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Top Ten Tech Trends 2018: Could Newfangled Business and Technology Combinations Upend the Landscape of Healthcare Delivery?

August 29, 2018
by Mark Hagland, Editor-in-Chief
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Could some of the business and technology combinations and ventures announced within the past year herald a new era of disruption in U.S. healthcare delivery? Industry experts agree—the answer, potentially, is yes

Editor’s Note: Throughout the next week, in our annual Top Ten Tech Trends package, we will share with you, our readers, stories on how we gauge the U.S. healthcare system’s forward evolution into the future.

In an article online in the Business Insider published in July, Shelagh Dolan put it very directly: “Healthcare disruption is no longer looming—it's here, and it's necessary. As the population continues aging, health organizations and providers are struggling to keep up with growing demand for care, while consumers are facing astronomical costs—often for subpar service.”

What’s more, Dolan wrote, “Desperate for ways to cut costs and improve accessibility of patient care, traditional healthcare providers are turning to tech innovations for help. In the last five years alone, healthcare funding among the 10 largest US tech companies jumped from $277 million to $2.7 billion. New technologies including telehealth, wearables, mobile apps, and AI are facilitating a shift towards preventative medicine and value-based care, in turn reducing claims, improving benefits plans, lowering patients' premiums, and increasing their lifetime value.”

What are these companies up to? Alphabet, Google’s parent company, is leveraging its extensive cloud platform and data analytics capabilities to hone in on trends in population health, the Business Insider report noted. The company plans to drive more strategic health system partnerships by identifying issues with electronic health record (EHR) interoperability and currently limited computing infrastructure. Meanwhile, Amazon’s recent acquisition of PillPack is another step towards integrating medical supplies and pharmaceuticals into its platform and distribution. The company is also ramping up its AI capabilities to transform Alexa into an in-home health concierge, thereby driving consumers to the website for prescriptions and basic medical supplies. Apple and Microsoft are moving in, too, with Apple looking to turn its popular consumer products into powerful healthcare tools — with monitoring capabilities that benefit both patients and providers, and Microsoft, like Alphabet, leveraging its robust data and analytics capabilities for visibility into population health.

As a June 15 report in the online publication EHR Intelligence noted, the research firm Kalorama Intelligence reports that those three companies—Google, Apple, and Microsoft—have filed more than 300 healthcare patents between 2013-2017—among them, Google’s 186 patents, mainly focused on investments for DeepMind, its artificial intelligence and Verily, its healthcare and disease research entity; Apple’s 54 patents focused on turning its iPhone into a medical device that can monitor biometric data such as blood pressure and body fat levels and to develop algorithms to predict abnormal heart rates; and Microsoft’s 73 patents, centered around expanding its artificial intelligence capabilities and developing monitoring devices for chronic diseases.

That EHR Intelligence article also stated this: “Although Amazon has not officially announced details, industry rumblings indicate that Amazon has been working with a secret project team that is exploring platforms for EMR data, health apps and telemedicine. This secret team is known as 1492 and is working on extracting data from EMRs to make it more useful to healthcare providers. Reportedly, the team is also working on building a telemedicine arm, using technology to make virtual doctor/patient consultations a reality.”

Will New Business Combinations Upend the Healthcare Provider Landscape?

Meanwhile, new business combinations are hitting healthcare, too. The announcement on Dec. 3, 2017, that mega-pharmacy retailer CVS was planning to acquire health insurer Aetna for $69 billion, threatened to reshape the landscape of healthcare delivery and organization in the U.S. And, just seven weeks later, three corporate giants—Amazon, Berkshire Hathaway, and JPMorgan Chase & Co.—announced on Jan. 30, in an ambitious-sounding, if vaguely worded, announcement, that they were launching an initiative to improve satisfaction and reduce costs for their companies’ employees.

And all of these moves to disrupt healthcare are connected, fundamentally, to the high, and growing cost, of the U.S. healthcare system, which Medicare actuaries expect to reach $5.6 trillion, and 19.9 percent of gross domestic product, by 2025.  As Joseph Walker noted in a July 31 article in The Wall Street Journal entitled “Why Americans Spend So Much on Health Care—In 12 Charts,” “Americans aren’t buying more healthcare overall than other countries. But what they are buying is increasingly expensive. Among the reasons is the troubling fact that few people in health care, from consumers to doctors to hospitals to insurers, know the true cost of what they are buying and selling. Providers, manufacturers and middlemen operate in an opaque market that can mask their role and their cut of the revenue. Mergers give some players more heft to enlarge their piece of the pie. Consumers, meanwhile, buoyed by insurance and tax breaks, have little idea how much they are spending and little incentive to know underlying costs.”

So what will the impact be of all of these bold technological and business moves, for established patient care organizations in U.S. healthcare?

With regard to the planned CVS-Aetna merger, Tim Zoph, client executive and strategist at the Naperville, Ill.-based Impact Advisors, Inc., and a former healthcare CIO, says, “This is a vertical play. Part of this is just the need to really manage the pharmaceutical supply chain and costs. Medications and drugs still represent the largest and fastest-growing costs in healthcare. So the idea that you can insure and also be close to the management and distribution of those medications, sort of brings the insurance risk of managing the PBM (pharmacy benefit manager) side, to the fore. And Aetna is really seeing an opportunity for CVS to reinvigorate beyond its current business model. There may be an opportunity beyond pharmacy management, to look at other retail services, in retail settings. Care is really the growth market; it’s lower-cost, distributed, and convenient. The idea that you have a retail venue that starts with pharmacy is a strong vertical play.”

Tim Zoph

Meanwhile, Steve Valentine, vice president of strategic advisory services at the Charlotte-based Premier Inc., says, “Today [Aug. 3], the California Attorney General opposed the CVS-Aetna merger over cost concerns. We would call that a vertical merger. They have the Minute Clinics, the PBM, etc.—we see them invading the healthcare space to compete for what we call ‘stickiness with the consumer.’ You have 9 to11 percent of the spend in pharmaceuticals. It will be interesting to see whether they go down a path like United, which has Optum, and which is acquiring medical groups.”

And, says Valentine’s colleague Shawn Griffin, M.D., vice president, clinical performance and applied analytics, at Premier, “You’re seeing continued attempts to find ways to put together groups that can help you save on healthcare spend. You’re seeing that with innovations, and with partnerships of all kinds, and they’re all trying to find out what the right team is, to become more efficient and improve quality. You’ve seen it with the EMR vendors, too.”

Don Crane, president and CEO of the Los Angeles-based America’s Physician Groups (APG), a nationwide association of physician groups involved in risk-based contracting, says of all the new combinations, both the technological and business ones, “To me, they signal a very restive employer world, a restive and dissatisfied employer world, certainly, when you talk about Google and Amazon, and so, too, with the carrier-PBM combination. There, it’s more about the players looking for a new model, implying that there’s a dissatisfaction to the point of abandonment of faith in the existing model. So, has the inefficiency of our current healthcare delivery system now produced pain at such a high level that it’s no longer about academic conversations, but time for a variety of different actions? That’s what it’s telling me, that we’re about to hit a pain point. Healthcare is using up more and more of our GPD, and really is hitting our global competitiveness now. So yes, this is very significant.”

Don Crane

Of course, the fundamental practical question is, should the leaders of hospitals, physician groups, and health systems worry about all these new disruptive developments? “Yes, I think so,” says Impact Advisors’ Zoph. “There are two trends to think about here,” he says, speaking of the pending CVS-Aetna merger. “One is the distributed-care, remote to retail, focus on the consumer, follow the higher margin, business; and the other is the issue of consolidation among providers. We’re seeing a growing consolidation of physicians, and of hospitals. That deal gives them greater control and greater market share; evidence shows that… there will be tension because of the consolidation and shoring up of the traditional healthcare market at the same time as these new entries.”

Meanwhile, APG’s Crane notes that “I don’t think that the architects of these various transactions see them all in the same way. They have slightly different strategies, and are facing different challenges. For example, he notes, referring to the CVS-Aetna deal, “The minute-clinic concept never really took off; it didn’t exactly work. But what’s different about these diagonal mergers? I think some of it lies in the data—you’ll be combining the data of a health plan with a pharmacy with a PBM. And we’re moving into an era of artificial intelligence and machine learning and the ability to stack up algorithms to the nth degree and know things we didn’t know before.”

What’s more, Crane says, the leaders of patient care organizations need to begin to rethink the organization and delivery of primary care, as new models come into being. “There’s also the factor of the idea of the transformation of primary care,” he says, speaking of the business and technology disruptors. “I think they envision a world where you don’t have to call your doctor six weeks in advance, drive through traffic, wait for hours, wait for days to get your results—and that just doesn’t seem cool in the second decade of the 21st century. It’s a model begging for revolution.”


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AMA Creates Digital Health Playbook to Guide Providers on Implementations

October 18, 2018
by Rajiv Leventhal, Managing Editor
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The American Medical Association (AMA) has created a new resource that aims to help physicians extend care beyond the exam room with technologies that are changing the way patients interact with healthcare.

The resource, called the Digital Health Implementation Playbook, offers a guide for providers on the path to applying digital health solutions, including key steps, best practices, and resources to accelerate and achieve digital health adoption. The AMA made this announcement in conjunction with the Digital Health Collaborative and Connected Health Conference taking place in Boston this week.

According to AMA officials, physicians are optimistic about the potential of digital health innovation to benefit medicine and expect to use more digital health tools in the near future. However, complex factors inhibit adoption.

The Playbook is designed for care teams and administrators in medical practices of all sizes and areas of specialty. Officials note that it’s a living document that will be updated to include new content over time. As the Playbook evolves, it will provide a 12-steps process to guide the implementation of a variety of digital health solutions. The first six steps are core to the implementation of any digital health solution, while the subsequent six steps focus on specific digital health solutions and the unique considerations relevant to that specific technology.

As it stands now, the Playbook provides resources for the implementation of remote patient monitoring (RPM) using devices, trackers and sensors to capture and record patient generated health data outside of the traditional clinical environment.

And as more connected devices and wearables are validated as accurate and reliable healthcare tools, the medical community will increasingly look to integrate digital health and mobile health technology into medical practices to better understand and manage chronic diseases outside of the practice environment as healthcare shifts toward value-based reimbursements, note AMA officials.

"Implementing digital health technology has been a challenge for those without a clear course to success," said AMA Chair-elect Jesse M. Ehrenfeld, M.D. "The AMA is committed to making technology an asset, not a burden, and the Playbook provides the medical community with widespread access to a proven path for implementing digitally enabled health and care.

More than 80 physicians, care team members, healthcare administrators, patients and digital health thought leaders contributed their expertise and input to the Playbook, according to the AMA.

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New Report Examines Healthcare in the “Amazon Era”

October 5, 2018
by Rajiv Leventhal, Managing Editor
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Hospital business leaders are open, and even optimistic, about the benefits of innovation from non-traditional healthcare players, such as Amazon and Apple, according to a new report from Captains of Industry, a marketing consultancy.

The research, which included interviews with hospital leaders across 11 hospitals in the Boston area, identified a gap between where hospital executives expect Amazon to debut in the marketplace and the areas where the market truly desires innovation. Principally, while hospital executives anticipate Amazon entering healthcare through supply chain and retail initiatives, the majority of respondents pointed to consumer-facing healthcare IT as the area most in need of transformation.

Indeed, hospital executives are keenly watching Amazon given its strategic edge. While Apple and Microsoft have the most traceable digital footprint inside hospitals today, healthcare leaders ranked Amazon as the #1 company most capable of bringing transformative change to healthcare in the next three years, the study found

As Healthcare Informatics reported in January, Amazon, Berkshire Hathaway, and JPMorgan Chase & Co announced they were teaming up on an initiative to improve satisfaction and reduce costs for their companies’ employees. Although not many details are known about this collaboration, the organizations named Atul Gawande, M.D., as CEO of the initiative, back in June.

Meanwhile, in August, Amazon said it would be part of another endeavor related to healthcare—to remove interoperability barriers and to make progress on adoption of health data standards. For this, Amazon will be teaming up with Microsoft, Google, IBM, and others to jointly commit to support healthcare interoperability by advancing healthcare standards such as HL7 (Health Level Seven International), FHIR (Fast Healthcare Interoperability Resources), and the Argonaut Project.

Indeed, over the past year, industry observers have had their eye on non-traditional healthcare players such as Amazon and what they can bring to the table from an innovation and cost-cutting perspective. One recent survey of 100 healthcare organization leaders found that most C-suite executives do have their eyes on Amazon to shake up healthcare.

This latest report, “Healthcare in the Amazon Era,” researchers explore the transition to Amazon era healthcare. It seeks to define the strategic questions that organizations, hospitals and leaders on the edge of medicine and technology must address to deliver care and conduct business in the Amazon era of healthcare.

“The ability to distribute healthcare broadly, reliably and timely—when the patient wants it—is exciting, but business leaders and clinicians who participated in this study call for a future where healthcare in the Amazon era is also safe, equitable and sustainable for all involved,” Lauren Prentiss, strategy director for Captains of Industry and head of Captains Research, said in a statement accompanying the report. “Delivering against those parameters is incredibly difficult. But the more we do it, the more rewarding it will be. Not only for those shaping the Amazon era of healthcare, but for our society as a whole.”

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CDC IT Leader Details Progress on Developing an EHR Blockchain

October 1, 2018
by Heather Landi, Associate Editor
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Blockchain is an innovative technology that has garnered a significant amount of interest across many industries, and, within the U.S. healthcare industry, thought leaders and innovators continue to weigh in on the potential opportunities, and the countless complexities, around the adoption of blockchain technologies.

Many healthcare organizations are pushing forward with pilot projects and proof of concept initiatives to explore the development of blockchain and distributed ledger technologies, yet this is a technology that is still very much in its nascent stages. Potential use cases for blockchain in healthcare will be topic of discussion by a panel of experts during the Healthcare Informatics Beverly Hills Health IT Summit, scheduled for November 8-9 at the Sofitel Los Angeles at Beverly Hills.

As noted in a Fast Company article, companies like IBM and Microsoft are exploring how the technology can be used in traditional industries to sync up data like logs and transaction records between business associates, like health providers and the Centers for Disease Control and Prevention (CDC). IBM and the CDC’s National Center for Health Statistics are collaborating to build a proof of concept for an electronic health record (EHR) blockchain, and there is the potential for the technology to be used as a data system that could track public health issues.

The CDC’s National Center for Health Statistics collects a large amount of health data from surveys. The blockchain project is focused on the National Ambulatory Medical Care Survey (NAMCS), which is a national survey designed to provide information about the provision of medical care services in office-based physician practices in the U.S. NAMCS is designed to meet the need for objective, reliable information about the provision and use of ambulatory medical care services in the United States. Findings are based on a sample of visits to non-federally employed office-based physicians who are primarily engaged in direct patient care and, starting in 2006, a separate sample of visits to community health centers, according to the CDC’s website.

Askari Rizvi, chief of the technical services branch of the CDC’s Division of Health Care Statistics, says the CDC looks for innovative solutions to resolve business problems and is developing a blockchain use case to potentially see what types of current and future EHR data collection challenges can be addressed. Rizvi recently spoke with Healthcare Informatics Associate Editor Heather Landi about this proof of concept project, what project leaders have learned so far about blockchain’s potential and what they hope to accomplish with the project. Below are excerpts of that interview.

What is the CDC-IBM blockchain collaboration focused on and what is the aim of the project?

The collaboration started about a year and a half ago. The CDC has an official collaborative agreement with IBM. The CDC is a large organization, and we have a lot of different centers and I’m part of the National Center for Health Statistics. The CDC’s Innovations Committee reached out to several centers to see if anyone had a project to utilize blockchain for, and I made a case for the EHR proof of concept on a blockchain project, and it was well received within the CDC community along with IBM as well. I picked one of our services, called the National Ambulatory Medical Care Survey, or NAMCS, and we based the proof of concept on the NAMCS to get us started. Currently, it’s quite a process to capture that data [for the NAMCS], so the idea is to capture EHR data, so that we can bypass a lot of that and so we can get the data in real-time.

Askari Rizvi

We have created a proof of concept, but we do have a small application where we can demo the project. I’ve spoken at a number of conferences and events where we have demoed the project. The entire project is hosted at IBM and it is a research and development project. It does not have any real data. I want to be very clear because we take privacy and security extremely seriously here at NAMCS; all the data that in this proof of concept is completely synthetic data. And, because it is an R&D project, and there’s no real data involved, we could put it offshore. There’s a lot of legislation and regulations we would normally follow in a traditional federal application, which you don’t have to do when you’re doing a research and development project. But as we move toward a production solution, which would be a long-term strategy, then we would need to get the appropriate approvals and the authority to operate.

Based on what you have seen so far, what are the benefits of using blockchain?

Essentially, we’ve created a promising EHR blockchain proof of concept based off our NAMCS. Thus far, the primary benefits that seem quite promising are consent management, sharing of data, enhanced privacy and security controls and embedded audit trails. The long-term vision is to be able to collect large sets of data, which should provide researchers and organizations the ability to develop deeper insights and trends. We are at a stage with our proof of concept where we are recruiting for partners, specifically EHR vendors. The vision is to partner up with EHR vendors to build capability in our solution where the sharing of the data becomes simple for the providers, and, at that point, all we would need is consent from the providers.

What drew your interest to exploring blockchain technology? Are there particular challenges that blockchain might help to solve?

I have a hefty background in IT; I’ve been doing it for a few decades. Anytime I see a new technology, I’m interested in finding out what it has to offer, so essentially, that is what piqued my interest. By no means am I a blockchain expert. It was more so as an R&D project, to see what it is and how can it possibly help us manage our national healthcare surveys. As we’ve been through a series of meetings and working sessions, we began to realize that it will enhance the privacy and security of our service, which is always a key aspect, along with better sharing of the data, consent management, and the audit trails.

But, besides that, there was another primary goal. The survey response rates have been declining throughout the industry, so we wanted to think out of the box in order to compensate for that. The idea was if we can build a solution with EHR vendors or these larger systems that host a lot of the data that we need for research, then it would become a lot easier. We would have larger data sets, and we would have them in real-time; there wouldn’t be any issues with the frequency of the data that we are receiving. Some people describe blockchain as a decentralized database, and it really depends on the model that we create going forward. We’re flexible; we have capped the proof of concept at a very high level in terms of flexibility, because depending on the partners that we select, we want to make things as easy as possible for them. I think for the next steps, once we have a number of partners, then we would ask for them to send data from their EHR system and then we would move forward.

What are the next steps with this project, and what is the long-term goal?

What we’ve built so far, it is promising. I see that it does offer several benefits, in terms of privacy and security and audit trails. For the next steps, when we’re able to get a number of providers and if we’re able to build a bridge, or let’s say [the providers] are a node on our blockchain, then it becomes easier to share data from that EHR system for any of the providers, because we would build that bridge between our application and the different EHR vendors. All the providers would need to do is to give us consent, and then we would have that data, from that EHR system. It’s a very long-term strategy. It’s not going to be done any time in the next few months. It is a holy grail of where we are headed, and then we can tap into the data, and depending on the different data sets, we can even enhance the data collection that we currently do. There are many data elements that we collect, and EHR systems have a lot more data elements, so we’re increasing our ability to capture additional data sets, and then providing the flexibility for researchers to be able to run their analysis, look at deeper insights, and come up with trends.

I just want to, again, that all the data for this blockchain prototype is completely synthetic; there is no real data that we’re using here. And, I want to be clear on our current state versus our “to-be” state. So, current state is, we have developed this proof of concept, it’s off-site, no data, and, on top of that, we’re simulating providers. The “to-be” state would be to get providers, partner up with them, start collecting synthetic data from them and then moving toward production state.

What does the status of this proof of concept signify to you about the potential for blockchain adoption in healthcare? Do you see other potential use cases?

There are a number of different centers in CDC that are focused on solving different business problems for CDC, and their mission and goals are very different. I think blockchain could be used for a number of those business units. The idea over here is to get this R&D project off the ground, get it working, have providers on board and move forward towards a production stage. I think that will open things up where others can see that this product looks promising and that it could resolve certain issues. People use blockchain for supply chain management, so another use case could be where the CDC could see the different areas when you are tracking down let’s say, some sort of bacteria in a product. If you have a system that’s developed on a blockchain, you can see where that product originated from. Essentially, you could work your way backwards, go all the way to the origins of where that product came from, and you could identify the source. That would be another use case.

Moving forward, what are some of the potential challenges with this project?

We’re at a juncture where we need to partner up with the EHR vendors or different providers or systems. I think that would be the current challenge, or the biggest challenge for us to face. We want to make sure we’re able to pick the right partners, so we can get something going and continue to make progress.

 


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