As 45,000 from 90 countries descend on Orlando this week for the 2019 HIMSS Global Conference & Exhibition, the marque trade fair for buyers and sellers of health information technology, the importance of information technologies to the future of U.S. healthcare will be in the spotlight.
For the 1300 vendors who will showcase their solutions, it’s prime time. By day, the exhibit hall is a buzz; by night, the big-name players and national consulting organizations host dazzling receptions hoping to lure their best customers and prospects. The lesser known’s host intimate dinner meetings hoping their targets show up. Each views HIMSS as an investment in name recognition, competitive differentiation and client relationship management.
HIMSS attendees are HIT solution users hoping to catch the next wave of solutions. The 300 educational sessions are secondary at HIMSS: attendees are there to navigate the exhibit hall and compare war stories with their peers. Start-ups will tout new mobile apps, virtual reality solutions, voice generated devices and advanced analytics in the shadow of acre-size booths hosted by the industry’s biggest names like Epic, Cerner, MediTech, McKesson and others. And some attendees will attend breakout sessions about cybersecurity, analytics, interoperability, innovation, digital health, artificial intelligence, robotics, real-world evidence and other hot topics.
Few trade shows in healthcare are as significant as HIMSS. Every year, hundreds of start-ups join the mainstays in looking ahead at the future of health information technology (HIT) in healthcare. Arguably, its evolution mirrors the growing importance of healthcare to our economy and globally.
HOW DID WE GET HERE?
The evolution of HIT is a hundred-year journey. Standardization of medical records in the 1920’s and the use of computers in healthcare facilities in the 1960’s set the stage for the emergence of HIT. In 1965, 70 hospitals adopted electronic health records and the Veterans Health System’s VisTA program was implemented in the 1970s. These pioneer efforts came at a time when banking was implementing automatic tellers, retailers began using UPC codes for their merchandise and laptops were displacing desktops. But in healthcare, HIT was still relatively new with its solutions largely focused on administrative functions like billing, medical record storage and others.
In 1992, the World Health Organization created the ICD-10 coding standard (the U.S. version ICD-10-CM would not be implemented until October 2015). In 2004, President Bush created the Office of the National Coordinator for Health Information Technology to accelerate HIT adoption. Congress then passed the Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH) as part of the American Recovery and Reinvestment Act to establish policies around data sharing and interoperability, and the 21st Century Cures Act of 2016 expanded data access and interoperability to add individual consumers use of their smartphones and other electronic devices.
Over these 100 years, healthcare evolved from paper-based record keeping to computers, data, electronic transmissions and now artificial intelligence and the cloud. Like other industries, the transition has been bumpy: the focus on simpler administrative functions like billings, purchasing, and staffing preceded more complicated processes like matching signs and symptoms to the appropriate evidence-based treatments. And like other industries, the emergence of social media, like Facebook that debuted 15 years ago, has made cybersecurity and protection of personal information top of mind concerns in every organization.
HIT is now a critical focus in every healthcare organization. The effectiveness of the Chief Information Officer (CIO) and the sprawling set of responsibilities overseen is now a critical factor in every organization’s success.
THE THREE CHALLENGES THAT NEED URGENT ATTENTION
The HIT industry has contributed to notable improvements in how healthcare is delivered and financed, but it has a long way to go, especially in three areas:
Cybersecurity and Patient Privacy
Cybersecurity is considered a major threat in corporate America, prompting expenditures of $91 billion for security protections to their systems last year (IDC Health Insights). Per the Ponemon Institute’s Sixth Annual Benchmark Study on Privacy & Security of Healthcare Data, data breaches cost the healthcare industry $6.2 billion last year and 79% of healthcare organizations were hit with two or more data breaches in the past two years.
The issue: cybersecurity and data privacy are existential threats in healthcare. We’re behind.
HIT is underfunded. At 3% of revenues, it lags other industries like financial services (4%-11%) and others that are capital intense, data driven, highly regulated and premised on competition among private operators. For 23 years, healthcare CIOs and CTOs have faced tough questions about their ROI: how to link their budgets to better results and lower costs. Studies indicate HIT investments have reduced overhead as functions shift to outsourcing and the cloud, but net spending for HIT remains inadequate to compete in the expanding world of healthcare. Forrester’s 2019 Healthcare Predictions forecasts 8.8% technology spending growth this year across all industries; 89% of its survey respondents report they’re increasing their budgets for HIT. However, forecasts for HIT spending assume only 3% annual growth.
The issue: HIT funding is inadequate.
The Last Mile
Consumers are the last mile. Their interactions with the health system leave much to be desired. Much of HIT’s focus has been improvements among trading partners to improve the efficiency and effectiveness of their transactions; the last mile has been important but arguably subordinated. For Gen X, Millennials and Baby Boomers, mobile engagement and voice recognition technologies are keys. One in four households uses Siri, Cortana, Alexa or Echo for routine queries; 80% use a smart phone. They’ve quickly emerged as the primary source of information including healthcare. By next year, experts believe 25% of the data used in medical care will be originate from consumers via their technologies. (IDC Market Trends 2019). The expanding capabilities of pattern recognition in smart devices will make this information customized, easier to understand and readily accessible in the teachable moments when needed by consumers. This is not a technology issue. It’s doable today.
The issue: sharing of customized information with consumers to equip decisions about health and costs has not been its highest priority.
In my view, our system is at a tipping point: employers want more value and lower costs, physicians are frustrated and consumers are worried about affordability. Healthcare spending is going up faster than wages (5.5% annually through 2026), the number lacking insurance coverage is going up and a majority of voters want to replace the current system without knowing exactly what they’d have to give up.
In response, the industry landscape is in flux. Sector boundaries no longer apply. The future of healthcare is the combination of health and human services programs, financing and delivery of services, basic and applied research, diagnostics and therapeutics with real-world evidence readily shared, clinical models that integrate physical and behavioral health, medical management models built on conventional and alternative health strategies and more. Proficiency in deploying HIT, capturing and managing data and integrating multiple solutions seamlessly in these burgeoning systems of health will be key to their future.
Health information technology is the bridge to healthcare’s future. But the industry faces three urgent challenges: cybersecurity, funding and the last mile. Looking back a decade from now, the organizations that cross the bridge will be those that addressed these issues with urgency today.
Fact File: Health Information Technology
EHR Adoption: As of 2017, nearly 9 in 10 (86%) of office-based physicians had adopted any EHR, and nearly 4 in 5 (80%) had adopted a certified EHR. As of November 2018, over 9 in 10 hospitals have 2015 Edition certified technology available from their most recently reported EHR developer Office of the National Coordinator for Health Information Technology
Market Share Use of Certified EHRs: As of November 2018, market share of physicians using a certified product by developer: Epic (27.8%), AllScripts (9.7%), E Clinical Works (7.5%), NextGen (5.8%), GE Healthcare (5.2%), others (44%). Market share of hospitals reporting use of a Certified Electronic Health Record by this developer: Cerner (23.7%), Epic (22.2%), MediTech (20.8%), CPSI (13.8%), McKesson (9.8%) others (9.7%) Office of the National Coordinator for Health Information Technology
Demonstrated Meaningful Use of Certified EHRs by Physicians: As of the end of 2016, over 60 percent of all U.S. office-based physicians (MD/DO) have demonstrated meaningful use of certified health IT in the Centers for Medicare and Medicaid Services (CMS) Electronic Health Record (EHR) Incentive Programs. The range is from a high of 93% in MN to low of 46% in AL. Over 20% of nurse practitioners (NPs) and 2% of physician assistants (PAs) have demonstrated meaningful use of certified health IT. Office of the National Coordinator for Health Information Technology
Security: A majority of individuals (74%) are confident their medical records are safe from unauthorized viewing, but have concerns (66%) when health information is electronically exchanged. These perceptions are unchanged since 2011. 10% of individuals reported withholding information from their health care provider due to privacy and security concerns regarding their medical record. This is down from 15% of individuals in 2014. Office of the National Coordinator for Health Information Technology
Security: As of February 1, 2016, protected health information breaches affected over 113 million individuals in 2015. From 2011 to 2014, 97 hacking incidents affected less than 4 million individuals – less than 10% of all reported breaches and affected individuals during this time. HHS Office of Civil Rights
Consumer Connectivity: In the last 12 months, 42% of individuals looked for a health care provider online, 41% filled out paperwork related to their health care or made health care appointments online, 35% communicated with their provider online, 34% tracked health care charges and costs with a computer, smartphone, or other electronic means, 35% communicated with their provider online and 29% communicated with their health care provider via text message. Office of the National Coordinator for Health Information Technology
Physician attitudes: 70% of physicians say Electronic Health Record (EHR) systems provide useful analytics, better integrate health information technology, and facilitate a more holistic patient care model but 75% physicians think EHRs increase practice costs and reduce their productivity. Deloitte’s 2016 Survey of US Physicians
Cognitive Technology/Artificial Intelligence: By 2021, 20% of healthcare and 40% of life science organizations will have achieved 15% to 20% productivity gains through the adoption of cognitive/AI technology. IDC Health Insights
Office of the National Coordinator for Health Information Technology. ‘2015 Edition Market Readiness for Hospitals and Clinicians,’ https://dashboard.healthit.gov/quickstats/pages/2015-edition-market-readiness-hospitals-clinicians.php
“Predictions 2019: Healthcare: CX Measurement Frameworks, Virtual Care, and AI come To The Fore” https://www.forrester.com/report/Predictions+2019+Healthcare/-/E-RES144495
“U.S. Life Science Top 10 Market Trends for 2019” International Data Corporation. https://www.idc.com/prodserv/insights/#health-latest_research
“Artificial Intelligence–Based Automation Evolution Framework” Dec 2018. International Data Corporation. https://www.idc.com/prodserv/insights/#health-latest_research
“Sixth Annual Benchmark Study on Privacy & Security of Healthcare Data” May 2016. https://www.ponemon.org/local/upload/file/Sixth%20Annual%20Patient%20Privacy%20%26%20Data%20Security%20Report%20FINAL%206.pdf
“Deloitte 2016 Survey of U.S. Physicians” https://www2.deloitte.com/content/dam/Deloitte/us/Documents/life-sciences-health-care/us-lshc-physician-survey-hit-factsheet.pdf
Health and Human Services Office of Civil Rights https://www.hhs.gov/hipaa/newsroom/index.html