One thing you are sure to find this time of year are predictions. I’ve decided to do my own not so much to join the crowd but rather because I look forward to comparing my predictions to what actually happens in a little less than a year from now. So with that, here are my predictions for the year in HIT – which ones do you think will come to pass, and which ones have I missed?
1. mHealth experiences a re-birth
mHealth is all the rage and for good reason – it holds great promise to make a significant impact for both providers and consumers alike. But while mHealth for consumers is still on the upswing of innovation and expectations, mHealth for providers is starting to pass the Peak of Inflated Expectations. Walk the floors of any HIT trade show over the last year+ and you were bound to run into iPads at every turn – not necessarily because these vendors were mobile app developers, but because they either 1) wanted you to think they were or 2) managed to make their products “accessible” via a mobile device. But accessible is not the same as usable or efficient. Perhaps the most public example of this was chronicled in a CIO magazine article that described physicians handing in their iPads after a poor experience accessing their EMR. This doesn’t signify a failure of mHealth for providers, rather it was a failure to recognize that app design is arguably more important on a mobile device than in a portal/web or desktop application. Design flaws and workflow gaps are even more exposed on a mobile device. Now that the market has begun to recognize and experience this reality, intelligently-designed mobile apps (whether native or web apps) will continue to rise to the top and carry providers through to the Slope of Enlightenment.
2. Providers begin to expect full workflow support on mobile devices
This prediction is admittedly a bit late as providers have already moved beyond mobile access to clinical results to expect full workflow support. And why not? We should not expect a physician to access lab results on his/her iPhone only to set that device down on the nursing station next to the computer terminal (that is already in use) to enter orders, document care, enter a charge, etc. Perhaps what has fueled this expectation the most is the iPad and other tablets (though not many others). Not many would expect to enter a clinical note or use order sets on a smartphone, however, the tablet form factor presents a new opportunity to do just that – support a physician’s entire workflow. Full, integrated workflow support is a (perhaps the?) critical component of sustained physician adoption of HIT. Where reasonably-sized form factors are concerned, this will also hold for mobile workflows.
3. What worked for Stage 1 will not for Stage 2
My summary of the first year of Stage 1 Meaningful Use (MU): fewer than expected (or budgeted by OMB) meaningful users in year 1, lots of confusion and less movement due to the Stage 2 delay that wasn’t a delay, and early movers characterized by the use of existing systems to meet the bare minimum Stage 1 objectives (e.g., using ED systems to achieve the 30% CPOE threshold). But many hospital IT and physician leaders have already or will soon realize that a Stage 1 strategy isn’t likely to succeed for Stage 2 and beyond. The latter stages are going to require much deeper adoption, use and exchange of health information. IT leaders will need to lay a strategic path that considers all stages of MU, ICD-10 migration, efficient revenue capture, ACO/Value-Based Purchasing and a litany of federal, state and local priorities if they are to be successful. Each of these and other priorities hinge on efficient, meaningful use (pun intended) of integrated systems that respect and protect physician efficiency (and revenue) if they are to succeed.
4. ICD-10 is not Y2K
As the fireworks exploded in Times Square last night, someone said to me “remember how freaked out everyone was at this very minute back in January 2000?” Yes, I do, and the fallout (or lack thereof) threatens to put providers and hospitals significantly behind the ICD-10 eight-ball if they consider that migration to be another non-event like Y2K. Most reports, surveys and commentary place providers and hospitals significantly behind in their preparations for migration to ICD-10. This will have to change in the coming year. But I believe the challenge and emphasis will ultimately be on documentation and not on systems simply supporting the 4-fold increase in the number and format of ICD-10 codes. IT solutions that focus on improving documentation (thoroughness and efficiency) will best prepare providers for ICD-10 and shield them from the potential loss of revenue.
5. ACOs will (continue) to get more attention than they deserve
This is not a repudiation of ACOs or what they attempt to accomplish. But ACOs have dominated much of the conversation during the latter half of 2011, and I expect that to continue. While the tenets and concepts of ACOs are likely here to stay, I still think it’s too early in that process to warrant the airtime to-date. Instead, providers will continue to focus on many of the critical building blocks required to support successful ACOs in the coming year – they just won’t necessarily be doing so in the name of a formal ACO. Do you sense a common theme? Use of integrated, efficient systems in the name of care coordination and higher-value care. While ACO will undoubtedly continue as the preferred acronym of the day, the foundational work required to support an eventual ACO model will be where the real action happens.
Happy New Year!
I wrote my very first blog post almost exactly one year ago. The topic – physicians aren’t technology-averse, they are just averse to technology that doesn’t meet their needs. An article published today by the American Medical News says “For years, many advocates of information technology viewed physicians as computer-phobic Luddites, slow to adopt and benefit from health IT. As it turned out, many doctors are enthusiastic users of technology. The key is for them to find something that serves their needs, rather than being forced to bend to the needs of the technology or the institution behind it.”
I couldn’t have said it better myself (actually, I did). The article cites physicians’ adoption of mobile technology, which vastly exceeds that of the general populace (5x greater), as a primary example of physicians adopting technology. The article continues to describe the App Challenge sponsored by the American Medical Association. Any U.S. physician, medical resident or medical student is eligible to submit an idea for a physician-focused app with winners to receive a $1,000 American Express gift card, a $1,500 Apple store gift card and a round trip for two to New Orleans for the AMA House of Delegates Interim Meeting in November. Great prizes and great idea.
mHeath has definitely greased the skids for successful physician use of IT, but the common theme is applications that support their workflow will be embraced by the physician community.
On it’s “face” (sorry, couldn’t help myself) it seems contradictory at best. How can spending more time with technology actually increase (and improve) the amount of time a physician spends with a patient?
But that’s just what a recent study found – moving certain functions online (namely, administrative functions like scheduling, bill pay and insurance verification) provides an opportunity for more efficient and productive doctor-patient visits (study results). While it only makes sense that taking care of largely administrative tasks online could improve this interaction, it goes beyond the transfer of work outside the actual visit. Providing patients with access to their health information as well as general wellness information increases personal engagement in their health, something that all providers should strive to achieve, particularly as they become more financially responsible for outcomes.
The key, according to a report by Arash Mostaghimi, MD in the Annals of Internal Medicine, is to provide “ubiquitous access to information instantly.” According to Mostaghimi, it’s not about the communication tool (e.g., email vs. social media) as much as it is about providing information by whatever methods patients prefer. This will likely take time, however, as adoption of Personal Health Records (PHRs) by providers and patients alike has been slow. And doctor-patient communication by email remained constant (and low) at 2.9% between 2003 and 2008 according to published by the Journal of Medical Internet Research. Time contrains, privacy and security, and lack of compensation are all listed as contributing to slow physician adoption.
According to Mostaghimi, waiting for the ideal or a standard technology won’t work. Physicians need to familiarize themselves with the kind of communications their patients prefer. As payment continues to move toward value- and outcome-based payment, physicians will continue to have the incentive to engage patients in their own health and improve the quality of the doctor-patient interaction.
Today, Manhattan Research announced that 75% of U.S. physicians own some form of Apple device while, unlike the general consumer market, the iPhone continues to dominate Android among physicians.
Overall, smartphone penetration among physicians has already exceeded earlier analysts’ projections of 81% by 2012. Why has Apple dominated the device market and why has smartphone adoption among physicians exceeded that of the general population?
The answer to why Apple is actually pretty simple – apple has the iPad while Android is still waiting for a real market entry to compete with Apple’s popular device. The iPad has captured physicians’ attention like no tablet (or device) before, and this trend is likely to continue as more EHR venders provide access to their systems on this device. Another potential reason for Apple’s dominance could be as simple as the availability of healthcare-related apps. Developers have shown a willingness to create apps on the iOS platform more often than on the Android OS. Of course this could be a chicken-egg scenario – more apps and more market share beget more vendors developing on the platform and the opposite. Whatever the reason, more vendors support iOS than do Android at this point. It’s also possible healthcare organizations prefer the closed app approval process required of the App Store. The open source nature of Android app development has lead to higher incidence of malware attacks, something healthcare organizations are sure to want to avoid.
As for why smartphone adoption among physicians continues to be higher than the general population – smartphones and tablets support physician workflow in many ways like no device before. Physicians are inherently mobile, whether simply rounding from floor to floor to lab in the hospital or traveling from hospital to different physician offices. Simply put, a smartphone or a tablet fit within a lab coat better than a laptop or a computer on wheels. Due to their screen size and form factor, these devices run applications that must focus on efficient user interaction and experience with near instantaneous “boot up” time.
Bottom line, where physicians’ are involved, smartphones and tablets appear to cure what ails EHR adoption.
I just returned from the Diabetic Limb Salvage conference in Washington, DC. I could end this post on that note. If there ever was an example that screamed for marketing help, it’s a conference (or anything for that matter) that goes by the name of “Diabetic Limb Salvage.” But that’s actually not the entire point.
Physicians get a bad rap for a number of reasons often characterized generally as being more Dr. Evil than Patch Adams. A common explanation (not excuse) cited is that doctors walk out of med school with triple-digit debt – and that’s only from four years of study – forget that most go on to additional years of training at salaries not in-line with their level of expertise or responsibility. That would certainly challenge my disposition.
But it goes beyond simple salary implications. For the first time in history doctors are being forced to purchase and use electronic medical records (EMRs). You might think this is a good thing given the rest of the world stands in line for hours to buy the next “iThing” that Steve Jobs dreams up. But EMR technologies have not been designed the way Apple designs their products – that is to say, they have not been designed to serve the end user above all else. In addition, all specialties are at financial risk going forward, and the delta between them is shrinking. Finally, healthcare reform aims to provide benefits to nearly everyone, thereby guaranteeing an oversupply of patients for a chronically under-supplied pool of physicians. We need doctors, now more than ever.
Two things stood out to me at the DLS conference this week. First, doctors are “wicked smaht.” Yes, I always knew this having spent my career working with and/or designing products for their use. But if everyone could sit in a packed conference room watching a surgeon operate on a patient while simultaneously discussing (and debating) the merits of his approach before a panel of world-renown experts, you would get a new appreciation for just how much they really know. Secondly, doctors care very deeply about their profession and their patients. The winner of this year’s Georgetown Distinguished Achievement Award in Diabetic Limb Salvage went to Dr. Gary W. Gibbons. Dr. Gibbons was one of the more, shall we say, challenging physicians on the expert panel. Yet not five minutes later, while accepting the award, he gave an impassioned, emotional speech not about his career achievements (which are quite lengthy and impressive) but about their collective calling. He challenged everyone in the room to work together like never before on behalf of their profession, but more importantly on behalf of their patients. His conviction was as clear as the crystal award he held at the podium.
The themes of Dr. Gibbons’ speech and the dedication of those in attendance at the DLS conference should be part of the broader healthcare debate. See you at next year’s “Diabetic Limb Preservation” conference!