The landscape of healthcare entering the new decade is immeasurably different than it was in 2010.
From an information technology perspective, electronic health records systems have become standard tools of the trade at almost all healthcare organizations. That’s a far cry from 2010, when a minority of hospitals and only a tiny fraction of physician practices had such systems in place.
And only 10 years ago, information technologies such as artificial intelligence, augmented and virtual reality devices and precision medicine have moved from experimental to capacities that hold significant hope for impacting medical delivery in the new decade.
Beyond that, information technology has become an accepted way of delivering care in healthcare organizations. Problems still exist in determining how best to promote efficiency and augment the work of healthcare professionals with it, but few question the value—and potential payoff—that can come from its use.
Meanwhile, HIT likely will be called upon to help the industry as it inexorably moves to value-based care reimbursement approaches, in an effort to restrain healthcare costs, and improve the quality and efficacy of care that patients receive.
With a new decade nearly upon us, the staff of Health Data Management sought to look at some of the emerging ways that information technology will make a difference in the delivery of medical care over the next 10 years. Given the scope of that assignment, the common response from our research was that it’s impossible to project accurately what the next decade holds, but it’s clear that the industry will make significant progress on using the technology and gaining results from it, not just focusing on “laying the pipes” as was necessary in the 2010s.
The following articles, then, are the best guesses from our sources and ourselves as to what benefits the industry might see from information technology over the next 10 years.
Artificial intelligence will vastly expand clinicians’ insight in treating patients
Artificial intelligence is an emerging technology area with perhaps the greatest potential to positively impact medicine in the next decade. According to one estimate, the AI in healthcare market is expected to grow worldwide with an estimated compound annual growth rate of more than 50 percent—reaching more than $ 127 billion by 2028.
The low-hanging fruit for the application of AI in medicine has so far been in the areas of radiology and digital pathology. In fact, Robert Wachter, MD, chair of the Department of Medicine at the University of California-San Francisco, predicts that machine learning will displace much of the work of radiologists and pathologists.
Over the next 10 years, AI will be increasingly integrated into routine clinical practice, significantly impacting the delivery of healthcare, Wachter contends. He points out that AI algorithms and machine learning are being developed today to help clinicians quickly sift through big data to diagnose diseases early and determine the best treatment options for patients that will improve health outcomes. Making this computing process possible is the widespread digitization of healthcare data.
While the growth trend in medical imaging and diagnostics is expected to continue in the next decade, the application of AI in healthcare will also extend to smart devices, virtual assistants and remote patient monitoring—among other technology areas.
John Halamka, MD, CIO of Beth Israel Deaconess Medical Center and head of its Health Technology Exploration Center, contends that there is no way to accurately predict the trajectory of AI over the next 10 years. But, he says within five years, “machine learning will be standard as augmentation for clinical decision making.” In addition, Halamka forecasts that “images, structured data, and unstructured data will all be part of curated machine learning training sets.”
At the same time, the lack of a skilled AI workforce in medicine is a challenge that must be addressed if machine learning, deep learning and natural language processing are to be widely adopted. Clinicians need training on how to integrate these tools into clinical workflows as well as understanding the technology and their ethical implications.
“The tricky part here is not AI’s predictions—the tricky part is going to be integrating them into real life practice,” observes Wachter.
When it comes to the “black box” phenomenon of AI and explaining to clinicians the internal workings of algorithms and how they arrive at their results, neither Halamka nor Wachter are concerned. “My experience is that clinicians will trust the black box as long as the results are well validated,” he explains.
Nonetheless, Wachter is concerned about potentially damaging biases in the data on which AI and machine learning algorithms are trained. “Some of the ethical and bias issues are real,” he concludes. “It’s an analogue of the black box phenomenon, because if you don’t understand what the algorithm is picking up on, there’s a risk that it may give a result that reflects a bias that was in the data sample that it analyzed.”
Digital health tools gain more traction in expanding the footprint for treatment
In the coming decade, providers will increasingly implement digital health tools, enabling new methods and modalities to improve healthcare.
With the industry moving to value-based care, clinicians are looking to integrate these technologies into medical practices to better understand and manage chronic diseases outside of the clinical environment.
Specifically, the implementation of remote patient monitoring by leveraging connected and wearable devices, sensors and trackers will be the platforms that gather patient-generated health data to facilitate disease management and patient engagement.
When it comes to the management of patients with chronic diseases, Robert Wachter, MD, chair of the Department of Medicine at the University of California-San Francisco, predicts that the “15-minute office visit every three months will be massively supplanted by a model where patients are being monitored at home” through remote monitoring that captures and records physiological data.
John Halamka, MD, CIO of Beth Israel Deaconess Medical Center and head of its Health Technology Exploration Center, contends that patient-generated data from these digital tools will personalize care in a way that was not previously possible.
“Internet of things data from mobile apps and wearables will be routinely included in the health record,” Halamka says. “Analytic tools will help to identify events and actions based on these new data sources.”
Nonetheless, the challenge is that clinical integration of these digital health tools is currently lacking and will be a complex healthcare data management problem to tackle in the next decade.
“It’s an incredibly interesting time in healthcare as we try to figure out how to make sense of all the data sources and present it in a way that doesn’t create data overload,” says Wachter. “It will become absolutely fundamental for any healthcare system to try to figure out how to take that data and monitor it, manage it and intervene in ways that do not depend on patients coming into the office.”
Cybersecurity, interoperability and privacy are among the challenges that providers will face in the coming decade as they figure out how to collect, store and analyze the tsunami of patient-generated data from digital health tools—and, then, how to make it actionable.
“Ten years from now, that system better be built out or you’re going to have this massive conflict between patients generating all of this data and it going virtually nowhere,” adds Wachter. “The question is where does it go and how does it get integrated into the data that’s in the electronic health record.”
However, Halamka believes a “new generation of apps and cloud services will surround the EHR” integrated by HL7’s Fast Healthcare Interoperability Resources (FHIR) standard. “The EHR will be more of a back office transactional system with new add on apps and services significantly improving usability,” concludes Halamka.
Imaging holds promise, but faces cost and appropriateness questions
The promise of radiological imaging in healthcare in the next decade won’t be curtailed by technological limitations—resolutions are increasing, and viewing options will expand to include three-dimensional viewing, as well as augmented and virtual reality.
The restraints may come in the form of increased oversight of the use of imaging procedures, as well as the impact that the rising prevalence of value-based care contracts will have on imaging studies.
Annual spending on medical imaging grew dramatically in the last decade—utilization of these exams in the U.S. was the second highest in the world in 2016, according to research published last year in the Journal of the American Medical Association.
In the next decade, clinicians will be prodded to pay attention to the appropriateness of diagnostic studies. A key initiative in this arena is Medicare’s Appropriate Use Criteria Program, which launches January 1.
With 2020 serving as a training year, beginning Jan. 1, 2021, the Centers for Medicare and Medicaid Services will stop reimbursing radiologists and other providers who perform imaging for certain outpatient advanced diagnostic imaging claims if the ordering professional did not consult a qualified clinical decision support mechanism. Clinicians who are found to be the most prone to ignore clinical decision support will be required to get prior authorization.
As healthcare systems gradually transition to value-based care, providers are expected to reduce the number of unnecessary imaging studies, according to experts such as Paul Chang, MD, professor of radiology and vice chair of radiology informatics at the University of Chicago. Providers are expected to lean more heavily on using technology and evidence-based medicine to ensure they do only the most appropriate studies.
Meanwhile, healthcare information technology will seek to assist clinicians with interpreting images and better integrating studies from diverse modalities together and into electronic records systems.
Artificial intelligence already is proving helpful in various one-off studies. However, more coordination is needed—while AI could transform clinical imaging practice over the next decade, research is still in its early stages, and knowledge gaps must be filled if AI is to reach its full potential in radiology, say researchers looking to develop a roadmap for AI use in medical imaging.
Medical imaging also is expected to give a boost to the use of 3D printing in healthcare. In the past decade, these printing capabilities have advanced rapidly, with substantial gains predicted for the next 10 years.
For example, two of the nation’s largest radiological organizations will collaborate on an initiative to gather 3D printing data at the point of care. The initiative is being coordinated by the Radiological Society of North America and American College of Radiology.
3D printing is expected to provide clinicians with the capability to manufacture customized replacement parts that are specific to patients, aiding in fixing bones, joints and other body structures. And, research continues on using 3D printing methods to create viable organs and body parts that can be implanted surgically and survive in the body.
Data sharing across healthcare will improve as pressure to comply increases
Both carrots and sticks should propel interoperability over the next 10 years.
As a result, significant improvements in the exchange of patients’ clinical information should become a reality in the 2020s.
A variety of factors will improve information exchange in the new decade. High among those are the maturation of HL7’s Fast Healthcare Interoperability Resources (FHIR) standard, which in 2019 reached the normative stage. The widespread adoption of FHIR is expected to facilitate information exchange throughout the healthcare universe.
App developers, health IT vendors and providers have widely embraced FHIR—which includes the RESTful application programming interface—to help solve the interoperability challenges confronting the healthcare industry as it seeks to increase access to electronic health records and data sharing, says Chuck Jaffe, MD, CEO of HL7, which has coordinated development of emerging standard.
Last year, the adoption of FHIR for sharing electronic medical information reached critical mass, according to the Office of the National Coordinator for Health It. And, ONC has proposed a rule that seeks to make FHIR a requirement for developers participating in the ONC HIT Certification Program.
The programming ease of FHIR, and the ease with which it can be incorporated into providers’ information systems, offers promise that data exchange will be simplified in the next decade.
In addition, information system vendors are facing increasing pressure from their customers to make sure information can be easily exchanged between different types of systems. And as consolidation occurs among records systems vendors, there’s greater likelihood that information can be more easily exchanged by customers using one vendor’s technology.
For example, Epic Systems is fostering a One Virtual System Worldwide initiative for clinicians across all organizations using Epic to exchange data and collaborate more around it. All of Epic’s customers are connected through Care Everywhere, and the Come Together initiative aims higher, to bring data together not only from Epic clients but also hospitals that use rival vendors’ EHRs.
Finally, there are the “sticks” mentioned earlier—increasing government pressure on the industry to improve interoperability. The federal government is increasing pressure on providers and vendors to use systems that don’t block the exchange of health information, and that regulatory pressure will continue to increase until the industry demonstrates that technology helps—and does not impede—information exchange, many experts believe.
Patient communication and engagement will get a boost
Patients and clinicians generally want more communication and interaction, and technology is expected to help enable that in the 2020s.
Previous generations of physicians tended to want to place limits on enabling direct communications with patients. But now, familiarity with technology—and its potential to increase productivity and effectiveness—have increased provider willingness. And other factors are providing impetus as well.
The uptick in communications isn’t waiting for the new decade—it’s already underway. A study in January 2018 examined how patients and healthcare providers communicating outside of the office was changing. The study, led by Joy Lee of the Regenstrief Institute’s Center for Health Services Research, considered how patients and providers felt about email, cell phone and text interactions.
Physicians, for instance, worried about patients missing urgent messages as well as not understanding the messages, and they also worried about the amount of time spent on communicating with patients and about data security. Now, Lee’s focus is on patient-clinician communications and interactions, and the effect that has on improved care.
With IT tools enabling timely data exchange, now is not the time to follow the status quo but to focus on data exchange that spurs action and leads to patient care improvements, Lee contends. Visualization tools and platforms let case managers analyze patient status to determine when they need to act, and the tools also support the streamlining of workflows to ensure that proper care is being given at the proper time, she adds.
In addition to patient-clinician communications, Lee also conducts research on improving chronic disease management and evaluating medication safety.
Healthcare organizations have made wide use of portals to enable patients to have access to information in their medical records. The new decade will see provider organizations improving how patients access their information, which will further support efforts to gain patient involvement, improve communication and ensure patient satisfaction with care.
Insurers reinvent themselves to react to the shift to value-based reimbursement
Healthcare payers will continue to see their roles in the health ecosystem change and shift in the new decade.
That presages a whole different range of information technology needs that are vastly different from the systems they’ve used for years.
Value-based care is the impetus for the change. Payers are feeling the pressure to change their reimbursement criteria from paying providers for the quantity of services they provide to instead measuring value as the basis for payment.
Initiatives that are using value incentives have gained traction and shown results. For example, accountable care organizations participating in the Medicare Shared Savings Program have generated $ 1 billion in savings since their inception—leading the way in value-based care, according to a report from Innovaccer, a data activation platform company.
Payers, which have concentrated on building and maintaining systems to manage claims submissions and payments, now will need to implement IT systems that will support changes in how they interface with consumers.
For example, as consumers take on more responsibility for their healthcare bills and expect on-demand services from mobile devices, providers and payers need to up their game. Consumer experience with healthcare organizations will extend to how they pay for services and the ease with which they handle growing financial responsibilities with a variety of healthcare organizations, according to a survey released by InstaMed, a company that facilitates medical billing and payments.
In addition, large payers are segueing from being claims intermediaries to wanting to play a larger role in improving patients’ health. As value-based care takes hold in the 2020s, health insurers will need to implement systems that interface with consumers and handle new types of data.
For example, UnitedHealthcare says it will increase its use of data from digital devices to help Medicare Advantage plan members manage chronic conditions. The company plans to increase its footprint in providing personalized, holistic support through its Navigate4Me program. It’s part of the insurer’s effort to build a more effective care management program.
Further, the company has started a program that uses the Apple Watch to meet daily activity goals intended to improve members’ health status. UnitedHealthcare says members who meet daily walking goals can obtain the Apple Watch. The device will be integrated into UnitedHealthcare Motion, a national digital wellness program that provides eligible plan participants to activity trackers.
Finally, as health insurers take on more responsibility for consumers’ health, they see the importance of being able to assess and influence all the forces that affect health—not just the care they get when sickness occurs. Health plans are paying attention to many factors widely known as social determinants of health—crucial keys such as access to transportation and food, isolation and loneliness, lack of family or caregiver support.
America’s Health Insurance Plans has started an initiative intended to gather and enable the sharing of approaches that address these social barriers to health and long term well-being. The program, called Project Link, “aims to make these efforts scalable, sustainable and measureable, with the hope to diminish long-term costs,” said Matt Eyles, president and CEO of AHIP.
IT has its work cut out for it as care becomes more personal
Healthcare’s one-size-fits-all approach to treating patients will start to be replaced next decade with a personalized approach to medicine that focuses on individuals, giving clinicians and patients access to the kinds of information needed to create individually-tailored programs to treat a variety of diseases.
While some pundits might contend that precision medicine is a distant future, the technology is already here, according to John Halamka, MD, CIO of Beth Israel Deaconess Medical Center and head of its Health Technology Exploration Center.
All that is required for putting genomics to use in precision medicine are to ensure that the critical pieces are more evenly distributed and adopted, Halamka says.
“Clinical genomics may not be synonymous with precision medicine, but it is certainly one of the key components that are helping practitioners realize its promise,” notes Halamka, who co-authored a 2018 book on the personalization of medical care. He points out that oncology and pharmacology are the specialties most impacted by genomics. However, Halamka predicts that by the middle of the next decade, “biomarkers, genomes and microbiomes will routinely be included in patient records and used as part of care planning.”
Genetic testing is opening doors for the identification of patients with increased risk of certain diseases as well as their response to targeted therapies.
Health systems like Geisinger have embraced precision medicine—integrating genomics and data science to prevent early-onset cancer, cardiovascular events and other diseases. Geisinger’s MyCode Community Health Initiative has enabled patients to detect cancer earlier than they might otherwise and to identify heart disease before any clinical symptoms are present.
In addition, medical research is poised to potentially yield breakthroughs next decade in personalized medicine. Robert Wachter, MD, chair of the Department of Medicine at the University of California-San Francisco, is encouraged by the National Institutes of Health’s efforts to recruit a million volunteers as part of its Precision Medicine Initiative’s All of Us research program.
Participants in the All of Us research program will contribute their physical, genomic and electronic health record data to help researchers make medical breakthroughs by measuring risk for a range of diseases based on environmental exposures, genetic factors and interactions between the two.
At the same time, Wachter warns that in everyday clinical practice the challenge is to “integrate all of this precision information.” He points out that EHR systems are currently “fairly clunky” in the way that they handle genetic information. “We have to embed that in the electronic health record and provide really useful, seamless clinical decision support to deliver individualized medical care,” he adds. “It’s not quite ready for prime time. The good news is that EHR vendors know that a whole lot of genetic data is coming at them and they are building out modules that will accept it.”
Patient demand for virtual care is expected to soar
In the 2020s, healthcare organizations will be looking to increasingly keep tabs on patients, whether they are inpatients or recuperating in their homes.
Many of the demarcations of care will continue to blur in the next decade, as providers are increasingly at risk for treating patients—and making sure they are not unnecessarily readmitted.
In fact, when it comes to virtual care, Paul Testa, MD, chief medical information officer at NYU Langone Health in New York, doesn’t distinguish among different approaches to care, such as distant care or patient monitoring. Patient monitoring, he believes, falls under virtual health, the ability to provide tethered care at a distance by the sharing of other connected devices and computers.
For years, patient monitoring has been hampered by state laws that made it difficult for providers in different states to collaborate. But with patient engagement rising and everyone having a smartphone the barriers are coming down. “States are recognizing the need to treat patients across state lines without onerous licensing regulations,” Testa says. “The trend now is for states to recognize providers treating patients outside state licenses.”
The idea is that if a physician has an established relationship with a patient that relationship should be permitted to continue even absent a license. “Technology has not been the limiter, it’s been how we support proper payment and states’ regulations. Much like patients are excited about the ease and convenience, so are doctors as it makes the practice more efficient and enjoyable.”
The industry now is beyond the days of beta-testing telehealth and other virtual tools, Testa contends. “Providers are showing that they want in, and as regulations fall there will be a substantial change in the way we delivery care in this country.”
While Testa is high on virtual care he also knows there are roadblocks ahead. “I fear the fear of change and am concerned of patients sharing data with care teams and not having to take the subway to get to the doctor. That could affect every doctors’ practice.” He worries how that would affect payment parity and how to reach out to patients where they want to be, which may be across state lines.
Telehealth, however, is inevitable; the horses have left the barn on that issue, Testa acknowledges, and patients have made it clear that they want virtual care even if the doctors don’t. “Obligating patients to come to the office will gradually go away.”