Only three weeks into January and there already has been significant developments shaking up the healthcare industry, such as the Centers for Medicare & Medicaid Services (CMS) unveiling of the Next Generation ACO program and acting CMS Administrator Andy Slavitt’s startling comments about changes to the meaningful use program. 2016 already is shaping up to be a very interesting year for healthcare leaders and the health IT landscape. Healthcare Informatics Assistant Editor Heather Landi recently spoke with Harold (Hal) Wolf and Daniel Herman with The Chartis Group, a Chicago-based consulting firm, about the health IT trends and developments to watch for in 2016. Wolf is a director with The Chartis Group and national leader for its information and digital health strategy practice, and Herman also is a director and leader of the informatics and technology practice at the consulting firm.
What do you see as the top health IT trends that will impact healthcare leaders in 2016?
Herman: I see three things developing in 2016; one is getting value out of the electronic health records (EHRs). There have been a lot of capital investments and major investments as well as time and effort going into technology over the last several years, and we’re now on the other side of the curve and it’s about getting the value out of these investments and optimizing them.
And, two, I think people are going to be looking beyond the EHRs at other types of technologies to integrate into the health delivery network. There are a lot of mergers and acquisitions happening, but also there are different kinds of affiliations developing that are not necessarily mergers but might be just the formation of clinically integrated networks among different partners. So, with those affiliations, people are looking at how do we move information from one place to another to access value and cost and also provide patients access to their information as they go across these virtual networks.
Third, and we’re seeing this consistently and I think we’re going to see more this year, is the issue of governance and decision-making regarding how to balance supply and demand related to technology requests and capital investments. It’s an insatiable demand going on right now and there’s just a limited amount of funds to go around, so looking at how we work with operational leaders to own those decisions just like they would own decisions related to investments, expansion or building programs or building new facilities.
Wolf: That demand is such a critical and fundamental part of the building blocks that are happening inside the industry. There is this other significant demand going on in conjunction with personalized care in the digital space. So what’s beginning to happen is you’re seeing a tremendous amount of attention to governance inside organizations that are more complex than they were even just two years ago. The necessity to match IT investment and integrate it into the enterprise strategy is at an all-time high because to gain the capabilities that are necessary for mobility, for population care management, for investment and analytics, you really have critical IT dependencies that have to be funded and they have to support the enterprise strategy. So the integration between the IT strategy and the enterprise strategy never before has been greater and it’s sitting inside that governance sphere. And, the fundamental approach to that is to not look at projects as strictly IT projects, as these are actually all business projects that are supported by IT and are critical to the success of the enterprise. Starting with that mindset, it’s really changed the ability of organizations to work together and to think about all of this within the context of the overall strategy of the enterprise.
There’s no doubt that cybersecurity will continue to be a challenging issue in 2016. Do you see any changes in how healthcare leaders will tackle cybersecurity?
Herman: We all recognize that no matter how good your systems are—whether you’re the CIA, the NSA, or the Defense Department—people will try to find a way into the environment, so there will be, appropriately, a huge amount of focus on data security and cybersecurity in 2016 as there has been in the past, and it’s only increasing as we recognize vulnerabilities. The other issue, which is adding to that complexity, is that while healthcare has often been an “inside-out” type of enterprise, with the addition of mobility apps and the addition of reporting mechanisms, it’s really “outside-in” and you open up your enterprise every time to more susceptibility. In response, healthcare organizations are adding more security officers with greater capabilities to their organizations, and many of these security officers are coming from inside and outside the industry, and I think that will only increase.
Wolf: The sophistication in the healthcare industry in terms of how to tackle this issue is improving. You’ll see more “white hat” hackers being hired as organizations test their own vulnerabilities and people are creating tiered network environments to make sure that they are secure, both internally and externally, so I think the sophistication and the knowledge in the industry is growing rapidly and giving the industry an edge.
How will the growth of mHealth and connected health impact healthcare organizations in 2016?
Wolf: It’s at the very root of the planning and strategies at almost every single health system. We’re seeing individuals on the consumer level developing their own applications and their own personal information on health, and they are bringing them to bear when they walk into the clinical encounter. You’re also seeing huge investments taking place in Silicon Valley in the wellness market. And fundamentally it’s driving toward personalization in healthcare, so what we’re seeing at the system level are innovations take place where hospitals and clinics or physician partnerships are all looking up and saying how do we recognize, participate and create a more personalized environment with the use of mHealth and eHealth capabilities and tap into this consumer direction? So it’s becoming front and center and it often represents itself on the innovation side of houses and innovation centers that are being created, and people are trying to figure out how to utilize those capabilities in their EHR, so I think it’s hitting on multiple fronts.
What do you see coming down the pipeline as far as policy issues related to health IT?
Wolf: I think the whole industry has been concerned about more policies and more restrictions brought in from Washington. It’s a very a tough balance between the speed of an industry which is growing very fast, both in terms of innovation and capability, versus the check points and regulatory policy that is needed to both nurture that seed as well as get infrastructure in place. I think the dialogues between the policymakers and the innovation side of healthcare will continue to be critical. One example is the reimbursement policy in conjunction with virtual care, e-visits, and that has to be accelerated. We’ve begun to recognize that an e-consult visit, or even email exchanges, are very much a part of the clinical landscape today and as long as reimbursement models are set up to complement it, you will see a further explosion in our ability to take care of the consumer and the patient beyond the four walls of our clinics and our hospitals. It’s already happening in the capitated market, where they can afford to reimburse, but straight reimbursement, and it’s on the table in Washington, that’s a great example of how policy will help drive innovation in the industry.
What about the future of the Meaningful Use program?
Herman: I think what you will continue to see heated dialogue between the industry and ONC (Office of the National Coordinator for Health Information Technology) in terms of meaningful use. This is fundamentally a change management exercise, and I think the healthcare industry has done an astounding job in a very short period of time both in the adaption of new technologies as well as how they are being used to improve measurements under Meaningful Use Stages 1 and 2. I do agree and join a number of my colleagues in suggesting that we need to fill in to the current Meaningful Use measures that we have before we go a little too far and leave people behind.
What else do you see on the horizon for health IT?
Wolf: I think something to watch for, and I think it will come quicker than we expect, is the integration of genomics into the EHRs and into our clinical decision support and our analytical approach to patients on a personalized basis. Recently, the government (National Institutes of Health as administered by the National Human Genome Research Institute) awarded $30 million to 12 institutions to research integrating genomics into the EHRs, so there’s a tremendous amount of research, data and information that is headed in this direction. It’s the next, obvious evolutionary step in the personalization of healthcare. We’re beginning to see the research organizations and the larger institutions that have the capability begin genomic integration so it has a big part to play and it’s definitely coming on the horizon.
Herman: For instance, it will play a role in drug therapy, so if you have the genomics of a person with a certain disease, let’s say breast cancer, and that person might respond differently to different drugs, so you’ve got not only a more focused treatment but also a more cost effective treatment. We’re seeing that now.