HMT Think Tank
Eyeing tech development in 2020
Visual acuity no match for creative ideation in high-tech world.
By Rick Dana Barlow, January 2014
Forget about the flying cars already.
Actor Avery Brooks expressed outrage in his characteristically poised but intense way about the lack of flying cars in the year 2000 as part of a television commercial promoting IBM personal computers. Viewers no doubt laughed or smirked.
Within five years, IBM sold its PC business to Lenovo. Still no flying cars. Perhaps Brooks continues to simmer today.
Six years ago, the housing market collapsed, automotive manufacturers and banks deemed “too big to fail” by the federal government teetered and Wall Street tumbled as the nation plunged into an economic recession.
The first-generation Apple iPhone seduced the smartphone set as the original iPad remained on the drawing board, Research In Motion’s BlackBerry device retained loyalty among the business herd, and healthcare reform was a germinating idea just starting to manifest itself as part of the Obama Administration’s second-term destiny.
Today, Samsung and Apple battle for supremacy in the smartphone and tablet computing market segments, each with a full and growing line of tools, healthcare reform officially debuted this month with electronic health/medical record adoption and implementation marking slight gains as forward momentum head-butts clinician resistance.
Six years from now in 2020, however, the United States will have a new president in Washington and conceivably will be operating under some semblance of a reformed healthcare industry, most likely facing new pressures to improve effectiveness and efficiency.
En route, computing technology will continue to struggle with four major lingering issues: Power, information security, integration/interfacing and end-user behavioral modification, in reverse alphabetical order, but not necessarily importance.
When natural disasters (e.g., hurricanes, superstorms and tornados) and man-made disasters (e.g., terrorist attacks) wipe out power lines and cellular towers and impede satellite broadcasts, healthcare organizations retreat to clipboards, sticky notes and ballpoint pens. Plus, short of access to an electrical power outlet, battery life on mobile devices remains more limited than an impatient consumer favors, often requiring daily charging, which leads to equipment downtime and hampered productivity.
Despite the efforts of HIPAA and HITECH, data hackers still manage to pierce through firewalls and seemingly impenetrable security measures, whether online or via stolen hardware and software. Clinicians and healthcare administrators certainly can view an arsenal of technological advancements each year exhibited at the various IT, laboratory, oncologic, radiological and surgical conferences and trade shows they attend, but they may not be able to afford them or cost justify their immediate or short-term acquisition. The underlying challenge is that even if they could finance these new tools, much of the gee-whiz-bang must-have/need-to-have tech they spot may not talk to the systems they already have in place or even plan to install.
Finally, the first three challenges alone only fuel the clinician and administrator reticence to change their behaviors unless forced by regulation or financial penalty.
Yet these four horsemen of the “e-pocolypse” aren’t blunting or dissuading tech development. Amid more powerful hand-held scanners, computing capabilities in smartphones, tablets, eyeglasses, wristwatches, injectable and ingestible implants and even electronic tattoos, data collection, storage and transmission will expand exponentially by the end of the decade.
So what will computing in healthcare look like then?
To kick off Health Management Technology’s fresh new perspective this year, coinciding with the formal rollout of the Patient Protection and Affordable Care Act, HMT invited more than two dozen healthcare technology company executives to gaze into their crystal ball, take a predictive time-travel trip and speculate on what they expect to see in play six years from now. Here’s what more than half forecast.
HMT: What are two significant technological developments that you foresee being used in healthcare organizations in 2020, and will these technologies enhance or replace what exists today and why?
Gary Palgon, Vice President of Healthcare Solutions, Liaison Technologies
Two developments we foresee will make a significant impact on the healthcare industry in 2020 are the use of patient monitoring devices and predictive or real-time modeling.
Patient monitoring devices are already in high demand. We use FitBit to track our activity and our sleep, and EKG Band-Aids to support heart monitoring. As we move into a world that is that much more connected, we’ll see many more innovative developments to track our health, from Internet-enabled toothbrushes that tell us who is brushing their teeth and how frequently, to whole house monitors that notify remote caregivers of a person who did not move from their bedroom to their bathroom by a certain time as typically expected, alerting that action may be required.
As more data flows in faster intervals, it increases the need to interpret and even predict such large quantities of data. Our capabilities are moving from “actuarial” to “actual,” ensuring that technologies give providers access to real-time information for improved decision-making and faster treatment plans.
These technologies will enhance what exists today and also enable newly innovated technologies to enhance the patient experience and improve overall patient care.
Ed Park, Executive Vice President and Chief Operating Officer, athenahealth
Healthcare organizations and patients are screaming for ways to enable better care at a lower cost. The problem is that, although we’re living in the Internet Age, healthcare isn’t. Technology is going to be what helps get us where we need to be.
There is huge opportunity in the mobile space to innovate on the edges. Apps are where it’s at. Surprisingly, there still are no apps for most of the medical verticals out there, and the opportunities are endless for developers. The coming of age of “millennials” and the increased cost shifting onto patients means those who can be efficient and innovative will reap rewards. We’ve already started to see the birth of diagnostic tools on the iPhone (to do an EKG, for example), and I think we’ll start to see more wireless care delivery and health management tools prescribed by physicians as a result of the innovation happening in this space.
By acknowledging the value of mobile health solutions, the FDA has taken a major step in encouraging innovation. In September 2013, the FDA issued final guidance on what it classifies as a mobile medical app and requires regulatory approval. This openness in healthcare technology is something we at athenahealth have been advocating for heavily in Washington, D.C. If you look at FDA-cleared apps for diabetes like LifeScan’s OneTouch Reveal (glucose monitoring), Glooko (diabetes data management) and WellDoc’s DiabetesManager (logging and coaching), you see how data collection and tracking are a big piece of the puzzle for apps. While these apps won’t likely replace all of the medical testing being offered in hospitals and physicians’ offices, they may inspire a change in how people manage their own care and coordinate that care with their physicians. Similarly, physicians will have access to better tools to obtain information on patients between visits.
This is where interoperability comes into play. There is a need for new technologies to “talk” to one another so that the valuable information that technology enables us to obtain is shared with the right people, at the right places and at the right time. That’s something a lot of us are focused on right now, particularly with meaningful use Stage 2. It is our view that getting to the point of interoperability with all EHRs will be a huge accomplishment for the entire industry — a win for patients and physicians. This will replace a massive amount of faxing, emailing and paper mailing, not to mention save an immeasurable amount of administrative burden.
Pallav Sharda, M.D., Director of Product Strategy, Omnicell Inc.
1. Big data infrastructure technology. The foundational stack needed to handle high-volume, variety and velocity of data in healthcare will be in wide use. This will include the types of technology tools that can perform at the needed scale for managing information generated by billions of individual care delivery events. In most cases, this will end up being replacement technology because the needed changes in areas like computing, architecture, storage, etc., are too radical for traditional technology infrastructure.
2. Health information exchange technology. The fundamental tools for health information exchange (HIE – the verb) are going to reach critical adoption. The accountable care model will drive various healthcare participants to start exchanging information using common standards. Meaningful use will force health IT vendors to provide a baseline set of functionality for such exchange. In most cases, these will probably be enhancements because much of the needed change has been gradually taking place with federal initiatives around HIE (the noun). Also, the tools being developed (such as Master Patient Index) are primarily designed to work in conjunction with incumbent EHR technology.
Juergen Fritsch, Chief Scientist, M*Modal
It is already becoming clear that today’s electronic health record (EHR) systems with their focus on episodic care are not very well-suited to the emerging needs around population health management for value-based reimbursement models. At the same time, many healthcare organizations have sunk multimillion-dollar investments into their EHR systems and they will continue to use them in the foreseeable future, but will try to augment them with additional systems to address the needs they’ll face in five to six years. I believe that we will see new technologies emerging that will focus on information-enabled longitudinal patient care in a way that will enhance existing systems. These technologies will accumulate and analyze large quantities of evidential data in order to identify and execute the most appropriate, most personalized treatment plans for each individual patient.
Another development will be an acceleration of mobile and Web-based applications that will seamlessly connect patients, family members, care providers and insurance plan managers. Patients will be able to perform most diagnostic and laboratory tests in the comfort of their home using their mobile devices with medical add-ons. Care providers will be connected to each other and to their patients and will be able to communicate, coordinate and share information securely. Most importantly, intelligent reasoning and abstraction technologies will become available that will summarize the right information for the right care provider at the right time, thereby preventing medical professionals from drowning in the sea of data that will be generated by 2020.
Ronald Razmi, CEO, Acupera
Remote monitoring of patients with chronic diseases and population health management tools will become critical for healthcare organizations in the future. As providers become increasingly responsible for managing the cost of care, they will need to proactively identify and manage high-cost patients.
Medical care will transcend the walls of the provider’s office. Healthcare organizations will start monitoring and engaging patients outside of the clinical environment more frequently. To do so, healthcare providers will need to embrace emerging technologies and monitor patients in their home environment, allowing them to intervene before those patients start on a downward spiral toward costly end-care.
In order to better manage costs and improve overall quality of care, providers must embrace population health tools. These technologies enable healthcare organizations to segment patients based on their risk levels and organize the most intensive resources around those who are at the highest risk, resulting in a shift to a more patient-centric, team-care model. This evolution of care will also require analytic tools along with intelligent workflows that ensure efficient collaboration between care team members.
John Glaser, Ph.D., CEO, Health Services, Siemens Healthcare
First, if recent history tells us anything, it’s that we cannot predict with complete accuracy where technology will take us. No one could have predicted the rapid development of cell phones into smartphones and, more importantly, their meteoric rise in society.
However, in the next five to six years, we can predict that mobile solutions will take center stage in health to enhance today’s care models and technology. As healthcare organizations evolve from the acute focus, providers will need ways to connect with other clinicians and with patients.
Patients are becoming more engaged in their own care, and the industry is just beginning to capitalize on this potential. We’re already witnessing growth in patient portals, which facilitate appointment scheduling, test results and patient/physician communication. Today, patients with chronic conditions, such as diabetes, can upload blood glucose levels into a system for monitoring by a care provider.
That will evolve and we’ll see diabetics and people with hypertension, for example, with home-based devices that measure blood levels and blood pressure and automatically transmit that information to care providers.
Secondly, HIT systems will become more “intelligent” in order to create personalized care plans and guidance – the first phase of personalized care. At the same time, intelligent systems will enable organizations to manage the care of populations of patients.
These intelligent HIT systems will leverage rules engines, workflow engines, predictive models, intelligent displays of data, algorithms that correct limitations in the data and advanced patient and provider decisions aids. HIT system emphasis will shift from supporting a transaction, e.g., enter an order of scheduling an appointment, to the intelligent support of transactions and decisions.
David Caldwell, Executive Vice President, Certify Data Systems
The first significant development I foresee is the ability to better track condition and disease progression with the widespread adoption of autonomous sensors throughout the healthcare setting and various points of care, communicated through a wireless grid. Eventually, this “advanced telemedicine” will also extend to home healthcare as well. By allowing patient data to be sent automatically rather than gathered by medical professionals, this technology will not only improve patient care, but improve efficiency, leading to lower labor costs for providers.
Another significant development I foresee is full implementation of big data technologies to make sense of the increasing amount of information that will be gathered to make more informed decisions in the clinical setting. These technologies are critical to increasing our ability to transform healthcare data into meaningful, actionable insight.
Joe Petro, Senior Vice President, Healthcare Research and Development, Nuance Communications
Mobile speech and Natural Language Processing are two significant technology developments coming of age.
Brad Ryan, General Manager of Payer and Provider Solutions, IMS Health
Overall, big data and analytics will play a more prominent role as technology enablers by 2020. We have not been wanting for technologic innovation in healthcare, but what’s been missing has been true incentives to drive technology adoption – and that’s where patient data and analytics come in to play.
Mobile health – consisting of all activities outside the office visit, from telehealth to home healthcare to mobile health apps – is starting to take root as part of our healthcare fabric, and generating a lot of patient data along the way. But the real opportunity is to find a way to measure the value of these activities and drive adoption – and we’ll be accomplishing this by 2020 through data collection and analysis. The healthcare industry has always been structured around the visit. Now, there are increasing opportunities for physicians and patients to engage outside the office, but the industry lacks a true incentive structure to drive their use. For example, if we can demonstrate how a mobile health app ties to outcomes or adoption, then we’ll be able to make advances in designing incentives to lead to further adoption.
Providers are starting to use mobile apps to treat patients the same way they would use medication therapies. And just like with a prescribed drug, physicians will soon be able to use analytics to understand the app’s efficacy – this will help us understand its real value and create the right incentives to generate adoption.
Wearables are another innovation that is starting to take hold now, but in the coming years, what will drive real adoption is the data they will generate and how providers make decisions because of it. Wearable technologies are completely changing not only how we measure data but also what we measure. They allow us the means to get more continuous data as well as new types of data that can impact clinical analysis and decisions. We can now track things we never even thought to track in the past, such as food intake, activity level throughout the day, sleep patterns and exposure to different external risk factors. For example, instead of making decisions for diabetes management based solely on blood sugar levels, the data generated by wearables will help providers make care decisions based on what the patient is eating, their activity level and their metabolic rates.
The amount of health data being created today is staggering, and it will only grow in the coming years. The key for the industry is to transform the way we use all this data and find ways to better understand it to make it meaningful. Only then will we be able to understand the value of innovations like wearables and mobile health more fully and use that information to drive adoption – and ultimately, better care.
Chris Watson, Chief Marketing Officer, Brightree LLC
Interoperability solutions for exchanging patient information across care settings is one particular technological development that will shape the future of healthcare organizations. Value-based care and health information exchanges are an increasingly important part of the overall healthcare landscape, and the ability for all providers – from general practitioners and specialists to post-acute care organizations, etc. – will only grow as a critical component of care delivery by 2020. These types of solutions have only started being developed in the past few years, and even then, providers have only seen such solutions link across a smaller number of disparate care settings. Including post-acute care providers in such interoperability workflows will be critical, as these providers are expected to be a big part of healthcare cost containment. By including post-acute care in interoperability strategies, healthcare organizations can ensure that critical patient information across all care settings will be connected, providing a more detailed patient picture for more specific treatment plans and improved patient care.
Although it’s only a goal in today’s market environment to standardize technologies, in 2020 this type of interoperability across care settings will be the norm, opening the door to a new era of healthcare technology. Vendors will need to be prepared to connect disparate data and offer regulatory standards, while still innovating around how to best ensure secure communications between disparate systems to reduce duplicate data entry and manual processes, to ultimately minimize cost and improve patient outcomes.
Another technological development that will shape the future of healthcare in 2020 is the availability of innovative mobile technologies that break down the barriers between patients and care providers. Recent reports predict that there will be six times more users of application-enabled health tools by 2018, growing to 96 million users. With this in mind, it’s critical to consider how healthcare will address the expectation of mobile access to health information. In many other industries, consumers have easy access to personal data right in the palm of their hands. Take banking and finance, for example. With a simple click of a button, people can quickly deposit checks, transfer funds and get an up-to-the-minute picture of their financial health.
By 2020, the days of patients waiting for their doctors to call with urgent test results will be behind us. Patients, instead, will consider it a necessity to access critical care information from patient portals and mobile devices. Clinicians will benefit as well from mobile technologies by having instant access to patient data at the point of care, no matter what the care setting is. Post-acute care providers, in particular, can leverage mobile technologies to access evidence-based content at the patient bedside, enabling them to more accurately provide the right care at the right moment while also capturing new problems and modifying the care plan immediately.
J.P. Fingado, President & CEO, API Healthcare
1. Flexible workforce solutions for managing across the entire continuum of care. With our care delivery model shifting from fee-for-service to pay-for-performance under the Affordable Care Act, the focus of health system executives is extending well beyond the four walls of a hospital. Issues such as reducing readmissions, coordinating care, expanding preventative care and improving population health will greatly impact how care is delivered, which in turn will affect the supply and demand of all caregivers, including primary-care doctors, registered nurses and nurse practitioners. Integrated and centralized staffing across the entire continuum of care will be critical, from wellness initiatives to the delivery of critical care.
Today, more than half of the hospitals in the U.S. use manual staffing methods, causing a plethora of inefficiencies and financial challenges. By 2020, hospitals and health systems can expect the demands on their workforce to increase exponentially, effectively rendering manual processes obsolete and potentially dangerous to patient safety. Over the next seven years, as more patients enter the system, healthcare organizations need flexible workforce management solutions to help caregivers across the entire continuum manage the dynamic needs and demands of their patients. Instead of focusing only on staffing an acute care facility, health systems will need to make smart staffing decisions that enable them to manage the health of diverse patient populations. Data-driven staffing strategies are essential for providing effective care as the healthcare delivery model shifts. With a complete and real-time picture of patient acuity, unit needs and available resources, healthcare leaders can make informed staffing decisions to meet patient care needs – both within the hospital walls and across the entire continuum of care. Within seconds, nurse leaders can receive detailed information about excessive overtime, low productivity, poor patient matching and new nurse performance. By automating scheduling needs and using data analytics, hospitals and health systems can identify and address the staffing gaps across entire organizations.
2. Mobile workforce solutions for clinicians. The average caregiver of today is not necessarily confined to the four walls of a single facility, and the need for staffing flexibility will continue to grow. As more organizations look for creative solutions to create long-term viability, we will begin to see more consolidations and the creation of complete health systems that span the entire continuum of care. As these newly formed and complete organizations look to maximize their workforce and control labor costs, mobile workforce options will increase in relevancy. As care teams become mobile and work in multiple facilities, they will need access to important real-time staffing and scheduling information regarding their unit, facility and, in fact, the entire organization while on the go. Mobile cloud-based solutions are the answer to keeping mobile employees engaged and empowered, as any employee or manager can review the staffing mix at any given time for any shift or unit.
Lenny Reznik, Director of Marketing, Agfa HealthCare Corp.
The biggest change we will see in 2020 is that patient data will no longer be locked into silos. Whether data is generated at home, in an ambulatory setting, in a community hospital, in a large academic hospital or essentially anywhere, the data will be readily available to the clinicians who need it on any device in seconds. Data aggregation and data access will be key fundamental technology changes that will be required to improve patient outcomes while streamlining productivity and reducing costs.
We are on the cusp of these changes today, and it is not only the United States where delivering better patient care at the lowest possible cost with the best outcomes is required.
As important as the EMRs that are being installed today is the enhancement of those systems with all clinical data, textual and images, to provide a comprehensive value chain throughout the patient’s multiple care episodes.
Most of the EMRs available today do not complement textual data with relevant clinical images in context. What is required is a comprehensive enterprise-class data system, helping organizations free all documents, clinical images, diagnostic images and information from silos, enabling meaningful capture, storage, exchange and access to these data directly through the EMR. In response to the diverse textual and imaging information challenges experienced by healthcare organizations worldwide, Agfa HealthCare designed ICIS, our Imaging Clinical Information System, which is a solution that delivers a comprehensive, longitudinal, multimedia patient imaging record to the clinician in a single interface at the point of care.
As our industry continues to evolve and grow in complexity, single application systems or the best-of-breed approach (which tend to create islands on their own) will slowly be replaced with enterprise-class systems capable of handling many different applications. Agfa HealthCare is focused on delivering a complete centralized and accessible picture of the patient’s full health record, delivering broad imaging and clinical information systems that expand beyond radiology and typical imaging roles, all while increasing departmental and imaging capabilities to facilitate reduced patient healthcare costs through better use of IT infrastructure and less administrative overhead. Just as the EMRs of today have upwards of 70 applications in a single platform, imaging, in its most broad meaning of the term, will evolve into an enterprise-wide solution.
Stuart Long, Chief Marketing and Sales Officer, Capsule Tech Inc.
Looking ahead, the first technology that we believe will drive the future of healthcare is in the area of Machine Learning algorithms, also known as artificial intelligence, neural networks or massively trained artificial neural networks. Given the amount of information being collected from patients in various care settings, the need to provide surveillance and intelligent decision support and/or computer-aided diagnosis to further improve patient care will become imperative. Additionally, the use of this data to ensure early detection and maintain patient’s health will become paramount as the need to understand the enormity of data across such broad environments will exceed the capacity of a single human or care team.
This will be an evolution of existing analytics solutions, and our expectations is that machine learning technologies will become required to ensure the creation of a data overload safety net.
Utilizing this information we expect the plethora of medical devices to become intelligent in their own design and utilize a level of awareness to the big data analytics to understand, recommend and adjust based upon a patient’s real-time medical condition. We fully expect the wireless body area network (WBAN) to become as routine as a Wi-Fi network in a consumers home. This will be an enhancement to today’s early stage medical devices that are now becoming wearable.
Michael Dahlweid, M.D., Ph.D., General Manager, Product Management, GE Healthcare IT
The two most significant technological developments impact the quality of diagnosis.
The first development, which is breakthrough by nature, is that tomorrow’s software will be capable of analyzing and selecting a patient’s genetic, epigenetic and proteomic data. Not only that, but it will take that data and put it in context with any other digital data that is relevant to the doctor and his or her patient – the data they need, when they need it at the point of care, to make diagnoses and treatment decisions.
The second technology evolution will happen in terms of real population health data management. This will give healthcare organizations the ability to pool treatment data by patient and illness cohorts.
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