Health politics, a hyper-market for health IT, health-engaged consumers and privacy ambiguities … 'tis the season when Jane Sarasohn-Kahn provides iHealthBeat readers with her annual health IT forecast for the new year.
Read on for Sarasohn-Kahn's look into the health IT tea leaves for 2011.
Bipartisan support for health IT.
It's a long, long way between December 2010 and January 2014, when most provisions in the Patient Protection and Affordable Care Act (ACA) are scheduled to be implemented. While it's rational to expect that the Republican-led House will try to strip out various provisions in the law, there's long been one area of bipartisan support: health care IT. The HITECH Act, which was included in the American Recovery and Reinvestment Act of 2009 (ARRA), will withstand the Republican health reform hazing in Congress. While health reform may be in limbo -- individual mandate, state lawsuits, etc. -- health IT is bipartisan. So from a legislative standpoint, expect the health IT stimulus for electronic health records to still be a "go" in 2011.
A slower road to meaningful use?
There's the politics of health IT and ARRA stimulus funding for EHRs, which from a policy standpoint should hold in 2011. Then there's the reality of EHR adoption by providers in the market, which is where policy meets the real world of working doctors. In 2010, about 50% of office-based physicians had adopted some form of EHR, according to CDC. On the face of it, that sounds like a promising picture. However, the CDC survey found that only 10% of physicians were using a fully functional EHR. A similar finding from the 2011 Black Book Ranking's user survey suggests that 90% of health care providers are not on track to meet their meaningful use implementation goals by spring 2011. Several factors are preventing doctors from reaching meaningful use, notably lack of vendor support, funding needed for additional support from EHR consultants, lack of staffing to implement an EHR and other key obstacles.
Further down the road to data liquidity.
The use of health data standards paves the way toward interoperability among IT applications. There's evidence that the journey toward data liquidity, which happens when bits of health data flow between different applications and devices, has begun. One-third of hospitals surveyed by HIMSS Analytics said they linked medical device data -- most commonly information from physiologic and fetal monitors, ECGs and ventilators -- to an EHR. Further, more applications based on open standards are fueling analysts' ability to bring disparate kinds of health data together to predict public health emergencies, identify patients at high risk for certain conditions and pinpoint optimal evidence-based medical practices.
Mobile apps will be adopted by both consumers and clinicians.
Employers will continue to shift health costs onto insured employees. Starting in 2008, and throughout the recession, one-half of U.S. consumers rationed health care, according to survey data from the Kaiser Family Foundation and the Employee Benefit Research Institute. This has driven some consumers to seek alternative channels of care, from retail clinics to mobile health apps for self diagnosis, tracking and care on smartphones and tablets, namely the iPad. Meanwhile, the Healthcare Information and Management Systems Society finds that iPad deployments among clinicians also will substantially grow in 2011, in part because of the availability of point-of-care applications. Mobile apps are positioned to go mainstream in 2011 with both consumers and clinicians. Furthermore, smartphones' geolocation capabilities will figure into more mhealth apps in 2011.
The home as health hub: phase one. As consumers have begun to adopt mobile devices such as phones and tablets for health information gathering and tracking platforms, the phrase "home health" will take on new meaning as health care to the home goes beyond visiting nurses and Lifeline personal emergency response systems. The RAND Corporation surveyed six countries, including the U.S., to find evidence that home health care technology could help alleviate stresses on nations' health systems. However, even with promising technologies such as broadband, a growing array of digital health devices and a willing health consumer, a lack of aligned incentives prevent this new model of home health to penetrate the market. Nonetheless, more evidence will be published in 2011 that will support the adoption of and payment for remote health monitoring at home. Furthermore, innovative provider financing models, such as patient-centered medical homes and accountable care organizations, will offer financial incentives to promote continuous care management for patients to keep them well at home.
One-half of U.S. health citizens will use social media for health. In 2010, about one in three U.S. adults used some type of social media for health, including blogs, wikis and social networks, according to an iCrossing survey. With adult women and older people representing the fastest-growing users of Facebook, social networking is moving into the mainstream among people who need to manage chronic health conditions. Online patient communities that focus on life-threatening illnesses -- such as PatientsLikeMe and ACOR's listserv -- are maturing in the market. In 2011, more sites will emerge that focus on other chronic conditions, such as pain and depression.
"Free" health IT.
Here, "free" is used in the Chris Anderson sense of free: that is, as in the old business models of razors and blades, or cameras and film. Microsoft's HealthVault said that it wouldn't charge U.S. users to use the software. Practice Fusion offers a "free" electronic medical record that's based on an advertising revenue business model. "Free" ends if the physician user decides to avoid the ads for the cost of $100 a month. Business models in health IT will be challenged to make money in innovative ways, beyond advertising. This will continue to challenge traditional venture capital approaches that serve the health industry segment. At the same time, government agencies, such as CDC and HHS, will further open up data vaults "for free" so new applications and knowledge can be derived through what HHS CIO Todd Park terms, "Data Liberación!"
Help wanted: skilled health IT workers.
There will be stiff competition for skilled health IT workers in 2011. The Office of the National Coordinator for Health IT estimates that hospitals and physician offices need an additional 50,000 health IT workers in the next five years to meet meaningful use criteria. The health sector will compete with other industry verticals such as banking and telecommunications, keen to grab at the short supply of IT professionals. This demand will outstrip IT labor supply, driving up salaries. Health providers, already cash-constrained, will need to scale up their compensation packages to staff necessary IT positions required to meet meaningful use.
Health privacy ambiguity. There were over two million health data privacy breaches in 2010, reported on the HHS Health Information Privacy website, which lists all breaches affecting more than 500 individuals. Even though HIPAA marked its 14th birthday in 2010, consumers in the U.S. still lack basic understanding of privacy protections for their personal health data. In November 2010, the Federal Trade Commission published a framework for protecting consumer privacy across all industries, but the report pays special attention to personal health data. Beyond consumers, physicians face growing demands by patients to communicate via e-mail and join online social networks. The American Medical Association issued guidelines for doctors considering entering into online communication with patients, suggesting that online communications should mirror what doctors do face-to-face with patients. In the meantime, more health consumers are sharing personal health information online with other patients in social networks as a way of benefiting fellow patients and paying-it-forward for future patients diagnosed with their condition. Those who do share personal health data see value in doing so, as long as they control where this information goes and how it is used. 2011 will see more ambiguity surrounding health privacy, which will be the subject of continued debate between public and private sector stakeholders.
State economies may force health innovation. There's a looming crisis in state governments, as governors increasingly can't balance their budgets. CBS News is calling this "the day of reckoning" for state and local governments. This unfolding fiscal drama may rival the housing crisis, according to many analysts. With Medicaid representing one of the two largest state financial commitments (the other being education), governors are desperately seeking new ways to deliver health care to their citizens. The Commonwealth Fund recently studied states' innovations in health care delivery due to constrained economies. Underlying many of these innovations is a health IT backbone. Necessity being the mother of invention, health IT enables payers to measure what works and pay for quality. We can expect more state Medicaid and other safety-net programs to leverage IT to improve efficiency and effectiveness of taxpayer spending on health in and beyond 2011.
Bottom-line: a buoyant health IT economy.
More money will be spent on health IT in 2011 than at any time in U.S. history. The signing of the 2009 federal economic stimulus package, which included the HITECH Act, attracted new entrants into the health IT market. We will continue to see a flow of health IT developers challenging long-standing players in the market on several fronts: for traditional applications, built on open source standards; for applications traveling over new platforms, such as mobile (phone and tablet) and cloud computing; and for innovative apps that pioneering providers and consumers will try out as early adopters.
Technology developments can be thrilling, like watching the dazzling array of new products announced at annual consumer electronics shows. However, the pace of change in health IT technology can blind us to market realities. Clinician workflow, patient life flow and health care financing models will shape just how and how quickly these innovations are adopted in a market that has been 10 years behind other industry verticals for many years. It's not national politics that will hold up health IT adoption; it's local market realities for providers, whose finances and workflows are already thinly stretched.