New to-do lists loom for 'post-EHR era'

IDC sees big changes afoot for 2014
By Mike Miliard
11:12 AM
New to-do lists loom for 'post-EHR era'

As the electronic health record becomes "just another app," more and more providers are setting their sights on an array of complex future needs. IDC Health Insights' latest report sees big changes coming for care delivery in 2014 and beyond.

The "U.S. Healthcare Provider Predictions for 2014" report, authored by IDC Research Director Judy Hanover, spotlights the technologies and strategies that will be top-of-mind in the coming year, and shows how new realities will be shaping investment priorities in an era of regulatory burden and increased risk.

Chief among those big changes will be a reshaped role for EHRs, Hanover tells Healthcare IT News.

"What I've seen in hospitals is since 2009, and starting in earnest since 2010, is they've been laser focused on getting to Stage 1 meaningful use, and then expanding use of the EHR and related functionality to get to Stage 2," she says. "For the larger organizations that have been successful with EHRs, that started to pull away in 2013 – and what I'm seeing for 2014 is that they're really maturing and moving on to the next step."

That means they're looking for "infrastructure and platform options that will help augment functionality, perhaps to go beyond what's available from the basic EHR in order to meet the needs of their workflow and how that's changed with accountable care," she says. "They're looking at backup and disaster recovery solutions. They're looking at storage environments that start to centralize and organize clinical and imaging data. They're pulling away from an EHR application-centered focus and looking at the broader IT ecosystem."

As shown by the following 10 predictions from IDC, 2014 looks to be something of a pivot point, as provider IT departments start to look beyond the basic commodity of EHRs and toward a more complicated and demanding future.

1. First-generation EHR will continue to fail

"'Fail' is probably a little dramatic," says Hanover. "But what we're seeing is that U.S. providers are feeling themselves in a place where they may have implemented the full functionality of an EHR, and they look at the roadmap for their EHR supplier and do not see the types of tools they need in order to restore productivity. They're looking at communication and care coordination, and at things that go beyond EHRs. So in that case, the EHR is just becoming an app on the platform. In that sense, the EHR as the go-to place where providers will work, in a sense, is failing. We're seeing EHRs getting replaced with other EHRs that support broader platforms, more apps, more capabilities. As well as EHRs being incorporated into larger IT initiatives to create platforms that allow new apps for specific populations or care situations and go beyond the functionality of the EHR. The EHR as the be-all, end-all for care delivery, I think that idea has failed, and we're seeing providers continue to realize that."

2. The industrialization of healthcare will accelerate

By "industrialization," Hanover says she means "the transition of healthcare from a one-off experience with a patient to a repeatable, standardized process of care where we have more uniform outcomes and approaches to care delivery." That translates to "better-quality care with improved productivity for providers, so we can really begin to create some value in healthcare delivery."

3. Healthcare cloud adoption will flourish

"Cloud aligns so well with accountable delivery and these communities of care we're creating," she says. "And I think the security issues that have surrounded the cloud have proven to be largely unfounded. The majority of CIOs we talked to in this survey felt that they could provide better security in the cloud than they could in their on-premise deployment. And with the HIPAA omnibus rule, and the ability to sign BAAs, that reservation about security in the cloud has decreased. I think adoption is flourishing: We're seeing more and more use of virtualization, desktop, server, storage in hospitals even when they're hosting their entire data center on-premise. We're seeing that architecture creating a pathway for those organizations to move to the cloud. And as they add new capabilities, they're resourcing them to the cloud."

[See also: Has the cloud found its moment?]

4. The criticality of analytics will grow

"We're looking more and more at costing, which is definitely going to be front and center," says Hanover. "I'm speaking to more and more hospitals about activity-based costing, cost accounting. And those systems really aren't available. We're seeing a rush to make those systems available so providers can understand their costs. And then performance analytics: The analytics we have now is not as precise as we'd like, but providers are still learning a lot about their costs, doing clinical and financial analysis. They're identifying high-risk patients to better understand their outcomes. They're looking at specific populations to develop analytic tool sets to keep track of those patients and reach out to them. And to really communicate and collaborate via those analytic applications – whether it's sharing patient documentation across a health system or aggregating and doing some reporting to identify gaps in care. Analytics is being applied to all those and we're starting to see some success from it. It will continue to be an investment priority."

[See also: Analytics means we 'roll up our sleeves']

5. Personalized clinical decision support will become closer to reality

Personalized medicine usually means care plans based on genetic data. And Hanover says this new development for CDS "eventually, I think, will involve genomics – that's sort of the end game." For now, however, "what I see coming close to reality is clinical decision support moving from rules-based systems that are generalized and don't really reflect the particular patient's medical history," she says. "So we're going to move from a rules-based CDS that fires an allergy alert for medication every time it comes up, to ones that really look at a patient's history in the system and only fire when it's appropriate. And then get more and more customized to reflect multi-factorial analysis. Patients with multiple comorbid conditions, and really provide specific, customized decision support recommendations that come from the organizations' own clinical data and guidelines, the patient's medical history, scientific and medical literature, best practices and guidelines from medical boards and other organizations. Boil those down and really provide detailed, personalized, patient-specific recommendations. It will make decision support more useful, and more likely to be accepted by providers."

[See also: Benchmarks: Changes are afoot for clinical and business intelligence]

6. Provider consolidation will continue

"Consolidating ambulatory practices, I think, has slowed down; It just hasn't been as successful," says Hanover. "But on the hospital side, I definitely see it continuing in 2014." One driver, she says, has to do with "haves and have-nots" -- smaller, under-equipped hospitals being scooped up by larger organizations. "I think some of the consolidation is coming from that gap: the haves consolidating with the have-nots, to cross that gap. When it comes to meaningful use, sharing technology is a factor. So are economies of scale, and the operating requirements to be an ACO."

7. Revenue cycle management will become mission critical like never before

"It all has to change because of ICD-10 anyway, so we're all going to do a better job with revenue cycle in general," she says. "We've been looking at patient satisfaction surveys, and no matter how good you do when the patient's there, if you send them a bill that has a really big number on it, if they can't understand why that number is there, and what they're paying for – and you send it a month after they're discharged – it's not adding much to their customer service experience. So we see revenue cycle really transforming: Looking to understand up front what the costs are, to be able to discuss costs with patients. To have them understand not just what the different treatment options are, but the financial impact. That will be particularly helpful for self-pay and high-deductible patients. And then concurrent coding – getting bills out quicker and being able to provide estimates when people agree to care and treatments will be really important. It's something that the current generation of revenue cycle management systems don't really do. We also see hospitals creating a lot of efficiencies by adding computer-assisted coding and clinical documentation improvement programs, and we think that's going to be critical. The provider organizations that have that in place are going to do a lot better with ICD-10 than the ones that don't. I think we're going to have a major claims denial issue with the implementation of ICD-10, and those are great ways for providers to prepare to do a little bit better at ICD-10 than their peers."

[See also: Revenue cycle ripe for radical change.]

8. Underinvestment in business continuity will come home to roost

"We saw another big EHR failure a few days ago," Hanover points out. "We're just starting to depend on EHRs. They always, by definition, were mission-critical. But providers, when they break down now, are really having to stop work. As organizations mature and there's staff turnover, we see fewer and fewer staff in the hospital who know the process from when we used to do it on paper. So we've really come to depend on EHRs and we can't afford downtime. It endangers our patients: Patient safety, when we have to go back to paper processes, is not as well-ensured. And it's becoming very inconvenient for providers. So investing in data recovery and business continuity tools – particularly as providers become more ready to use the cloud, and to access capabilities in the cloud that were very expensive or very difficult to install on-site, or even just the ability to have a second site for business continuity via the cloud is becoming very attractive. EHRs and other clinical applications are becoming better suited for continuous and more frequent replication. Providers need to invest in business continuity. They need to test their systems to ensure they know what to do and that they work well when they do have trouble. And to be able to continue to deliver safe, quality care even when there are network troubles."

9. Security and privacy issues will drive providers to the private cloud

"This is one of the things that's driving private cloud investment: the ability to better support security requirements," she says. "Our survey results show that 67 percent of respondent say they can offer better security than the level their own IT team can provide when they use the cloud. That's starting to solve a lot of privacy and security issues and reduce risk."

10. Compliance will cost you more than you think

"With all of these investments, we see providers under-budgeting for them," says Hanover. "The size of their IT budgets in general – and the amount that's pointed towards business continuity and disaster recovery, and compliance with privacy and security, in particular – is woefully small. They are going to start to see penalties, and see those problems grow in importance. And they will need to budget for it. They need to prepare to expand those budgets, because they will need to make those investments."