In 2020, healthcare was the major focus for every country throughout the world. It consumed the world’s attention from April through December. Almost all non-essential initiatives were put aside while the world dealt with a new strain of coronavirus (SARS-CoV). This novel coronavirus strain (SARS-CoV-2), called COVID-19, had not previously been identified in humans and spread quickly throughout the world.
As of January 18, 2021, close to one year after it started, the COVID-19 pandemic has caused 95.4 million cases and 2.04 million deaths worldwide. Cases in the United States have totaled 24.1 million and a devastating 400,000 deaths. And unfortunately, it is not over yet. It will continue to be a major issue for the U.S. until the majority of the population has received the vaccine – probably sometime in the third or fourth quarter of 2021.
In addition to the overwhelming loss of lives, the COVID-19 pandemic has also caused a cumulative financial cost estimated at more than $16 trillion, about 90% of the annual GDP of the U.S. This economic loss is more than twice the total of the cost of the wars in the past 20 years (Afghanistan, Iraq, and Syria) and about the same as the damages incurred from all severe weather events and decreased agricultural productivity resulting from 50 years of climate change. These financial losses are staggering, but they are also causing major economic hardships for millions of people in the U.S.
Looking Forward to 2021
Although looking back at 2020 is very discouraging, the look forward into 2021 offers anticipation and hope that the new year will bring us out of isolation and “lockdown” and back to some sense of normalcy. President Biden was just inaugurated, and he promised to place the healthcare crisis and the economic issues that followed at the top of his priority list. He admittedly has a key interest in healthcare, as he was instrumental in bringing the Affordable Care Act (ACA) to fruition as vice-president in the Obama administration. The following are President Biden’s goals for the first 100 days and the healthcare proposals for his administration.
Top Healthcare Goals for the First 100 Days: While these goals seem daunting, he and his healthcare leaders feel they are doable.
Top Healthcare Proposals for the Biden administration:
• Allow Americans to be eligible for Medicare at the age of 60, instead of 65
• Build on the current ACA structure to improve it, such as introducing new policy initiatives and subsidies. Examples include:
[NOTE: There is a case before the Supreme Court challenging the constitutionality of the individual mandate and the Affordable Care Act itself. If the ACA is found to be unconstitutional, it would mean that 22 million people would lose healthcare coverage, so this case is extremely important. A decision is expected in June 2021.]
• Reduce the cost of prescription drugs by requiring drug companies to negotiate prices with Medicare and allow drugs to be imported from Canada. These options seem to have some bi-partisan support.
• Eliminate unexpected billing caused when providers charge out-of-network rates when the patient has no control over which provider they use, such as in a hospitalization. Both parties seem to agree this is an issue, and hopefully they will be able to work out a bi-partisan agreement.
These are complex, difficult priorities, especially in light of having to launch a new administration at the same time and manage a myriad of other issues, but there is no alternative. They must be solved.
Trends for 2021
Numerous 2021 trend articles were researched, and several trends appeared on multiple lists. This year’s list includes new processes, products, initiatives, and strategies that were quickly implemented in 2020 due to the needs of COVID-19, but they will need continued work in 2021 to standardize and solidify them in the healthcare system. The following trends are listed in random order. Some “like-categories” have been combined.
Top 10 Healthcare Trends
1. COVID-19 Vaccines & Treatment Options
There are currently two vaccines being used throughout the country, with others that are scheduled to be released soon. These vaccines were developed in operation “Warp Speed” to test and bring them to market much quicker than any vaccines in the past. However, this was only possible because they were developed based on information researchers had discovered in working with other SARS-related incidents in the past.
That is also true for treatments options that are now being used. Through trial and error, using medications that were used for other illnesses, clinicians found that some, like Remdesivir that was used for Ebola, also worked for COVID-19. Two arthritis drugs (tocilizumab and sarilumab), that previously failed in treating COVID-19, have now found to be effective in lessening the severity of the disease, if they are given early to hospitalized patients, before the patient becomes critical.
Monoclonal antibodies that mimic the body’s response to infections were also tried and then set aside because they needed specialized infusion equipment and the efficacy was not clearly proven. However, a new study from Mayo Clinic now shows one therapy, bamlanivimab, seems to reduce hospitalizations and emergency department visits by 70% and may reduce mortalities. Convalescent plasma from recovered patients is also being evaluated, but it has had mixed study results.
The research of vaccines and other treatment options is a key goal for 2021. Since COVID-19 is going to be an ongoing issue, it is critical to find ways to make it less lethal for those who get the disease.
2. Genomics, Gene Editing, Gene Therapy, & Gene Sequencing
Genomics focuses on the structure, function, evolution, mapping, and editing of genomes, which are an organism’s complete set of DNA including all of its genes. Gene Editing involves inserting, deleting, modifying or replacing DNA in a genome of a living organism to change its DNA. This is being used to try to find a cure for sickle cell. Gene Therapy is a technique for treating disease that alters a patient’s genetic material by introducing a healthy copy of an abnormal, defective gene into the patient's cells. Gene Sequencing capabilities were developed for COVID-19. Breakthroughs in this field have helped to hasten progress in precision or personalized medicine, where drugs or therapies can be custom-made to match a patient's genetic profile, making them more effective.
Research studies are currently being done to develop accessible and affordable genetic tests. One study is evaluating an antibody test that rapidly detects COVID-19 within 2-3 minutes with more accuracy than current tests. This would be crucial in helping to increase and improve our testing capabilities. Another study is using a fluorescent molecular probe that causes a sample to glow when coronavirus genetic material is found. These tests seem to have promise. If they are successful, they could be beneficial in returning the world to a level of normalcy. Genomic research has been a trend for a few years and continues to be essential for 2021 because of its evolving role and tremendous possibilities.
3. Telemedicine & Virtual Care
Healthcare has been working on making Telemedicine a reality for decades, but it has never been able to break through and become a significant care delivery option. The processes, technology, and underlying structures were developed and used in some rural areas, but the standards of care, regulations, payment structures, and approvals from the Centers for Medicare & Medicaid Services (CMS) have never been finalized to make it a reality. Patients like virtual visits because they are convenient, allow them to receive care they probably would not be able to get otherwise, and allow their family members to be included and more involved. Providers also like virtual visits because they are more convenient and time-efficient for them and reduce the spread of disease by not having communicable patients in the office.
When the pandemic caused non-emergent facilities and offices to close, it meant that care was delayed or eliminated and patients were not receiving the ongoing medical care they needed, which could lead to worsening conditions or death. As noted, Telemedicine had been growing slowly over the years into a recognized care delivery option, but with the needs of COVID-19 and the quick approval from CMS, virtual visits were suddenly an overwhelming success.
Telemedicine was suddenly being used across all areas of healthcare and virtual visits grew from 22,000 in March 2019 to 440,000 in March of 2020. The global market for Telemedicine grew from $41.63 billion in 2019 to an 91.7% in 2020. The market is expected to be $185.6 billion by 2026. It is now predicted to be a mainstay of care delivery.
Telemedicine is still listed on almost all trend lists because, even though it was used immediately in an emergency situation, the industry needs to go back and develop the overall structure (policies, procedures, regulations, documentation, billing codes, reports, payment structures, quality standards, etc.) to assure it remains an ongoing care delivery process.
4. Remote Worker Force
As the COVID-19 transmission rates started to rise in the spring of 2020, the economy began to shut down and businesses began to have employees work from home. This continued for months and remote work forces were created out of necessity. This transformation would have been almost impossible 20 years ago before computers and the internet were available. However, in 2020, remote working was adopted rather quickly. Non-essential and office employees brought their laptops home and continued to work “as usual” and in-person meetings were replaced by “Zoom-type” meetings. Essential workers, of course, needed to work on-site, but it was amazing how healthcare functions were quickly adapted. This is a 2021 trend, since organizations need to re-assess work functions to identify if it makes sense to keep some positions remote after the pandemic. If so, a formal structure needs to be developed for the remote work program with policies, procedures, standards, IT requirements, quality measures, etc.
5. Big Data and Predictive Analysis
The COVID-19 pandemic is something that has not been experienced before in our lifetime. It caught the entire world off-guard. At the beginning, there was a great need for large amounts of disparate types of data to try to understand what was happening, how serious it was, and what should be done. This created the need for centralized, effective data management processes that could gather, coordinate, analyze, and report data so it could be used for research and to determine operational efficiencies and best practices for patient care delivery. These functions were quickly assumed by state and federal agencies, as well as academic institutions. Large amounts of data were gathered from a variety of sources and effectively analyzed, reported, and placed on open websites, so it was available to everyone. The data was then able to identify high risk and mortality situations and treatment protocols were adjusted accordingly, as clinicians used predictive analytics to identify the best course for bedside treatments. Years ago, before the internet, computerized systems, and the world of technology, this type and volume of data would not have been available, nor would there have been the ability to use predictive analytics. The types of medications, automated infusion units, ventilators, and other technological medical equipment would also not have been available. Consequently, the number of deaths would have been even more devastating than they were in 2020. The use of big data and predictive analytics was very significant in this pandemic and is a trend that will evolve in 2021.
6. Artificial Intelligence
Artificial intelligence (AI) is the ability of computer systems to imitate human intelligence (learning, reasoning, and self-correction) and perform tasks that normally require human intelligence (visual perception, speech recognition, decision-making, and language translation. Examples of AI include: machine learning (ML), natural language processing (machine translation, question answering, and text generation), image recognition, speech to text or text to speech, and robotics.
AI processes information like humans, but can be quicker and more precise, which leads to more timely and accurate diagnosis and treatment. During the pandemic it is used to analyze and identify trends in big data sets and analyze clinical research data. It has evolved into a closer integration with clinical care by performing virtual patient monitoring to predict and prevent adverse events, identifying the best treatment protocols and increasing operational efficiencies. These are crucial in managing the COVID-19.
7. Virtual & Augmented Reality
Virtual Reality (VR) is an artificial environment that is experienced through sensory stimuli (such as sights and sounds) provided by a computer. The participant’s actions partially determine what happens in the environment. It is used in medical education programs to provide life-like simulation training. This unique, immersive learning appeals to audio, visual and kinesthetic learners. Augmented Reality (AR) is a system that overlays computer images onto the physical world, providing a mix of real and virtual worlds visible to the user and a unique learning experience. Examples include seeing a realistic 3-D version of internal organs or bones, ligaments, and tendons as they appear in the body or using a scanner device to see where veins and arteries are located in a patient’s arm before injecting a medication or drawing blood. Clinically they are also used to research and treat numerous conditions, e.g., stroke, mental health, cancer and chemotherapy, pain control, and cognitive impairment. VR and AR have been trends for several years and will continue to grow in importance.
8. Healthcare Equity
Health disparities and inequities became a large area of focus during the pandemic. It seemed to be a complete surprise to people that COVID-19 was having more devastating results in certain communities and groups that had specific vulnerabilities to the disease, social or economic inequities, disabilities, or other quality of life issues. For example, Black and Native Americans have had 5 times the number of hospitalizations than Caucasians and Hispanics have had 4 times more. These disparities and inequalities are obvious and have been known to those of us working in healthcare, but apparently not to others outside healthcare until the COVID-19 pandemic hit.
The Business Group on Health defines health equity as being “achieved when every person has the opportunity to attain his or her full health potential and no one is disadvantaged from achieving this potential because of social position or other socially determined circumstances.” Inequities are caused by community and environmental factors because of “differences in lengths of life; quality of life; rates of disease, disability, and death; severity of disease; and access to treatment.”
Healthcare needs to collectively examine and address health equity, so everyone has the opportunity to achieve optimal health and well-being. COVID-19 identified the issues of disparities, inequities, diversity, and inclusion and generated an even greater need to re-focus this effort in 2021.
9. Internet of Things and Internet of Medical Things
The Internet of Things (IoT) consists 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. Examples include: smart phones and tablets, smart watches, smart refrigerators, smart fire alarms, smart door locks, smart bicycles, medical sensors, fitness trackers, smart security systems etc. Every second, 127 new IoT devices are connected to the web. In 2019 there were 26.66 billion active IoT devices. During 2020 the number of devices increased to 31 billion, and by 2021, it is estimated that 35 billion IoT devices will be installed worldwide. 30% of the IoT market comes from healthcare and by 2025 IoT will be worth $6.2 trillion.
There is now a secondary grouping referred to as the Internet of Medical Things (IoMT) that refers to medical devices that connect to a provider’s computer system through the internet and generate, collect, analyze and transmit healthcare data. There are 10 - 15 million medical devices in U.S. hospitals today with an average of 10 to 15 connected medical devices per patient bed. These devices include wearable EEG and EKG monitors, glucose monitors, skin temperature devices, and BP monitors. These IoMT devices are becoming more and more popular and essential to the care of patients.
10. Integration of Physical & Behavioral Health
The need to integrate physical and behavior health has been identified and discussed for decades. The separation of each focus of care has been a known issue, and improvements have been made, but integration has not been totally achieved. It became an issue during the pandemic as physical issues, along with isolation, caused an increase in behavioral issues. Yet the focus has been on the number and severity of physical issues, so behavioral issues have not been prioritized. This is not surprising, but it has brought more focus to the need for continued work on accomplishing this integration.
Top 8 Healthcare Information Technology Trends
Healthcare Information Technology (HIT) needs increased exponentially in 2020. The COVID-19 crisis created immediate HIT needs related to processes, procedures, tracking, and reporting. It also created urgent needs for concerns that had not even been thought of previously. However, the IT departments were able to move swiftly to handle the needs and the HIT’s role in the organization was appreciated. When the crisis slows down people will begin to evaluate lessons learned to identify future needs. The following trends are listed in random order with “like-categories” combined.
1. The Cloud & Data Storage
Over the past 10 years, computerized data has been moving from being stored on individual computers to being stored “in the cloud,” which makes it available to anyone who has access to that particular cloud from any device. Cloud computing is generally described as data centers available to users who can access their data remotely over the Internet. When something is in the cloud, it means it's stored on internet servers instead of an individual computer, tablet, or phone. 96% of all companies are using at least one cloud server. It makes the IT department’s update process much easier, because they only need to load changes to the cloud server and it is immediately available to all users. It also allows better integration and problem solving, increased care coordination, and more innovation and efficiency. There have been major changes over the years to cloud capabilities, but it remains a key trend for 2021.
2. Cybersecurity / Breaches / Ransomware
Cybersecurity became a major issue in 2020. Not only were many U.S. federal agencies attacked by foreign hackers, but hackers took advantage of the chaos caused by COVID-19 to attack healthcare. It was the most impacted sector and accounted for 79% of all reported data breaches during the first 10 months of 2020, which was more than double the amount seen in other industries. Ransomware attacks saw the biggest increase, with hospitals having twice as many attacks in Q3 of 2020. At one point there were 6 hospitals attacked by ransomware in 24 hours. Weekly healthcare attacks reached an average of 626 per organization in November, compared to 430 in October. More than 500 healthcare organizations reported a breach of more than 500 patient records through October 2020, an increase of 18% over 2019. Email continues to be the most common method of attack in healthcare providers. Many of these attacks also resulted in bringing the systems down completely resulting in significant problems with care delivery. Cybersecurity is a major concern for 2021.
3. Electronic Health Records & Data Sharing
The COVID-19 pandemic highlighted the importance of inter-connected electronic health records (EHRs) and data sharing. During the pandemic, the need for hospital ICUs and EDs to see a patient’s chart and previous history is essential, especially during times of extremely high patient volumes. EHRs provide the ability to standardize procedures and streamline documentation, share data with other systems, and obtain quick access to needed information. New capabilities, such as voice, listening, and language processing with prompted voice commands are needed enhancements that will act as virtual assistants and increase clinicians’ efficiency.
4. Privacy Issues
Privacy is an extremely important issue, especially with regard to HIPAA. HIT systems need to have interoperability to be able to obtain and share data with other systems. The rise of remote users and the use of tablets and phones has made privacy an even bigger issue. Privacy is an identified issue for 2021.
5. Digital Assistants (Chatbots)
A chatbot (short for chatterbot) is an AI feature that can be embedded and used through a messaging application. It simulates a human conversation through voice commands or chats or both. They sound like a real person, and good chabots are difficult to identify when interacting with one on the phone. They are in the experimental phase, but are starting to be used in healthcare settings as digital assistants to keep track of appointments and contacts. They can also be used for routine scripted calls or to collect answers from patients on questionnaires or surveys in a more cost-efficient manner than using office staff. Chatbots are revolutionizing business processes and providing clear, practical solutions for monitoring and modifying patient activities. They are time-saving, cost-effective options that need to be evaluated for use in healthcare.
6. Automated IT Operations
The COVID-19 pandemic reinforced the need for more automation in healthcare systems. Standard, routine tasks and functions should be automated to increase efficiency and improve the accuracy of documentation. Lessons learned from the COVID-19 pandemic should help to identify opportunities for automated workflows.
7. Digital Resiliency
Healthcare systems need to focus on digital resiliency, which will allow them to rapidly adapt to disruptions and respond to new conditions 50% faster. Organizations that can adapt quickly and leverage digital capabilities will be able to maintain business operations during difficult times, giving them a competitive edge. Looking at lessons learned should help organizations to identify their needs.
8. Consumerism & Patient Experience
Consumerism has been a trend for several years, and organizations have placed emphasis on identifying consumer needs and expectations. They are now starting to focus on neglected areas that are important to consumers to improve the patient experience. Examples include: new websites, mobile apps, schedules, telemedicine, and educational resources. Improving the patient experience and increasing patient satisfaction will increase the organizations overall return on investment. Goals need to be focused on a more comprehensive health approach rather than just focusing on health problems. This will allow patients to be able to move toward managing their own care.
Conclusion
COVID-19 forced many healthcare organizations to postpone or cancel some of their 2020 goals due to the urgent needs of the pandemic. Financial issues were also a key problem and funds for new projects or updates were no longer available. It is estimated that pandemic debt will shadow 70% of CIOs. Some CIOs will see this as an opportunity to revise and modernize their infrastructure and applications in order to deliver more flexible capabilities and create new products, services, and experiences for employees and customers. The lessons learned will identify needs for tools and technical processes, as well as provide the ability to implement rapid changes and develop new or revised processes and procedures.
The COVID-19 pandemic is stressful, but it also offers a view into the future, identifying what will be needed. It helps us realize that we can handle whatever is thrown at us in the future. Working on these 2021 trends will help prepare us for that future and realize that HIT is an ever-changing, exciting field with a myriad of opportunities to improve healthcare.