There’s a familiar quote that says, “Never make predictions, especially about the future.” But ‘tis the season for doing just that so we asked some of the leading healthcare experts to give us their predictions for the industry in 2018. Their outlook on the coming year cover a wide range of issues including technological innovation, EHRs, cloud services, cybersecurity, healthcare costs, legacy data management and the Internet of Things.
John Halamka, MD, MS, CIO of Beth Israel Deaconess Medical Center
I believe most of the news in healthcare in 2018 will revolve around technology. Private sector innovation will be the key driver, not new government regulatory requirements. The real breakthroughs will occur in startups creating products that layer on top of existing EHRs via FHIR APIs.
The move to cloud hosted services delivered via mobile technologies will accelerate and machine learning will enhance the usefulness of EHRs so that they become valued tools to clinicians instead of just burdens.
And to no one’s surprise, cybersecurity will still be the most top of mind issue facing CIOs in the coming year.
Brent Magers, FACHE, FHFMA, CMPE, Executive Associate Dean and CEO, Texas Tech Physicians
First, not surprisingly, I think medical costs will grow at a slightly faster rate than was the case in 2017. Costs have stayed flat for a few years, but that’s about to change.
The increase in pharmaceuticals alone will drive up the “spend.” In our own practice, I see several examples of expensive infusion drugs that physicians say are particularly effective in treating disease, but which are very expensive. And, of course, as healthcare costs go up, medical costs in the employer insurance market are bound to go up as well. Better utilization with better data and tight, real-time monitoring via an EHR may help mitigate the rate of increase.
The rejection by many doctors of “pain as the vital fifth vital sign” should help slow down the opioid crisis. Drug manufactures will also work to reduce the use of opioids since they are looking at a huge liability (much like the tobacco industry faced a few years ago) if they don’t tighten controls on access.
Technology will take on a more prominent role in 2018. We will see more growth in long-promised clinical application of technology via telemedicine. Telehealth is a broader, consumer-facing approach covering an array of applications and entails the delivery of healthcare services by healthcare professionals.
I think we will see a significant number of downloadable digital apps for both providers and patients. Patients will like it because they get lab tests as soon as results become available and providers will like the analytics for managing the individual patient. When individual patient information is aggregated, these technologies will also be key to population health. Tying this data to evidence-based practices will be beneficial for all.
Jeff Liddell, Harmony Healthcare IT Consultant, Licensed Social Worker, Emergency Psychiatric Services High Reliability Organization Coach
I believe we will see a continued trend toward market consolidation in the EHR market in these turbulent times. Because of this rapid consolidation, the inability to meet criteria set out in Meaningful Use and the Advancing Care Information component of MACRA could force many EHR vendors to the sidelines. This will continue to force vendors to achieve interoperability standards the industry has been trying to achieve for years. Patients and providers will add more pressure by demanding more robust technology to do more than meet the minimum regulatory requirements.
I think 2018 will see an emerging market of legacy data management driven by the rampant consolidation and continued threat from cybercriminals. Organizations are going to have to make a greater commitment to cleaning up legacy applications in the IT portfolio. As software systems grow older and fail to meet the needs of users, they pose a significant security risk. To thwart attacks, these systems need to be modernized to increase their security profiles.
The upcoming year will see physicians becoming more vocal and active in shaping the EHR. They will look to help drive the impact EHRs have on their practices especially when it comes to driving efficiencies, reducing clerical burden and increasing face time with patients. There has been widespread grumbling from clinicians on how the constraints of increased demands in general and the constraints of EHRs specifically, have taken the joy out of practicing medicine. Look for physicians to be active in helping to reverse that trend.
Dr. Joseph Schneider, MD, MBA, Department of Pediatrics, University of Texas Southwestern
The increasing intersection of cybersecurity, usability and patient safety will give rise to a new role - the Clinical Director of Cybersecurity or in rare cases, Chief Clinical Cybersecurity Officer. This clinician will partner with the CIO, CSO and CMIO in balancing the clinical and patient safety aspects of security decisions with security needs, particularly regarding the Internet of Things (e.g., pumps, pacemakers). In some cases, they may chair a decision-making Clinical Security Committee.
Ideally the position should report to the Chief Clinical Officer (e.g., CMO) or CMIO, depending on the organizational structure. While physicians may fill this role (I had one working in this capacity at Baylor), it’s also highly likely that a nurse will fill this position.
These new leaders will also be responsible for helping clinicians appreciate the importance of good cybersecurity practices and why these sometimes need to interfere with their workflow. For their own personal development, these Clinical Cybersecurity Clinicians will get special training that professional societies will start to develop.
I also believe that general patient consent forms may start to have cybersecurity clauses to shield hospitals and other organizations from liability for harm caused by hacking, ransomware, and other cybercriminal activity. Similarly, “informed consent” forms that patients must sign for implantable devices that connect to the Internet will start to have clauses that allow patients to opt-out from this connection. The current assumption is that every patient wants their device to be connected, but with increasing numbers of cybersecurity episodes, there will be a growing awareness of the risks and a desire of some patients to "go off the grid.”
For more blog posts from healthcare's greatest thought leaders, check out our Healthcare Thought Leadership blog series.