BOSTON — Healthcare IT leaders struggle with the tug of war that is addressing clear and present dangers such as meaningful use, the ICD-10 conversion, security, data exchange and interoperability while also identifying future needs. Focusing on the former is understandable, especially when looming deadlines promise financial penalties for noncompliance, but doing so at the expense of the latter can stifle innovation.
This year's Center for Connected Health Symposium, presented by the Boston-based Partners HealthCare system, aimed to place today's healthcare challenges in the context of the innovations that will drive change. Here are four trends that will shape future advances in healthcare — and what will catalyze these and other advances in years to come.
1. Data Analytics: Improved Population Health Management
Analytics, to no one's surprise, ranks highly among healthcare innovations with the most untapped potential. Big data use cases for healthcare continue to emerge, but many organizations remained mired in more traditional analytics practices. In these instances, it can take months to conduct an analysis, says Michael Greeley, founder and general partner with Flybridge Capital Partners; by then, the "window to intervene" has long since shut.
Greeley and other venture capitalists on a panel at the symposium suggest that analytics is where healthcare should be investing. Organizations struggle to add information and analytics to the "necessary set of data" provided by electronic health record (EHR) systems, says Dr. Lee Wrubel, general partner with Foundation Medical Partners. As healthcare continues to move to the risk-based, accountable care model, though, and as larger providers acquire smaller practices, this "dramatic culture change" will force organizations to take analytics seriously.
"Data are an absolute, total mess and hard to clean up without a lot of human intervention," says Bill Geary, partner with North Bridge Venture Partners, "but the fact is, you have to do it if you want to deliver population health insights."
While some suggest that technology itself is the culprit here, that "smells like opportunity" to Dr. Andrew Firlik, also of Foundation Medical Partners. Yes, stakeholders and technology remain disconnected in healthcare, but that was also the case in the Internet's early days. The key is "unlocking the power of all that's there," he says, and the growing consumerization of technology movement will aid in this effort.
As that movement grows, patients stand to gain greater understanding of their personal health and to improve the relationship with their doctors (who, thanks to abundant data, would know more about them). But this can only happen, says Dr. Leslie Saxon, chief of cardiovascular medicine at the University of Southern California Keck School of Medicine, if patients get continuous access to their data. There's no reason why a patient with a pacemaker can't access and interact with that device's data through a smartphone app, she suggests.
2. Telestroke: Improving Stroke Diagnosis, Treatment and Recovery
Like analytics, telestroke seems poised to move from pilot phase to sustainability.
A need certainly exists. More than 40 percent of the nation's hospitals have fewer than 100 beds, says Dr. David Hess, chairman of the Georgia Regents University Department of Neurology, and therefore have little choice but to transfer stroke patients to facilities with more comprehensive stroke centers. But most of those small hospitals are in remote areas, and moving a patient is literally a life-or-death decision.
Technological advances such as cloud-based videoconferencing, though, make it increasingly easier for hospitalists to confer with neurologists, look at a patient's CT scan and quickly answer the "treat, transfer or admit" question. Sure, there are concerns, among them privacy, security, data interoperability and the need for 24/7 tech support — it's OK if your video chat software drops a call with your son at 2 a.m., but not as you await a decision to administer tPA.
But that capability to deliver a tPA decision in the middle of the night is the "Trojan Horse that gets us in" and proves telestroke's worth, Hess says. What's more, adds Yulun Wang, chairman and CEO of telemedicine vendor InTouch Health, hospitals that have laid the infrastructure required to support telestroke technology can then expand the model and apply telemedicine to psychiatric care, pediatrics and other specialties facing pressure to treat more patients with fewer doctors.
3. Healthcare at Home: The Patient-Centered Medical Home
While the so-called patient-centered medical home is largely absent from the Affordable Care Act, the principles of healthcare reform and the accountable care model nonetheless present an opportunity to demonstrate the value of telemedicine and mobile health. The key task is reducing hospital readmissions — which is part of healthcare reform, so much so that hospitals with "excess" readmissions within 30 days face reduced reimbursements.
Simply put, care can't stop just because a patient has been discharged, says Dana Sheer, director of clinical programs for Partners HealthCare at Home. Providers must better monitor, and communicate, a wide range of activities, from medication adherence to falls. Cynthia Campbell, associate director of operational consulting with Fazzi Associates, says she sees telehealth — perhaps in the form of a geographic-agnostic nurse practitioner communicating over a HIPAA-compliant, Skype-like application — as a solution to this problem.
Providers also need to develop "care pathways," Sheer says. It takes years for someone with a chronic disease to actually get chronically ill. Many such patients have multiple co-morbidities to boot. Educating a patient about diet and lifestyle changes can treat the disease or reduce the likelihood of complications. This takes time, though; as Sheer puts it, patients rarely have a "sudden epiphany" when returning home from the hospital. Plus, the same interoperability challenges that stymy analytics and telemedicine initiatives make it difficult for healthcare organization and their partners, let alone their affiliates, to exchange patient data.
4. Emotional Sensing: Understanding How Patients Feel
Skydiving brings similar physiological effects to all comers, says Meghan Searl, a research psychologist with the Center for Connected Health — an increased heart rate, a shortness of breath and, well, the feeling that one's dropping from the sky. Some find it exhilarating; others, downright frightening.
Emotional state isn't necessarily "discrete and categorical," Searl says. That's makes emotional sensing an important part of the care process. But it's equally difficult, as so much of what we communicate is unconscious, and as a result represents a "huge burden" of overall healthcare costs.
For years, healthcare has attempted to address emotional state through surveys — but survey takers aren't always honest, and results can be manipulated, says Martin Peddie, founder and chairman of Emotional Sciences Ltd., which makes sentient emotional analysis technology.
Instead, Peddie suggests, let patients talk during the diagnosis process, but keep close tabs on what they say. For example, a teenager diagnosed with high blood pressure may say he worries about whether his new lifestyle will affect his relationships with family and friends. This could point to a risk for depression that a lengthy paper form may not have revealed, he says.
This technology need not be confined to the doctor's office, either. Peter Costello, senior vice president of customer solutions for Cogito Corp., says self-monitoring tools can show patients that they need to change. When the behavioral data systems vendor took part in a pilot project in Boston this spring, he notes, many participants noticed a significant drop in social and physical activity in the days after the Boston Marathon bombing.
What Will Drive Future Healthcare IT Innovation?
So what will drive emotional sensing, analytics, home healthcare, telestroke technology and other healthcare IT innovations? Connected Health Symposium speakers offered these prognostications.
Sensors. Saxon has used sensors to help athletes pinpoint cardiovascular tendencies and military personnel identify who experiences the least stress. She also says she sees potential in automobile sensors, which are already plentiful and could be augmented to, say, monitor a driver's blood pressure using sensors in the steering wheel. External sensors, in particular, are prime for growth, Firlik adds: "As soon as we don't invade the body, we have a lower regulatory barrier."
Social media. YouTube is the most popular "TV network" among 18-34 year olds, Saxon points out, and works well as an educational platform for, say, sharing recipes and diet tips for young diabetes patients. Meanwhile, Saxon's everyheartbeat.org encourages people to post a photo of their heart rate to Instagram, simultaneously offering "another window of experience" for the photo-sharing site and providing an easy-to-access data set.
Scale. True solutions will need to span hospital departments and lines of business, says Dr. Scott Howell, senior vice president of clinical affairs for Cardinal Health Specialty Solutions. They'll also need to be integrated, which will mean cooperating with pharmacies, acute care facilities, nursing homes and other affiliates and business partners.
Startups. Large tech firms such as Google are hiring chief innovation officers. To Greeley, this signals two things: That they recognize that data drives healthcare and that they represent potential co-investors for early-stage investment.
As Wrubel says, a quick glance at the event's exhibitor list — and, for that matter, most healthcare IT events — shows a handful of established vendors and then "a bunch of 25-year-olds. It tells you there are a lot of folks who understand that this industry is ripe for change and want a piece of it."
Brian Eastwood is a senior editor for CIO.com. He primarily covers healthcare IT. You can reach him on Twitter @Brian_Eastwood or via email. Follow everything from CIO.com on Twitter @CIOonline, Facebook, Google + and LinkedIn.