“We’re in the middle of an incredible moment in the health care industry, where expectations and standards are shifting.”
That statement was part of the opening remarks from Cerner’s Senior Vice President of Population Health John Glaser at the 2017 Cerner Health Conference. His position was a strong one: The industry, he says, is shifting from reactive sick care to proactive health management, from fragmented niche care to a cross-continuum care system and from reward for volume to reward for quality, efficiency and safety.
Today, we’re watching as the physician, long considered to be at center of the health care universe, is moving aside in favor of the consumer.
These shifts aren’t happening in a vacuum: They’re touching in every area of the industry, and they are reshaping the way the business of health care is done. Here’s a look at some of the top trends that will push the industry forward in 2018.
Consumer-centered health care
We talked a lot about the rise of consumerism in health care over the last year, and that train is not going to slow down in 2018. Increasingly, we're seeing people wanting to have a more active role in managing their own health and care (this is particularly clear when we consider the rise of mobile health apps and wearables). They expect the same level of information, detail and options that they have in other industries when it comes to making purchase decisions, and there is a rising call for data transparency and access.
While there have been some great strides toward empowering the individual with health care organizations working to improve the patient experience, we're still waiting for the health care industry to wholly adapt to the needs of the consumer.
At Cerner, we recognize this as a new era, where the consumer will at last join their own health care team. That's why, at this year's CHC, Cerner President Zane Burke announced that we’re making a free consumer-directed health record available within our clients’ enterprise portals, providing individuals more control over how their data is used and shared. Each patient will have his or her information compiled on their behalf and can direct the use of that information to create their own experience.
The era of the consumer is here – and it’s time for the health care industry to embrace that.
From controlling the thermostat on your phone to monitoring your health with technology, the Internet of Things (IoT) is transforming the way we work, live and interact with the world around us. IoT has been a popular phrase in health care for the past few years, but today, the conversation is shifting. The primary issue now is understanding how we can take the plethora of big data available from connected systems and tailor it to provide person-centric care.
Moving forward, we need to harness the potential of IoT to drive better efficiencies. From a data collection perspective, the advantages of connected medical devices are vast. When we can provide data bridges from disparate health care systems within a single organization, we’re making critical patient information more accessible to clinicians and care teams and ultimately impacting patient outcomes.
Through use of IoT devices, we have the opportunity to deliver true virtual care for chronic condition management, virtual visits and other care coordination activities to streamline and benefit the patient. Connected devices enable more real-time insights and health status for a person.
“IoT is tied to consumer enablement, which ranges from remote patient monitoring to mobile applications,” Hamilton says, “and it certainly includes the ever-increasing trend of telehealth, which isn’t going to go away.”
“Intelligence isn't a new idea,” Glaser said at CHC. Our cars tell us when the oil is low, and they’ve been doing that for years. But we’re about to take a significant leap in the intelligence of our devices. We’re already seeing this with products from companies like AWS, Azure and Google.
We're in the early stages of seeing how artificial intelligence will play out in the health care industry. One example is in precision medicine, an approach for disease treatment and prevention that accounts for individual variability in genes, environment and lifestyle for each person. This approach relies heavily on big data analytics, where machine learning algorithms and precision molecular tools make it possible to understand mechanisms of disease and match up individual problems with personalized treatments. The implications for genomics and precision oncology are significant.
We’re also beginning to see AI algorithms affect and enhance medical imaging. These algorithms find patterns in images, identifying specific anatomical markers and scoping details that the human eye can’t – while simultaneously combing through a patient’s history, helping clinicians make efficient and quick diagnoses. The future of AI in health care won’t see clinicians being replaced by machines, but rather empowered by them.
“Data is the new oil,” Andreas Weigend, Amazon's former Chief Scientist, said recently. It’s a bold statement, but he has a point: Big data and cloud technology are changing how we interact with data, and previously untapped data sources are now attainable.
One of the greatest examples of big data’s implications for the health care industry is in predictive analytics, where data is used to identify behavior patterns in a patient or population and forecast outcomes. For example, when EHR data is organized into meaningful groups, such as social determinant factors, it can help predict hospital readmissions and can shed some insight on strategies to improve readmission rates.
This power to affect additional value and efficiencies within a hospital setting is no small thing. Perhaps most critically, these newfound big data insights are pushed to those that can make a difference: clinicians and care team members. Acute and ambulatory decision support, for example, can be enhanced by creating an empowered care team with a clear picture of the patient, thanks to increased access to patient data that's built directly into the existing daily workflows. And big data has exciting implications for precision medicine.
Whatever route organizations hoping to take with big data, it's clear that it will be catalyst for change for the better good and health of society.
As organizations begin to share data across departments and with other health systems, there can be a few questions: Who owns this data? Have the appropriate parties consented to its release? What are the rules, conditions and terms of data sharing?
“Data governance is a huge thing that organizations are struggling with right now, even as they try to solve for it,” says Hamilton. In a recent survey, only 44 percent of hospital leaders said they had data governance capability across their entire organization, while 56 percent said they had inefficient governance standards.
What organizations really need is a governance strategy that everyone understands and can abide by, Hamilton says. In the future, we’ll see more and more health care organizations looking for help from external experts to create and refine their data governance protocol and practices.
Open platform development and API usage expansion
Open data access and increased interoperability are continuing to clear the road for development in health IT (HIT) – particularly when it comes to academic medical centers and rural health care systems. This trend will only continue to grow as open standards, like SMART Health IT and the HL7 FHIR standard, encourage a new level of collaboration and innovation.
As the FHIR standard matures, we’re going to see an explosion of new apps that can integrate with EHRs to help improve workflow efficiencies and achieve better outcomes. Application programming interfaces (APIs) offer direct programming access to the underlying health IT system and enable 'app' developers to create tools that can ingest EHR data and provide new services to consumers.
In a previous blog post, Cerner's Dr. David McCallie discussed how, through projects like SMART® on FHIR®, providers are becoming familiar with APIs that support customization of the EHR experience. However, API access is not limited to providers. A new class of APIs will give consumers the ability to access their health information on demand via apps of their choice. These APIs are emerging thanks to consumer demand, and they are also driven by major regulations coming into effect – particularly Meaningful Use Stage 3.
Consumer-directed access will place control of personal health information in the consumers' hands. APIs that allow the transfer of discrete data will help drive the advancement of interoperability by delivering more specific data where it makes sense within the workflow, in a way that positively impacts outcomes.
UX and health IT
On the coattails of the rise of consumerism in health care is a growing emphasis on integrating user-centered design into health care products and solutions. To optimize any solution, user experience (UX) must be engineered in at every step of the solution design process. This way, the experience for the HIT user – be they a clinician or a patient – should meet or exceed their expectations.
Cerner's Vice President of User Experience, Paul Weaver, discusses the integration of UX design thinking and health IT through the example of mobile health apps. "When you think about consumer apps today, there is a huge amount of competition to get people's attention," Weaver says. "If you search for a notes app on the Apple store, for example, there's probably a few hundred for you to choose from. So, if I'm an app developer, how do I design the app of choice?"
The answer, Weaver says, is by providing a quality user experience.
"In the health space, historically, this has been a little bit of a walled garden," he adds. "You go to a health provider, and they give you a link to the app they want you to use, and there's no choice in the matter." It's the responsibility of the UX team to think about that application in the context of all their other solutions available, so that whatever they're designing sits alongside its contemporaries in an equal level of quality.
UX is about more than just creating user-friendly applications. It’s a state of mind – a perspective that favors taking a human-centered approach to creating solutions. "That's what we're starting to achieve here," Weaver says, "and we're on the cusp of it becoming real for our end users, which is fantastic. How there be anything more exciting than an application that actually helps your health?"
One of the most significant trends in today’s market is the blurring of roles between providers and payers. As the industry shifts toward value-based care, it should become increasingly easy for payers and providers to collaborate at the point of care. A person’s relevant medical history, including medications and treatment plan, should be available to both the health care provider and payer – that way the patient’s insurance benefits are included in the provider network and are in sync. Shared access to this data means that clinicians are empowered to provide the right care at the right time to the right patient.
That’s payer-provider convergence in theory – but the reality is that there are two dynamics happening in tandem.
“You've got providers trying to take on characteristics of a payer because they’re doing at-risk relationships, and you’re seeing the payers making a direct play into the provider market,” says Ryan Hamilton, Cerner’s Senior Vice President of Population Health. Recent moves, such as UnitedHealth’s Optum purchasing DaVita Medical Group and Amazon’s push into pharmaceutical distribution, suggest that the trend of payers and providers merging together will continue to rise.
Along the same lines, there’s a lot of interest right now around provider network management – and that focus is only expected to grow. “How you actually recruit, manage and maintain a high-quality network of providers is and will continue to be a huge focus for our client base,” Hamilton says.