It is perilous to attempt to predict the future during a time in history like this where so many disruptive technologies, legislations, and population dynamics have made change the new normal. However, I will try to divine what might become new realities in healthcare and business in general. My predictions are not wildly futuristic, but instead focused on the near-term future. My tea leaves are observations of trends and known possibilities:\n1. Healthcare organizations will compete more and more on service and less on quality\nQuality will always be important. After all, no one wants a simple knee replacement to become a life-threatening event because an institution or physician has poor patient safety practices. However, as governmental accountability standards for quality and safety get stronger, patients will assume an acceptable level of quality is present just on the fact that the hospital is still open, and the physicians are still licensed. This is especially true since physicians still enjoy a halo effect in their profession. For the most part, patients simply trust their physicians, and assume their trusted physicians will only admit them to good hospitals.\nJust like the presence of an electronic medical record (EMR) is assumed by patients, so is quality. Therefore, competition will move to service\u2014the patient experience. CIOs will notice a shift of pressure from EMR performance, to discovering and implementing technologies that differentiate their healthcare organizations based on their ability to excite and delight patients, patients\u2019 families and friends, and physicians. The health systems that make it easy for the public to acquire health care services, and that delivers those services with kindness, consideration, convenience, and respect will be winners.\nThere will also be pressure to improve the work-life experience of employees, so the health system can attract its most important competitive tool\u2014high performing talented employees and physicians. Talented employees and physicians care about the tools, conditions, and opportunities to succeed that a new employer has to offer. IT can contribute greatly to creating an attractive work-life experience with intuitive applications, mobile workforce support, smooth on-boarding experiences, and so on.\n2. The role of the CIO will undergo a major overhaul\nMore and more often, CIOs will be called upon to move from being implementers to innovators. Solid implementation skills, strong ITIL based procedures, and on-time on-budget project execution will continue to be vitally important. However, a new dimension of leadership is needed to engage broadly across the entire value chain of the organization, and to not only support health care services, but create new ones too. Organizations need CIOs who are moving from enablement thinking to value creation thinking.\nSome of the grittiest most challenging work a healthcare organization can take on is implementing an integrated electronic medical record. Over the last decade under the leadership of talented CIOs, and after millions of dollars and as many labor hours, most hospitals and physician practices in the US now boast at least a basic EMR, and many have very advanced configurations. Healthcare organizations deserve to pause and take a bow for accomplishing this formidable task, but they can\u2019t bow too long because now the task of getting value out of these huge investments is in front of them.\nEnter the healthcare CIO. Many, if given the chance, can reinvent themselves and become the innovators their former realties may not have allowed them to be. Those who cannot convince their leaders they can make this shift may well be pushed aside. Simply put, CIOs will have to show the will and ability to think about the enterprise\u2019s products and services more than they think about IT capabilities, and admittedly they are strongly linked, but the skills to produce benefits in one are different than the skills required to produce benefits in the other.\n3. Healthcare organizations will shift their focus away from optimizing the electronic medical record (activating all its available functions and modules) to optimizing operations\nI believe we will see a move away from the term optimization because it carries with it a lot of IT centric baggage, and it does not linguistically reflect the sensibilities of healthcare administrators or physicians. As information technology becomes more pervasive in business and clinical operations so too it will become pervasive in the strategic thinking and operational performance of organizations. In other words, leaders are beginning to think of IT and operations as two sides of the same coin. This is as it should be. Therefore, organizations will begin integrating electronic medical record (EMR) improvement initiatives with their business and clinically driven continuous improvement programs, allowing business objectives and competitive priorities to drive EMR functionality, add-ons, and custom innovations. Satisfying a vendor\u2019s definition of full use of their products will no longer be an attractive goal because it is not necessarily true that achieving full application functionality will produce a high performing or profitable organization. EMR and related systems must support the continuing evolution of the healthcare delivery system by delivering specific capabilities needed to be successful in its unique markets. Let me give you an analogy.\nSuppose you were a military General and your gun manufacturer told you they now possess technology to deliver a self-aiming sniper rifle accurate to two miles; but your current theatre of battle is in the close quarters of an urban city. Would you invest in the impressive sniper rifle technology to fill that missing gap in your arsenal; or would you instead tell your manufacturer to build a state-of-the-art close quarters weapon such as a low recoil assault rifle? The answer is obvious. In like manner, our aim in healthcare IT investments should be to implement what is needed rather than what is possible. You really shouldn\u2019t climb the mountain just because it\u2019s there.\n4. Healthcare organizations will struggle to get value from their investment in business intelligence and analytics\nOrganizations will continue to discover that though it is important to own business intelligence and analytics platforms, it is just as important to have the skills in-house to find the meaning hiding in the data. Canned reports can help, but they only go so far. The top performers will possess the ability to discover hidden meaning in the data.\u00a0 It is a science and it is an art to tease truths out of ones and zeroes\u2019.\u00a0 It is great to have tools that correlate and compare data, but do you have people who know what to correlate and compare?\nData scientists will continue to become more and more important as will epidemiologists to gain insights from data. Data science is an interdisciplinary field of scientific methods, processes, algorithms, and systems to extract knowledge or insights from data in various forms, either structured or unstructured. Epidemiology is the study and analysis of the distribution (who, when, and where) and determinants of health and disease conditions in defined populations. Rather than hiring these skills, many healthcare organizations will source them from managed services organizations. But even having these skills in-house won\u2019t guarantee a win.\nOrganizations will discover the need to prepare their organizations to act upon the insights that are mined from data. For example, it does no good to discover a simple change in the intake process can produce a better patient outcome if there is no means to get the affected professionals to accept and implement the change. Leaders will have to create a learning culture in the organizations, develop governance processes to drive engagement, and multi-disciplinary initiatives to move quickly from discovery to action.\n5. Continuous IT operations with almost no downtime will become a necessity\nEMR downtime is a serious problem that puts patients at risk, healthcare professionals under extreme stress, and the bottom line under pressure. Downtimes of twelve hours or more have been common practice for implementing application or hardware upgrades, and these costly disruptions have been tolerated because there seemed to be no other choice. It can take days to fully recover from these huge disruptions. However, the increased dependence upon software and hardware to deliver patient care makes downtimes a dangerous proposition, even with the best downtime procedures in place. At a minimum, downtime can negatively affect patient throughput, and therefore the patient experience, which may result in the health system being deselected the next time the patient needs services. At worse, downtime may precipitate an uninformed clinical decision that leads to harm.\nIt is not that technologies today don\u2019t support continuous operations, but such a design is quite expensive, so bypassed. With the cost of processing power and storage decreasing rapidly, organizations will be in a better position to consider investing in continuous operations platforms and may find themselves with little choice. Applications vendors will make it a priority to build this capability into their software to remain competitive. Some healthcare organizations will choose cloud computing or managed services suppliers who can deliver continuous availability in the five nines (99.999% or less than 5.3 minutes downtime per year) or better range.\nSo how did I do? This is an exciting time in technology, business and healthcare, but also quite challenging given the velocity of change. I will continue this series in my next post with five more prognostications; that is unless my friends convince me I bombed so badly that I should write about stuff that has already happened.