By Jane Sarasohn-Kahn, iHealthBeat
While the health care market environment for 2016 has many uncertainties, there is one certainty that will drive adoption and deeper use of IT: the need to do more with less money. Whether value-based, bundled or slashed reimbursement, health care providers and consumers will be faced with rising costs and the need to do more with less.
Providers are savvier, more critical health IT buyers. With several years of living and working with electronic health records, health care providers know what they like, and don’t like, about the first generation of adopted systems. Most physicians are dissatisfied with their EHRs, and many will shop for a second generation of new-and-improved systems at HIMSS 2016. Others will add complementary functionality through niche tools — such as team collaboration and patient engagement platforms — that help extend care beyond the providers’ walls that enable more team-based care to more effectively function in the value-based payment environment.
Telehealth finds a business model. The do-more-with-less imperative requires a focus on using (expensive) labor inputs at their highest-and-best use. To enable adoption, telehealth legislation is gaining bipartisan momentum in Congress, including but not limited to the Telehealth Innovation and Improvement Act (S 2343), sponsored by Sens. Cory Gardner (R-Colo.) and Gary Peters (D-Mich.). In the meantime, providers are increasingly using telehealth as more commercial payers cover the service, and a growing number of employers are bringing telehealth into workers’ health benefits, some contracting with mobile telehealth services for employees to access care via smartphone apps (think: Facetime with board-certified doctors). Pharmacies are also channeling telemedicine direct-to-consumer: CVS is working with three vendors (American Well, Doctor on Demand and Teladoc) and Walgreen is working with MDLive in 25 states. Adoption of the direct-to-consumer technology is growing among patients who do not have an ongoing relationship with a doctor (e.g., a medical home) and have high-deductible health plans.
Tele-mental health care to expand in 2016. Behavioral health services is a fast-growing component of virtual care. MDLive acquired Breakthrough, a provider of telehealth for behavioral health therapy, in 2014 and raised an addition $50 million in August to expand the offering. This is one sign that tele-mental health care is coming of age and will further grow in 2016. With the recognition that mental health providers are in short supply throughout the U.S. — one-half of U.S. residents have no access to mental health services — combined with a lingering taboo among people seeking these services, behavioral therapy delivered virtually has gained popularity and a growing evidence base. The Department of Veterans Affairs’ health system has been a pioneer in using tele-behavioral health for virtual visits and mobile health apps. VA will continue to grow its portfolio of tele-mental health services in 2016, signing with AbilTo to deploy a Military Transitions Program to help veterans returning from service deal with emotional challenges during their readjustment period to family and community life.
Remote health monitoring goes mainstream. Two-thirds of hospitals and health systems adopted some type of remote health monitoring in 2015, according to Spyglass Consulting Group. This growth is being driven by the need to manage patients with congestive heart failure, chronic obstructive pulmonary disease, diabetes and hypertension. While there is a growing array of remote health monitoring devices which redesign and re-size hospital-type medical devices for monitoring in the home environment, more providers are looking to wearables and activity trackers (like the Fitbit) to assess how these personal health technologies could be effectively used for more medical applications.
Growing evidence for mobile health. There were some 165,000 mobile health apps in app stores in 2015; 12% of mobile health apps accounted for 90% of all consumer downloads, while 40% of them had fewer than 5,000 downloads, based on an assessment from the IMS Health Informatics Institute. Nine in 10 physicians would recommend a mobile health app to patients, according to an eClinicalWorks survey. Most physicians would like to recommend (“prescribe”) mobile health apps to patients where they can be effectively used for self-care in managing chronic conditions. In 2016, more evidence will come to prove the efficacy of some mobile health apps, through the work of Evidation Health and SocialWellth working with HITLAB, among other organizations analyzing the value of digital health tools. In addition, the results of Partners Healthcare’s work on a $500,000 grant from the Robert Wood Johnson Foundation to research consumer engagement with personal health trackers will help inform how to inspire peoples’ sustained use of digital health technologies.
More IoT in health care. In his new book, “The Internet of Healthy Things,” Joseph Kvedar of the Center for Connected Health talks about the inevitability of the Internet of Things (IoT) coming to health care. The center has partnered with Samsung to envision and build personalized digital and mobile tools for health and wellness. The CEO of Samsung told the audience at the 2015 Consumer Electronics Show that everything the company makes and markets in 2020 will be connected to the Internet. In fact, the health care opportunity for the IoT could be transformational as more consumer electronics products get connected to the Internet. More IoT-enabled health and fitness electronics will be unveiled at the CES in January 2016. As value-based payments take hold in health care and more consumers want to self-manage care via wearable tech and mobile platforms, IoT will blur into health care and more clinical apps for chronic disease management.
More breaches and hacking of information and devices. Health care data breaches and cyberattacks cost the U.S. health system a total of $305 billion, according to an Accenture report. This risk has become a growing factor in credit rating agencies’ assessments of health care providers’ financial viability, which may negatively impact credit ratings. Moody’s Investor’s Service in a recent report noted that the increase of cybercrime is increasing health care institutions’ risk of a drop in their credit ratings. Moody’s views the addition of cybersecurity committees in provider organizations as a “credit positive,” which could help to mitigate and better manage the risk of a cyber-hack of patients’ personal health information.
Growing attention to privacy and personal health technologies and wearables. Beyond data security, there is a greater realization of the potential for hacking connected medical and activity tracking devices. The Health and Fitness Division of the Consumer Technology Association (formerly the Consumer Electronics Association) issued privacy guidelines for companies involved in wearable and mobile tech for health, addressing security, policy practices for consumer notices, unaffiliated third-party transfers of personal data and fairness, among other principles. Representatives from Fitbit, Google, Humetrix, Jawbone, MC10, Qualcomm, Under Armour, Valencell, Walgreen and other companies were involved in the consensus-building process. Watch for growing attention by consumer advocates and policymakers, alike, on the privacy and security of APIs in health care in 2016.
Getting practical about interoperability. Health information system interoperability remains an elusive, crucial state of being in American health care. The American Hospital Association’s Interoperability Advisory Group in October published a report on the barriers to electronic information sharing: insufficient infrastructure, technology challenges and unresolved policy issues. The hospitals put much of the blame on health IT vendors, which AHA says have levied in “tolls” for developing interfaces for information systems but don’t solve the larger challenge of standards-based interoperability. In 2016, David Kibbe of the Direct Trust organization expects that federal and state agencies will push Medicare, Medicaid and VA toward greater interoperability with greater adoption of Direct Exchange and “vendor-neutral” means of electronic data exchange through EHRs. More providers and developers will also apply the newer FHIR framework. The acronym stands for “Fast Healthcare Interoperability Resources” (with emphasis on the “fast”), part of the HL7 standards. Ken Mandl of Harvard has been building a so-called “app store for health” based on the FHIR standards, which will be increasingly used by providers long frustrated by the lack of interoperability.
Consumers get more health info-engaged. Earlier this year, Rock Health’s digital consumer health survey found that 24% of U.S. adults had either asked for or downloaded their personal health records. One in four people engaging in their PHI may seem uninspiring, but 63% of health consumers who had not yet engaged with their health information said they were interested in obtaining their records. With the fast growth of high-deductible health plans and consumers’ growing responsibility for making both financial and clinical choices for health, more people will ask to access their PHI and also engage in health care shopping for services on transparency sites, online marketplaces for services and in retail health settings.
Health ecosystem institutional barriers breaking down. The growth of retail health is part of the changing overall health/care landscape for 2016. For this health IT forecast, chain pharmacies’ adoption of electronic health record systems is a key data point. Both CVS and Walgreen adopted EHR systems from Epic in 2015. These implementations will lay the groundwork in 2016 for community pharmacies to play a larger role in consumers’ health, more conveniently and closer-to-home. Pharmacies will be one important node for consumer self-care and health provider value-based collaborations. Expect more cross-ecosystem alliances due to providers taking on greater financial risk for payment, such as pharmaceutical companies allying with mobile app developers and digital health tools. One example is the recent announcement of GSK partnering with Propeller Health for patients with respiratory conditions.
Health care acts on “information economics.” Information economics is a concept developed by Iron Mountain, a storage and information management company. Iron Mountain identifies three areas where information impacts the bottom line: reducing risks, containing costs and unlocking value. When considering the role of IT in health care in 2016, health ecosystem stakeholders should keep these objectives in mind: They mesh well with the Triple Aim of improved quality, improved health outcomes and reduced costs. The financial trend of technology adoption in health care has too often been cost-additive, not cost-saving or technology-substituting. Keeping in mind this information economics framework: it can enable health care organizations filter technology decisions based on risk management, cost optimization and value maximization, all of which can help drive the Triple Aim in 2016.