is not stored in any single location, making the records truly public and easily verifiable; (2) there is no centralized version of this information for a hacker to corrupt; (3) it is hosted by millions of computers simultaneously; (4) its data is accessible to anyone on the internet. It is used to facilitate more comprehensive, secure, and interoperable repository of health information.

3.The Cloud will receive the greatest investment in 2017, because it is making it easier to bridge gaps between current technologies within an organization and demonstrate its business value. Over 83 percent of healthcare organizations are using the cloud. A trends and forecast survey for 2016-2021 estimates that healthcare cloud computing will grow to $9.48 Billion by 2020.

4.Consumer-facing technologyis ready to move healthcare beyond the traditional office visit.

A business and technology study found that 91 percent of the healthcare customers took advantage of mobile apps and 80 percent preferred them to a traditional office visit. Technology initiatives are being developed to understand which data is useful in encouraging patient action, versus data that does not encourage action or involvement.

5. Disease Management Technology is being used to differentiate treatments. Changes are being made due to innovations in mobile applications, the use of predictive analytics, and new data-driven applications. Precision medicine will accelerate this trend by providing more detailed information about what is really important for each patient.

6. Work continues on implementing and improving EHRs. Areas being worked on include: improving interoperability, workflows, and usability; adding population health tools; and interfacing/integrating with other technologies, especially those that advance best practices or population health management.

7. Imaging will continue to advance while adapting reimbursement incentives. Technological advances make imaging more robust and accessible. VBC and inter-operability will reduce duplicate imaging and make it easier for physicians to make earlier diagnoses.

8. The Internet of Things (IoT) is a slow-growing movement. It will allow consumer connection with providers and the ability to monitor and treat conditions more proactively, but the security of networks and devices is still a critical issue. For now, a majority of organizations (56 percent) are not planning on launching an IoT project in 2017. Most are starting pilot projects instead, due to security concerns.

9. Interoperability is still a major initiative. Expect to see more effort on HIE initiatives, information exchange standards from HL7 development, and use of Fast Healthcare Interoperability Resources (FHIRs are draft standards for data formats and elements and an application programming interface for exchanging electronic health records). Planned projects include: Planned projects include connecting to external databases (65 percent); connecting applications within the organization (58 percent); and adding connections from medical devices to existing systems (37 percent). Some experts feel that today’s data standards, interoperability constructs, and EHRs are sufficient; there just needs to be motivation to complete the tasks.

10. Telemedicine, Telehealth, and Telephonic Triage will continue to grow because of consumerism and value-based demands on providers. These programs help providers to remotely diagnose and treat patients, using wearable, Smart Medical devices that help monitor, diagnose, and facilitate treatment of chronic diseases. Telemedicine("virtual critical care staffing programs", and remote emergency department and office visits) and Telephonic 24/7 Triage Programsare very popular and save millions of dollars by reducing on-site staffing in ICUs, and reducing unnecessary emergency department and office visits. Telehealthprograms, focused on disease management and population health education, and remote monitoring, are also a growing area of healthcare. Ninety percent of employers are expected to make telehealth a benefit in 2017. These programs are a form of access and a way to connect with consumers, especially those in remote areas. In addition to improving productivity, and reducing staffing needs and overall costs, these programs provide more proactive education and care; quality outcomes; and favorable patient satisfaction.

Technology Surveys Showing Trends for 2017

Surveys are another way of looking into the future. The following two surveys show the technology plans for organizations in 2017.

The 2017: The Year Ahead in Health IT survey was conducted in October 2016 and included 95 healthcare executives. It predicts that cybersecurity, analytics, and population health will have the attention and dollars of healthcare organizations in 2017, followed closely by artificial intelligence and prescriptive analytics (a step above predictive analytics. The process is able to recommend one or more courses of action and predict possible consequences based on different choices of action). Examples of popular, new initiatives for 2017 include analytics, workflow improvements, telehealth, population health, smart medical devices, and remote patient monitoring. (PowerPoint slides describing the entire survey can be found here).

The following are the main findings of the survey:

1.Cybersecurity, especially related to applications and networks, is the most critical issue. Other issues include data encryption, malicious employees, mobile technology, the internet of things (IoT) devices, and accidental employee activities.

2.Analytics will be a big area of investment. It turns information into trends, practices and patterns of care, as well as patterns of illness. 24 percent are planning to launch new analytic systems, while 59 percent are adding tools to existing systems. Organizations expect analytics to improve the quality of healthcare, enhance ways in which care is delivered, reduce healthcare costs, and manage the shift from FFS care to VB care.

3.Population health management (PHM) is a high priority in many healthcare organizations, as it attempts to improve the health of a whole population, not just individual patients. Early adopters have technology systems in place and 42 percent are going to enhance and integrate their system with other applications to optimize their capabilities. Another 20 percent plan to implement a system in 2017, while 29 percent have no plans for population health.

4.Work continues on implementing and improving EHRs. Areas being worked on include: Improving interoperability (60 percent), workflows (55 percent), and usability (47 percent); adding population health tools (37%); migrating to the cloud (28 percent); performing a major system upgrade (24 percent); and replacing the EHR at one or more sites (24 percent).

5.Caregiver acceptance to EHRs is still a problem. Initiatives are being worked on to get nurses and physicians to fully embrace EHR technology. The data clearly showed that EHRs markedly reduce time spent on tasks outside of direct patient interaction.

6.Data exchange improvements are needed. EHRs were initially put in as data communication systems without emphasis on data exchange and workflows. But data exchange is now important for payment, so data exchange incentives need to be developed.

7.Organizations have a variety of emerging technologies in the pipeline for 2017: prescriptive analytics (63 percent), artificial intelligence (34 percent), genomics tools and machine learning (21 percent), cognitive computing (19 percent), and Blockchain (6 percent).

8.Precision medicine is a promising early stage trend to improve care.

The Tech Forecast 2017 survey asked 196 management-level HIT professionals to determine their priorities for 2017.

1.Technology spending will slow down. Fifty-nine percent said their IT budgets will remain the same or decrease, compared to 54 percent last year. Those with increased budgets also declined from 46 percent last year to 41 percent this year.

2. Budgets will be spent on security technologies, data analytics, mobile applications, software-as-a-service (SaaS) and application development.

3. Budgets will be scaled back on hardware, legacy systems, storage, on-premises software and data center projects (consolidation, optimization and/or modernization). It is interesting to note that legacy systems modernization/replacement was on the list to be scaled back, but was still listed as the No. 2 most important technology project. (It is on their to-do list, even if it is not in their budget).

4. The Internet of things (IoT) tops the list of projects that organizations will spend money on for the first time in 2017, although it will remain a pilot program for the next several years, due to security concerns.

5. Security and budget constraints are the biggest leadership challenges. IT managers are planning to outsource security to bring in help quickly and fill knowledge gaps, thereby eliminating the hiring of additional staff.

6. Security (hacks and data breaches) is the single most important IT project and the No. 1 tech skill that organizations need, but expect to have a difficult time hiring. Other skill sets needed include those with a hybrid set of technical skills, helpdesk/technical support, and programming/application development. In addition, the 10 hottest tech skills for 2017 states hiring managers are seeking candidates with multiple in-demand skills, e.g. database administrators who also understand business processes and user interface requirements.

7. Increased productivity, security and customer experience were listed as the top 3 goals for technology projects.

8. A reduction in IT hiring is expected. Seventy-one percent of survey respondents said their staff size will either remain the same or decrease compared to 63 percent last year. Self-service IT and investing in more cloud services will be used to compensate for understaffing.

9. Reasons to hire include corporate growth andnew systems and projects.

10. Cloud computing/SaaS and big data/analytics were the technologies most likely to disrupt the organization in the next three to five years, followed by self-service IT, which is looked at as a way to improve efficiency and keep staff levels down as they deal with flat or reduced budgets.

11.Big data/analytics leads the list of beta testing technologies.

More insights into the year ahead can be found in this free download: Tech Forecast 2017 complete survey results.

While the experts have identified what they feel will be our biggest initiatives for 2017, it could all change if President-elect Trump and the 115^th Congress determine to dismantle the Affordable Care Act. That would mean we would have to start over to create a whole new healthcare system, with time, resources, and money diverted to that initiative. But let’s keep a positive attitude and hope that the ACA will be revised and updated with bi-partisan support to develop a system that works for everyone. In addition, that will allow us to accomplish all the other healthcare initiatives planned for 2017.

Pat Stricker, RN, MEd, is senior vice president of Clinical Services at TCS Healthcare Technologies. She can be reached at pstricker@tcshealthcare.com.