2013 Healthcare IT Predictions Revisited

For those who follow healthcare IT — heck, even for those who don’t — 2013 will be remembered as The Year of Healthcare.gov. The failings of the federal health insurance marketplace dominated headlines. What’s more, the site’s troubles surprised many people but, admittedly, not everyone.

In January, I offered 13 predictions for 2013, which I expected to be a very active, not to mention interesting, year for healthcare information technology. It was indeed both active and interesting — just not always as I’d thought. Here’s a look back at what I thought would happen — and whether I was right or wrong.

Prediction: The ONC will give meaningful use a long, hard look. Was I right? Yes. (Off to a good start.)

As the year began, many had deemed Stage 2 of meaningful use, with its emphases on health information exchange and patient engagement, too complex for providers, who already have numerous technology and government quality reporting initiatives on their collective plates, as well as EHR vendors, who struggled with the rigors of updating their software and getting it certified.

So on Dec. 6, CMS announced another one-year extension of meaningful use. It’s admittedly a mixed bag: Yes, Stage 3 won’t start until 2017, but stage 2 still begins in 2014 for anyone who attested to stage 1 in 2011 or 2012.

Prediction: The EHR software market will get smaller. Was I right? Not quite. Got ahead of myself.

Numerous reports, articles and other analyses appeared in 2013 and did suggest that EHR vendors unable to adjust to changing market conditions would go the way of the dodo — in a few years. The aforementioned meaningful use stage 2 criteria, requiring healthcare providers to go beyond simply using EHRs and start sharing the information contained therein, were supposed to spell doom for these vendors. Whether the meaningful use extension will give these EHR vendors enough time to improve their offerings or simply delay the inevitable remains to be seen, though.

Prediction: Organizations will finally have to take security seriously. Was I right? Yes.

But did they take security seriously? No. Embarrassing breaches that fail to consider even the most basic tenets of IT security continue to make the news, even if the overall number of breaches, as well as the number of patients affected by a breach, is expected to decline from 2012 to 2013.

Perhaps security posturing is misguided. Yes, healthcare needs to protect itself from hackers, but (regardless of industry) most data breaches are caused by human error and system glitches as opposed to malicious activity. Maybe 2014 will (finally) be the year of stronger security policies and effective employee education. Then again, maybe not.

Prediction: Mobile health in the hospital will disappoint again. Was I right? Mostly.

I get a lot of pitches about individual institutions rolling out some sort of mobile application or service in the name of improving efficiency and care while reducing costs. Clearly, then, the industry is embracing mHealth?

Not so fast. Those apps do save money and streamline processes, but they typically serve a single purpose and can’t convince a hospital board to go mobile. Plus, the bulk of the apps that should be mobile in a 21st century hospital — legacy EHR systems — don’t work on a small screen. Security and network access also stymy mobile adoption, though both are improving as time marches on.

Prediction: Personal health will finally catch on. Was I right? Not really.

I want personal health to catch on. The more the quantified self movement catches on, the more people know about their health and the more people are able to make informed decisions about not just healthcare but diet, exercise and overall wellness. This reduces healthcare costs for everyone, since healthy people go to the doctor less than sick people.

However, until wellness apps effectively connect patients to their physicians, and unless mobile health can fix its glaring yet largely ignored security problems, personal health will largely remain the purview of early adopters and the worried well.

Prediction: Telemedicine will spread its wings. Was I right? Mostly.

Telemedicine tends to be an easy win for healthcare organizations, especially as videoconferencing and collaboration technologies advance and, increasingly, go mobile. It helps smaller, often rural providers offer better care by, say, connecting to university hospital systems for after-hours stroke treatment, and it gives those larger systems an additional revenue opportunity. It lets pharmacies and retailers get into the business of providing care — and address the long wait times for appointments that drive so many patients to the emergency room — by virtually connecting patients with doctors. Finally, it eases the transition from hospital to home with remote patient monitoring tools.

Prediction: More high-profile organizations will call for another ICD-10 delay. Was I right? No. But …

… many organizations still remain ill-prepared for the Oct. 1, 2014 deadline to use the ICD-10 code set and (finally) put ICD-9 to bed. The transition is so difficult because it’s less software upgrade and more cultural change — replace anything that’s been used for decades, as healthcare in the United States must do with ICD-9 codes, and you can expect resistance.

Yes, there are incredibly specific, silly ICD-10 codes, but they aim to make medical bills and patient records more accurate and, in the process, reduce fraud. Perhaps 2013 was the year that folks realized the ICD-10 conversion was inevitable.

Prediction: The success of health information exchange will spread. Was I right? Mostly.

The United States still doesn’t have a national HIE entity, and no HIE standards have been set in clay, let alone stone, but 2013 did see many localized “wins” for health information exchange. Initiatives are advancing in many states, hitherto competing organizations are sharing data, and patients records are crossing state lines and even oceans. On top of that, the CommonWell Alliance, announced at HIMSS13, has started its first interoperability pilot, which will help the industry address what’s arguably the biggest barrier to health information exchange. (Well, that and paper.)

Prediction: Insurers will flex their healthcare IT muscles. Was I right? Pretty much.

Payers have an easier route to IT innovation than healthcare providers; they typically have more money to invest in technology, a more “global” view of a patient’s overall health (through claims data) and better insights into customer behavior. This has led to analytics initiatives aimed at fraud detection, disease management and, yes, identifying new revenue sources. Insurers are also using social media, mobile health and gamification to encourage wellness and reward patients for making good decisions — as they, too, realize that healthier patients cost them less.

Prediction: States will race to implement health insurance exchange. Was I right? Well, um, you see, uh, what I meant to say was …

Given the gift of hindsight, more states should have raced to implement their own health insurance exchange sites instead of relying on the federal Healthcare.gov site, which, let’s face it, was an unmitigated disaster. But even the states that did build their own sites — including Massachusetts, which has had an online insurance marketplace for several years now — ran into problems.

Next slide, please.

Prediction: Accountable care organizations will mature. Was I right? Not really.

The ACO model is often touted as the embodiment of healthcare reform: An integrated system that eschews the fee-for-service model to focus on shared savings through better care coordination. Unfortunately, it’s easier said than done. This summer, nine hospitals left the Pioneer ACO program, out of 32 participants, and only 13 produced “shared savings” that went back to the government. One critic suggests that the (flawed) ACO model aims to be “one big thing” rather than a “dozen smaller things” that, collectively, could better cut Medicare costs. It certainly doesn’t help that ACOs face daunting IT challenges, not to mention a strict 2016 deadline for demonstrating savings.

Prediction: Healthcare will start its slow crawl toward the cloud. Was I right? Yes. (Finally, a definitive answer!)

Two studies released in the latter half of the year suggest that healthcare is finally warming to the cloud. The technology has matured enough that organizations are willing to store personal health information in the cloud. The willingness of cloud service providers to sign HIPAA business associate agreements certainly helps, as does the proven value of cloud adoption in other, less risk-averse industries. Above all, though, healthcare’s need for integrated systems that better share information seems to be drawing healthcare IT leaders to the cloud.

Prediction: Healthcare will use big data to improve population health management. Was I right? Almost — and that’s OK.

Big data use cases in healthcare abound, and population health management is poised to have a bigger short-term impact than other big data initiatives, but the analytics use cases presented, demonstrated and announced in 2013 actually had a wider impact. From medication management and readmission reduction to EHR-based clinical decision support and, in the case of Camden, N.J., the holy grail of a citywide all-payer claims database, big data in healthcare was about more than just care management in 2013.

Even taking into account my attempts to be vague and general — Security will be important? Gee, ya think? — I was sort of right eight times and kind of wrong five times. (I’d like to think my mediocrity stems from being so forward-thinking that I predicted certain trends before they would happen, not from throwing proverbial darts at a metaphorical dartboard. Let’s go with that.)

Here’s hoping I do better with my 2014 predictions for healthcare IT — coming soon.