13 Healthcare IT Trends and Predictions for 2013

The healthcare industry is three years into meaningful use, an ambitious incentive program to convince hospitals and private practices to use electronic health record (EHR) software. Regulators are also bringing HIPAA, the 1996 rule protecting patient data, into the 21st century. The same goes for telemedicine. On top of that, healthcare finally seems ready to benefit from big data, cloud services and other disruptive technologies that have dramatically changed other vertical industries. But certain advances won’t come without a fight. Here’s a look at 13 straightforward, complicated and surprising predictions for healthcare IT in 2013.

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More than $10 billion in meaningful use incentives has been paid, but a RAND Corporation report said what we’re all thinking: With healthcare costs having tripled in the last decade, EHRs aren’t exactly saving money and improving efficiency. Meanwhile, meaningful use criteria are under fire for being too hard, thanks to unrealistic deadlines for avoiding Medicare reimbursement penalties, and too easy, thanks to a lax approach to EHR interoperability. (Neither argument is incorrect.) With the Office of the National Coordinator planning to look at meaningful use stage 3 this year, and with numerous high-profile organizations already scrutinizing stage 3, expect many meaningful use headlines in 2013.

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Step from the shadow cast by EHR market leaders Cerner, McKesson, Siemens, GE Healthcare, Epic and Allscripts—who control half of all EHR implementations—and you’ll see a few hundred EHR vendors clamoring for clients. Some focus on medical specialties. Others are regional. Others are home-grown offerings hospitals started selling. Not all will survive 2013. Some will be byproducts of EHR market consolidation, as vendors such as Athenahealth look to improve mobile EHR. In addition, EHR certification will separate wheat from chaff; companies that can’t meet the requirements to make the certified EHR product list will lose significant business. Finally, in a competitive market, it’s inevitable that some EHR vendors will simply close shop.

The HITECH Act of 2009 strengthened HIPAA privacy and security rules, but healthcare data breaches remain a huge, almost embarrassing concern. Expect 2013 to place a heavy emphasis on improving security. First, the Office for Civil Rights is expanding its HIPAA audit program, which puts risk assessment in the spotlight. Second, the OCR’s new HIPAA rules go into effect Jan. 25. Third, healthcare data breach threats are evolving. End users still (and always will) misplace laptops and thumb drives, but institutions now know the importance of encrypting these devices. In addition, paper records are increasingly “safe.” However, cybercrime is on the rise, and small practices remain unprepared.

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Physicians, like everyone, love mobile devices. However, 2013 will likely be yet another year during which, despite anecdotal evidence to the contrary, mobile health will fail to catch on. Why? Blame the BYOD tug of war between end users and CIOs; the former want more access to clinical applications and patient data than the latter, for security reasons, will concede. Blame disconnect between new, intuitive mHealth applications and legacy clinical systems caregivers must use every day. Blame EHR vendors for putting legacy apps on tablets and smartphones without considering the UI implications. Blame a health startup scene that, though robust, focuses less on innovation and more on duplication. Above all, blame clipboards that refuse to go away.

Sure, we poke fun at the fork that tells you to stop eating too fast, but the plethora of personal health gadgets at the Consumer Electronics Show illustrate a simple fact: We need help managing our health. Free or cheap mobile health applications can help you see how far you walk every day, what you eat and what medications you take, while (admittedly more expensive) gadgets can measure vital signs, send the data to an online portal and help you track your progress. Even if doctors can’t see that information—which, for a variety of interoperability reasons, they can’t—they can see the results when you arrive for your yearly checkup.

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Why will telemedicine, which can require expensive equipment, succeed where mHealth fails? One reason is broadband. The Federal Communications Commission, long a telemedicine proponent, has committed $400 million to a Healthcare Connect Fund to bring broadband to rural communities, often identified as “underserved” by the healthcare industry. The other is a bill poised to lift restrictions on practicing telemedicine once and for all. The Telehealth Promotion Act of 2012 from Rep. Mike Thompson (D-CA) calls for a federal telemedicine reimbursement policy—patchwork state rules are a mess—and expanded access to telemedicine in federal health programs for the elderly, the poor, veterans, active service members and children. Unfortunately, it costs money.

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Last year the government delayed the transition to the ICD-10 code set used to represent diseases, injuries and medical procedures in clinical and billing software. The AHA was pleased with the new Oct. 1, 2014 deadline, but the AMA and the MGMA want to move further, saying ICD-10 conversion is too costly and challenging. Other professional groups, including AHIMA and CHIME, prefer not to budge again, since the U.S has known since the late 1990s that the existing code set, finalized by the World Health Organization in 1979, is outdated. The critics have a point, though, and another association will likely join them in calling for additional ICD-10 delays this year.

Health information exchange is another initiative many deem long overdue, but 2013 may be the year of HIE. In December 2012, HHS touted Kentucky, Maine and Ohio as HIE success stories for connecting both rural and urban providers and, in the process, helping them achieve meaningful use. Here differing HIE architecture types help rather than hinder; Maine uses a centralized data repository, Massachusetts (another HIE leader) uses a federated model, and both exchange health data quite well. While patients do have HIE data privacy concerns, only 1 in 100 Maine residents have opted out, and NIST has begun a demonstration project for improving the security of health data transfer in all instances, not just those involving HIE.

As payers acquire HIE vendors, patient registry developers and analytics firms, it’s clear that insurers have their own IT plans. IDC Health Insights sees payers creating a technology platforms for services such as health and wellness, care management and accountable care organization, as was the case when Aetna acquired Coventry. (All this comes with value-added services available on the side, of course.) This is important, according to HIMSS, since it will help payers (and their claims data) integrate with providers (and their clinical data) in the name of improving outcomes while reducing costs.

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The health insurance exchange, a health care reform provision that lets the uninsured compare insurance options like they would airfare, seemed all but doomed one year ago. However, the Supreme Court decision to uphold the health reform bill and President Barack Obama’s subsequent reelection has moved HIX to the front burner. More than 20 states (many led by Republican governors) have opted to default to the federal health insurance exchange, a handful have opted for a state-federal partnership and the remainder are in various stages of HIX implementation. With a Jan. 1, 2014 deadline for getting HIX up and running, states will be busy this year.

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Meanwhile, accountable care organizations—a complicated Obamacare initiative through which hospitals, specialists, PCPs and other providers integrate with one another, embracing a shared savings model in order to improve care and cut costs—has been likened to a unicorn (awesome, yet imaginary) or the Clinton era’s failed health maintenance organization. That’s changing. Hundreds of ACOs have been formed, many in California, where physician-led groups and integrated networks predated health reform. Measuring ACO success is difficult—the ACO model is nascent, and its interoperability needs make health information exchange look basic by comparison—but organizations are increasingly willing to share risk as they collaborate and integrate along the road to better, more efficient care delivery.

In most industries, cloud security concerns are over-blown. Healthcare’s hesitance to jump to the cloud is understandable, though. Cloud service providers who touch protected health information (PHI) are now considered HIPAA business associates; CSPs may be liable in the event of a healthcare data breach, but it’s the healthcare institution that’ll have to do damage control. That said, private clouds (often beget from previous virtualization endeavors) aren’t uncommon at large facilities, and vendors such as AT&T are increasingly pitching cloud imaging and messaging technology to diverse sets of healthcare customers. As healthcare data centers bulge, and as CSPs mature, expect more hospitals to trust the cloud.

Related: Doctor’s Orders: Healthcare in the Cloud

Healthcare organizations store terabytes of data. Most is unstructured and therefore sits in a silo. Advances in BI and predictive analytics technology, though, make that data less unwieldy. For example, improved population health management, when coupled with health information exchange, gives physicians a more comprehensive view of a patient by eliminating “gaps” such as missing lab results. Beyond treating individuals, big data drives health IT innovation by enhancing inventory management (to improve purchasing), collecting real-time temperature and humidity data (to keep tissue samples safe) and crunching population numbers. The latter point is huge: Determining which chronic conditions prevail among an institution’s patients and developing plans to reduce related readmissions saves money and improves care for patients and providers alike.