12 Healthcare IT Predictions for 2014

In early 2013, I made 13 predictions for the year in healthcare IT. Many were admittedly general, if not obvious, if for no other reason than to avoid looking foolish at year’s end. (And yet I still missed the mark on a few predictions.)

In 2014, I’m aiming to be a bit more specific — and a bit more bold. Another year of watching the industry has given me a confidence boost. No more Telehealth will take off or Security will be important. So here are 12 things I expect to happen in the world of healthcare IT in 2014. Let me know what you think.

The Healthcare.gov launch failed miserably; would-be applicants couldn’t access the site, couldn’t view information about insurance policies without creating profiles and couldn’t get guarantees that their passwords would be safe. The fixes promised for Jan. 1 were met with mixed results; even well-prepared states such as Connecticut had problems. If the site still isn’t working properly by the March 31 enrollment deadline, expect lawsuits from those who tried — and failed — to use the site to get coverage. Even if those suits aren’t filed, expect CGI, QSSI and other Department of Health and Human Services subcontractors to get hauled into court.

The closer healthcare gets to Oct. 1, 2014, the less confidence organizations have in their ICD-10 compliance efforts. That’s no surprise: Preparing to use ICD-10 codes is a complicated process that necessitates concurrent documentation, education and training endeavors, not to mention the attention of staff members distracted by meaningful use, readmission reduction, quality reporting, e-prescribing and other mandates. This struggle, coupled with a toxic political environment and a precedent for ICD-10 conversion deadline postponement, leads Carl Natale of ICD10 Watch to suggest that, as Oct. 1 approaches, ICD-10 will face the same scrutiny as Healthcare.gov and the Affordable Care Act. I’m inclined to agree.

Consumer mobile health apps are all the rage, especially among venture capitalists. It’s not surprising: The computing power of smartphones and, increasingly, wearable technology makes them excellent resources for tracking diet, exercise and vital signs. There’s one problem, though, and it’s a doozy: Many mHealth apps are insecure.

The FDA regulates mobile medical applications that turn a smartphone into a medical device (using, say, a sensor or electrode) and would harm patient safety if they malfunction. Most mHealth apps post no such safety risk and aren’t FDA regulated. Fair enough. But they store personal health information, so they pose a security risk — and a major data breach in such an unregulated, largely uncertified market is unfortunately inevitable.

Recently, Modern Healthcare assessed the mobile health market and discovered two key things: Most apps for patients don’t track or capture data, and the most popular clinical apps are mobile versions of longstanding client- or browser-based apps. This helps explain why mobile health hasn’t been catching on quite as fast as some have hoped. To give patients and clinicians what they actually need, the mobile apps released in 2014 will have to make it easy to input data (instead of just viewing it), capture data (from medical devices as well as a growing market of wearable technology), interpret data (in a way that anyone can understand) and — above all — secure data.

In July 2013, amid rumors of an imminent iWatch release, Apple hired many medical sensor and fitness experts, and paired them with hardware and software engineers. Last month, Apple received two patents; one is for a heart rate monitor, embedded in iOS devices, which Apple has been developing for four years. It’s hard to say what exactly Apple will do, and smartphones may not cut it as diagnostic tools, but last year’s events suggest that Apple may make a major medical device announcement in 2014.

Providers may not necessarily like the idea, but IDC Health Insights says 2014 will be the year they learn to get along with third-party service providers. Part of this stems from healthcare’s willingness to use the cloud, which has risen in recent years. Part comes from an evolving role, too: Health organizations aren’t “doing” IT anymore, IDC says, so much as they are “managing” IT service providers. Some are internal, such as the Boston Children’s Hospital Innovation Acceleration Program, but the bulk will be external — and they’ll help dictate when, and how, healthcare adopts mobile, analytics and social solutions, IDC says.

EHR implementations are like blockbuster professional sports contracts — several years, hundreds of millions of dollars, lots of scrutiny. That, plus the largely finite number of U.S. hospitals, makes gaining market share tough for the 6 biggest EHR vendors (based on meaningful use attestation): — Epic, Allscripts, eClinicalWorks, NextGen, GE Healthcare and Cerner.

Enter the hundreds of EHR vendors that lie beneath. Each vendor fills its own niche: Regional, cloud-based, free, made for a certain medical specialty, home-grown, mobile and so on. If one of the “Big 6” wants to grow, innovate or improve customer satisfaction, it will probably need to buy a competitor.

I expected this to happen last year, but it didn’t. Like a Chicago Cubs fan, I should’ve known to wait ’til next year. In 2014, after all, the certification process for meaningful use stage 2 begins. EHR systems that struggle to share records — that are, in essence, EMR systems — will likewise struggle to meet the certification criteria. Vendors that can’t get certified won’t necessarily close their doors — especially amid growing sentiment, particularly from small physician practices, that meaningful use stage 2 may not be worth the trouble — but they may have trouble finding new business. Chilmark Research thinks one-third of EHR vendors won’t bother with stage 2; that sounds high but won’t be far off.

The EHR market may experience upheaval in 2014, but meaningful use itself won’t. In 2013, CMS granted a one-year meaningful use extension. In 2015, CMS expects to release its draft of the meaningful use stage 3 standards. In 2014, Washington will be so concerned with the Affordable Care Act, Healthcare.gov and ICD-10 that meaningful use will fly under the radar. Will providers complain about rigorous meaningful use stage 2 criteria for patient engagement and health information exchange? Yes — but these complaints won’t be anything new. The bigger issue, as noted: Will physicians abandon meaningful use, having received the bulk of their incentive money and decided that foregoing more comprehensive EHR use is worth the meaningful use noncompliance penalties?

If for no other reason that a clear alternative hasn’t emerged since the Direct Project was announced in 2010. Why 2014, then? With meaningful use stage 2 beginning this year, EHR vendors and healthcare providers alike have to shift from simply telling the ONC that they can share data to actually doing it. And why not the CommonWell Alliance, which has started its interoperability pilot? Because some suggest CommonWell’s work is less about interoperability — and patient engagement — and more about competitive advantage. We’ll know more at HIMSS14, when CommonWell expects to reveal some preliminary results and HIE will be a hot topic.

Thanks to Scott Brill’s seminal Time magazine article (now behind a paywall), Regina Holliday’s growing Walking Gallery (which honors those wronged by the medical system) and numerous major news outlets highlighting enormous pricing discrepancies and out-of-control costs, 2013 showed us the real world of healthcare. Frustration has bubbled below the surface for quite some time — witness the “Give Me My Damn Data” movement — but I have a feeling 2014 will the year words turn into actions. When price transparency, the quantified-self movement and an increasingly educated patient population come together, inefficient and expensive healthcare systems will suffer. Expect no love to be lost.

Keith Boone, who knows as much about meaningful use as anyone, offered his take on meaningful use stage 3 about 10 days after CMS announced the one-year extension. Stage 3 won’t start until 2017, and the criteria won’t appear until 2015, but Boone anticipates adherence to a variety of new standards for patient engagement, lab orders, clinical decision support, quality measures and (possibly) document exchange. The EHR vendors that do opt to stick with meaningful use will be busy, it seems.