The 5-year plan: Where will healthcare be in 2017?
Now is time of year when people dust off their crystal balls, polish up their powers of prognostication and make predictions for the annum ahead. What will 2012 hold in store?
But with healthcare information technology evolving at warp-speed, Healthcare IT News wanted to cast a longer view: What can we expect five years from now? Where will we be in 2017?
Changes and about-faces, after all, can come quickly. Look at healthcare reform: That "big [blanking] deal" (in Joe Biden's timeless turn-of-phrase) was signed triumphantly into law in March 2010. In March 2012, the Supreme Court will weigh whether the legislation lives or dies.
But change can also come steadily and inexorably. Few could have imagined, after all, back when George W. Bush first called for expanded health IT deployment in his 2004 State of the Union Address, the vast growth the sector would see. From here-goes-nothing EHR installations at the smallest physician practices to huge, hospital-wide RTLS deployments to an explosion of patient-centric mobile health technology, the past five years have seen an unprecedented shift in the way care is delivered.
So where will we be five years from now? Can we transcend a bad economy and worse political discourse to further transform healthcare for the better? Will we be reaping the benefits of the fully wired and interoperable system to which we all aspire? Will the data and metadata gleaned from meaningfully used EHRs be transforming patient- and population-level health? Will access be improved? Will the cost curve be bending?
By 2017, meaningful use Stage 3 will – with luck! – be written into history, the last stimulus check long since cashed. The ICD-10 switch will – with luck! – be old news, having gone off without a hitch four years prior. Accountable care organizations will – with luck! – be accepted and established across the land.
Or not, of course. Only time will tell.
FIXING A BROKEN SYSTEM
As a certain gnomic Secretary of Defense once put it, there are known knowns, there are known unknowns and there are unknown unknowns. Let's start with what we know.
At the inaugural HIMSS Leaders & Innovators event, "Future Healthcare: Finding Answers, Creating Solutions," held this past November in Florida, C. Martin Harris, MD, chief medical information officer of the Cleveland Clinic, pointed to one thing all healthcare providers can count on: "Expect reimbursement to go down," he said. "You're going to get paid less and less for every service you provide."
Clearly, those fiscal constraints will help dictate the evolution of healthcare in the coming half-decade.
At the HIMSS event, former Vermont Governor Howard Dean, MD, called American healthcare "an insane system" whose annual cost increases are "preposterous." The good news? Dean said ACOs have "potential to really fix the healthcare system."
But former Senate Majority Leader Bill Frist, MD – with whom Dean was debating – demurred, opining that true "population-based medicine is five years off."
However long it takes, health IT continues to march forward at a brisk clip in the meantime, said Todd Park, chief technology officer of the Department of Health and Human Services, who spotlighted an array of public-private initiatives designed to spur innovation and increase return on investment for healthcare technology in the years ahead.
"The government is thinking very entrepreneurially about how to improve the ROI on entrepreneurship," said Park, excitedly describing the "emerging and very strong business case" for adopting the technology. The simple fact, he said, is that for all the highfalutin' talk about transforming healthcare, "you can't make it happen without innovative use of data and IT."
The good news is that new incentives for young developers, coupled with the "information liberation" spurred by Web 2.0, means "rocket fuel for innovation." In a lot of ways, said Park, "the future is already here."
SUCCESSES AND FAILURES
But there are still lots of improvements to make. And "I cannot see successes without an absolute state-of-the-art backbone on information technology," says Jeffrey Bauer. "Nobody can succeed in the future of healthcare without the best possible IT system."
Bauer bills himself as a health futurist and medical economist. With 40 years of experience as a researcher, policy adviser and consultant, he's written more than 200 articles and several books tracking the ebbs and flows of an evolving healthcare system. But before that, he was a weatherman.
Whether its healthcare finance or atmospheric physics, "I've just always been a data geek," says Bauer. About 25 years ago, he realized that if he wanted to glean where healthcare was going, "instead of doing the predictive modeling that I'd focused on in the '70s as a medical economist … what I really ought to be doing is applying training from my weatherman days."
The future of healthcare is "not a single point," he says. "I have a very expansive view, and that comes as a forecaster. A forecaster realizes you can have lots of different weather." Likewise, "healthcare in the United States is going to head in many different directions in the next five to 10 years."
At one extreme, will be some "colossal failures," says Bauer. "A lot of healthcare organizations in the business today are going to find that it's extremely difficult to stay in the business. We'll see a lot of hospital closures." On the other hand, "I think we're going to see some smashing successes. People are beginning to recognize the need for change – and the need to do it around health IT."
And the most successful organizations five years from now will be those that not only used IT, but "realized the need to use it much faster" than HITECH initially mandated, he says: "the people that didn't wait for the government to tell them" how to be effective care providers.
"By 2017, we will be well down the way to a shift in the clinical paradigm from one-size-fits-all to highly individualized medicine," says Bauer. "That can only be done with IT and team-based practice."
But these advancements won't be without significant stumbling blocks. The "biggest constraint," he says, is "a horrible economy. And that dismays the heck out of me." Not for nothing, "virtually everything being done in Congress right now will make things worse," he adds. "I've been an upbeat guy my whole career, but our dysfunctional politics really scares me."
A DELUGE OF DATA
But government can do good things. Barry Chaiken, MD, founder and chief medical officer of DocsNetwork, Ltd. and former HIMSS board chair, points to initiatives such as HHS-inspired code-a-thons aimed at "people who are young, who are thinking about these new ways of doing things."
Getting that new generation involved in health IT – a tech-savvy cohort who've seldom met a problem a few clever lines of code can't fix – is "really going to make a difference" for the future, says Chaiken.
Best of all, "the cost of these innovations is relatively small," he adds. "You don't have to have a server and multiple workstations and huge training sessions to do these tiny, little innovative things that can impact healthcare in these little spaces."
But beyond that technological sea change, by 2017, "I think you'll see a cultural shift," says Chaiken. "People will take more responsibility for their care. They'll get more involved in it. It won't be that they're as passive as they are today.
George Kovacs, an executive director at McKesson, agrees. One of his predictions for the near future – one that's already well under way – is that "mobile devices will seep into every corner and tablet devices will be much more accessible," and that patients will use them to monitor and improve their health and wellness.
The issue that raises, of course: "What do we do with all this data?" Kovacs sees provider networks increasingly "viewing data as intellectual property," and making more creative use of "tools to mine, search and deal with the data, not only for evidence-based medicine, but for real-time statistical correlation of individual patients to a normative database."
That "blows the doors wide open," he says, for decades to come. "We now have a generation that's growing up with electronic medical records that have been created for them from birth. When you connect all that, I can only wonder what we're going to learn."
This past summer, Alfred Hamilton, assistant professor in the Department of Health Services Management and Leadership at George Washington University, co-curated a symposium at GW titled "The Role and Future of Health Information Technology, in an Era of Health Care Transformation."
The confab – featuring National Coordinator Farzad Mostashari, U.S. Chief Technology Officer Aneesh Chopra, and others – aimed to tackle issues around interoperability and data sharing to better lay the groundwork for the future.
One of the session's many takeaways, says Hamilton, was that there are still "some major issues with trust, privacy and security" that "might limit the ability to be innovative and creative" in health IT if not addressed.
Patients need to trust the system. Because, ultimately, health system change will come from them. "Once we build a system where we empower the patient to take charge of their healthcare, it would be tremendous," says Hamilton. "Once we start focusing on the patient – not the payer, and not all the other stuff, we'll be in the ballgame."
The next few years represent a tipping point. Open-source collaboration, semantic technologies, universal exchange languages will lead to a new era of interoperability, says Hamilton, enabling system-wide advances in how data is put to use. "Once we start talking the same language, we can compare like things and develop quality indicators. If that happens, costs will go down and quality should improve."
In the meantime, there's work to be done. "It's a continuous improvement," he says. "I tell my class, it takes one to three years for an individual to change. It takes five to 10 years for an organization to change. It takes 15 to 25 years for a society to change. And it takes 50 to 100 years for a nation to change.
"Will we be there in five years? I'm not sure what 'there' is. In five years there will probably be something else we need to pay attention to. But in terms of addressing the issues of quality and efficiency, and putting the patient at the center of healthcare, I think we're going to be much closer – much closer – in five years."