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6 Healthcare Trends to Watch in 2018

6 Healthcare Trends to Watch in 2018 | Healthcare and Technology news | Scoop.it

It’s 2018, and the world looks much different than it did a year ago. Go back even further and the differences are even starker. No place is that more evident than in healthcare. As the largest industry in the world, healthcare has weathered the most significant political waves of the last fifteen years. As the costs of healthcare increased unchecked, politicians took notice.

In our pseudo free-market health system, where a considerable portion of costs are covered with public funds, and where the largest public payor initiates changes that are then emulated by commercial payors and, likewise, where government entities heavily regulate healthcare’s techniques and technologies, politicians have intervened to force changes. With healthcare being a major topic of the last several elections and a top priority for President Obama during one of his two terms (as it was for President Clinton, though his primary initiatives in healthcare didn’t pass), it’s no surprise that the current administration also would like to impart change. President Trump is now working to alter some of what the Obama administration put into place. This move creates more uncertainty and requires change. I think everyone agrees on a defined set of goals for the industry, known as the triple aim (better outcomes, lower costs, improved experience), but the path to achieving those goals is wildly variable depending on your political position.

 

Unfortunately, these required changes have placed the industry in turmoil. In an effort to modernize its technology, EHRs have been forced between providers and patients to ensure better, more consistent data collection. Ideally, this move should reduce medical errors and redundant tests, however, the government missed a massive opportunity here when it spent north of $40B on incentives to increase digitization of medical records — EHR software that wasn’t built to reduce medical errors, unnecessary tests or even improve clinician communication or data sharing across providers that would ensure continuity of care. At the same time, government financial incentives prompted a change to healthcare services to ensure quality. Yet, most of these quality initiatives didn’t go far enough and consequently increased data reporting burdens for clinicians. Meanwhile, payments for the majority of healthcare services have been reduced, squeezing provider margins and changing the rules for how providers are paid.

 

Healthcare hasn’t improved for consumers. During appointments, providers struggle to connect because they have screens, not patients, in front of them. Insurance coverage has gotten worse; choices have been reduced and the complexity of bills and payor communications to consumers more complex. How much worse have things become? I have an MD, MBA, and MS. I run a healthcare company with ~50 employees and have been writing and speaking on healthcare and healthcare technology for ten years. My wife and many of my friends are practicing physicians; some are my physicians. Yet, I woefully struggle to understand my medical bills, choices in providers, and generally how to navigate our broken system.

 

Where does that leave healthcare going into 2018? I’d argue that healthcare, if anything, is worse today than it was a year ago. The government, individuals, and private sector will certainly continue pushing for more changes in 2018. Given that, I predict we’ll see a few major healthcare trends as we move through the new year.

Subscription / direct pay / cash-based practices

Consumers, with minimal choice in healthcare, find it difficult to speak with their wallets or their feet. Similarly, providers have even fewer options. It’s no wonder that subscription medicine and cash-based medical practices are growing in popularity for both providers and patients (more on that below). These care models align incentives and are transparent. Geared towards those who have the ability to pay extra for better services, today, the majority of these care models bank on the pocketbooks of the middle to upper class. However, emerging data sets show the success of this model is also possible for underserved populations, as well. Learn more about what I think will happen with cash-pay practices in 2018.

Post-EHR healthcare

The gravy train of meaningful use (MU) is over. The effect of MU was a significant, artificial, driver of adoption for a few EHRs. Today, digital health records are the standard. As we move through 2018, keep an eye on EHRs and how they justify their ROI once massive capital expenditures are written down. Likewise, you’ll want to consider how clinicians adjust to this brave new world. Read more about my 2018 predictions for the post-EHR world.

Clinicians as developers

The EHR wave of health IT left out clinicians. EHR and IT vendors drove those early technology decisions. Now, with software eating the world, clinicians are acting like software developers and corporate innovators in helping to design and, in some cases, build new technology and technology-enabled services for their colleagues and their patients. Read more of my thoughts on clinicians as developers.

The real cloud

HIMSS 2018, the largest health technology conference on the planet, will for the first time see the behemoth booths of EHR vendors challenged by the equally massive booths of public cloud service providers like Amazon, Microsoft, and Google. This is the canary in the coal mine moment for healthcare, not just for the adoption of the real cloud over simple virtualization, but also in the fragmentation of infrastructure and services managed by third parties for healthcare delivery organizations. Learn more about the real cloud in healthcare.

Beyond digital health hype

Digital health has been hyped for a long time as a savior for healthcare. Unfortunately, healthcare is not that simple and no savior exists to untangle us from our current mess of a system. Technology, for technology’s sake, is not going to fix healthcare. While we’ve witnessed incredible enthusiasm around new technologies disrupting healthcare, we’re also now seeing some public failures, like the recent acquisition/fire sale of Practice Fusion, or the Castlight Health initial public offering hype and valuation assumptions compared to the market reality of today. Similar to EHRs, digital health now must prove it’s worth if it’s going to have sticking power. Find out more about getting beyond the digital hype.

Blockchain to the rescue

Speaking of hype, blockchain has made its way into healthcare. Smart contracts, immutability, and a clear audit trail — hallmarks of blockchain technology — hold much promise for healthcare data and exchange. The problem is that technology, especially when it comes to data sharing and interoperability in healthcare is not the dominant roadblock. Layering in new technology, like blockchain, leaves the fundamental organizational and political problems unsolved.

 

I’ll focus on each of these trends in subsequent posts, distilling all of these healthcare trends down into one larger narrative: post-EHR healthcare is finally ready and incented to start making the necessary changes that will align with the triple aim. Massive organizations will vie for their place in this new healthcare world; some will win and others won’t. The winners will be the providers AND the patients.

Technical Dr. Inc.'s insight:
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ScientificAnimations's comment, May 22, 2018 8:46 AM
Blockchain is a system that makes health information accessible to doctors from anywhere, anytime, and on any electronic medical system. http://sco.lt/5yVeuP
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Why 2015 is the pivotal year for #digitalhealth

Why 2015 is the pivotal year for #digitalhealth | Healthcare and Technology news | Scoop.it

While we don’t truly know what the future holds, we all know that health is personal—and will need to be handled accordingly to optimize the progress that is possible with digital health.

The mainstream healthcare consumer in 2014 embraced the ALS Ice Bucket challenge and panicked (rightfully so) about the staggering wake-up call of the Ebola outbreak. While the politicians in US played the Obamacare ping pong game, and Brussels accepted its first applications for eHealth projects as part of Horizon 2020, there was also a major undercurrent in how digital health and health IT have penetrated our everyday lives.

In the US alone, digital health funding more than doubled from 2013, according to RockHealth, and even almost tripled according to StartupHealth. While the delta is not a rounding error, the key point is the exponential trajectory that showcases the fact that smart money believes this industry is ripe for significant disruption.

There are still many companies and investors that are sitting on the sidelines and watching the show from the balcony. As an example, there are many critics of wearable devices and even some hesitations on the value of big data. But, I want to remind everyone that Rome was not built in a day and the first generation or even second generation of devices, big data platforms, and decision support tools will improve care mainly driven by healthcare entrepreneurs, healthcare consumers and passionate scientists and clinicians – the “stormchasers”.

On February 2nd, I attended a local Singularity University lecture with a keynote from Gerd Leonhard, who is a thinker, futurist and a digital heretic. One of the statements he made really resonated with me: “Technology is exponential, humans are not”. The keynote was all about ethics in the age of exponential technology. But, leaving privacy and ethical issues aside, 2015 will be a pivotal year for digital health in an era of exponential technology:

1. Precision medicine

During the State of the Union Address, President Obama announced the precision medicine initiative.  

"I want the country that eliminated polio and mapped the human genome to lead a new era of medicine — one that delivers the right treatment at the right time. In some patients with cystic fibrosis, this approach has reversed a disease once thought unstoppable. Tonight, I’m launching a new Precision Medicine Initiative to bring us closer to curing diseases like cancer and diabetes — and to give all of us access to the personalized information we need to keep ourselves and our families healthier."

Precision, or personalized medicine, (I use the term interchangeably) is an approach to using medical and genetics data, body-generated data, biotechnology, and science, to first and foremost understand the root causes of the disease—but also come up with personalized and individualized treatments and therapies.

Due to forthcoming government funding, but more importantly smart money and brilliant entrepreneurs, we will certainly see more activity this year. After all “Health IS Personal”.

2. Genomics

As DNADigest describes it:

"The techniques for researching and characterizing genomics diseases are available to both researchers (next generation DNA sequencing) and the general public (in the form of personal testing), so we should soon be able to diagnose any genetic disease by sequencing a patient’s DNA."

Indeed, this is the future but the future is almost here: Illumina with $1,000 per full genome sequencing, Tute Genomics which is now allowing researchers and clinicians to interpret the entire human genome, and a big announcement for 23andMe regarding their entrance into the UK market.

As an industry, there are still a lot of hurdles, but we will see some significant moves this year in this space—including ways to actually analyze 150 zetabytes (1021) of data per full genome, begin integrating this data into evolving and ancient EMR platforms, and provide genetic counseling to offset the lack of knowledge by the masses.

3. Smart Data and Data Science

Well actually, data itself is not smart, people are! And while there is huge promise in big data analysis, collecting and hoarding zetabytes (yes this term again) of data does not bring any value.

People need to ask the right questions of the data. We are at an age where collecting data is easy with body-generated data, environmental data, and traditional medical data—but it is the data scientist combined with sharp business and clinical skills that will empower the healthcare system to make all this data actionable, with the healthcare consumer at the center.

"If you torture the data long enough, it will confess to anything" - Ronald Coase
4. Next Generation EMR is personal

Let’s face it—and this is not news to anybody—core medical data is already becoming a small percentage of the overall personal health record. Existing EMR platforms are over two decades old and some are struggling to keep up with archaic architectures, millions of lines of code, and minimal-to-no differentiation to their client base today.

The smart ones are looking to open up their APIs, integrate body-generated and genomics data, and even combine that with environmental data at a personalized level to be able to provide that precision medicine at point of care.

5. Design and Aesthetics

Our bodies are complex, and therefore the medical profession is complex. Once again, an unprecedented amount of content is generated daily—and for both consumers and clinicians alike, dealing with this information overload is becoming yet another full time job.

The aforementioned smart data discussion is only one piece of the puzzle. User experience is another.

At the core of our health is human behavior. Hence, incentivizing healthcare consumers (patients), making their treatment pathways clear, and presenting stupid data in a smart and actionable way are all key to improving our healthcare system.

Global health care transformation is still in its infancy. While we don’t truly know what the future holds, we all know that health is personal—and will need to be handled accordingly to optimize the progress that is possible with digital health.


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