10 concerning trends in health IT


The pandemic accelerated many trends in healthcare, including telehealth and data analytics.

However, it has also exposed areas of weakness, and there are some concerns emerging about how the industry will evolve amid the pandemic and for years to come. Here are 10 concerns and key considerations.

1. Healthcare organizations continue to struggle with population health. Many healthcare organizations that had issues executing population health initiatives before the pandemic are having an even harder time now as hospitals take a financial hit and at-risk populations are seeing higher rates of infection and death from the virus. “We’re reading about reductions in traditional primary care and well visits across all age groups,” said Professor Sanket Shah, clinical assistant professor for biomedical and health information sciences at the University of Illinois, Chicago. “Overall the reductions in elective surgeries and routine procedures may impact the course of care provided for an individual.”

For example, what will the long-term implications be for individuals who don’t have their regular cancer screenings or children who don’t have their scheduled vaccinations? “While some transition to virtual consultations, engaging the entire patient population to continue their course must be a primary focus,” said Mr. Shah.

2. Hospitals’ inability to gather and real-time data. The pandemic exposed how unequipped many hospitals and health systems are to gather and report real-time data. In the past, real-time data was a “nice to have” feature that large systems and academic medical centers could support; now it’s a matter of life and death. Many institutions scrambled to piece together data gathering and reporting on PPE, hospital beds, ICU beds and staffing to make sure they can handle the surge of COVID-19 patients.

By contrast, hospitals within the NewYork-Presbyterian health system were prepared for the surge because their data analytics capabilities were so advanced. “Our early detection system allowed us to identify Queens as a hot spot and prepare for early volumes at our Queens hospital,” NewYork Presbyterian CIO Daniel Barchi told Becker’s. “Then we saw it move to Northern Manhattan and Southern Bronx, and we were able to respond in kind. Early on, we were focused on patients and the number of new positive cases that we would expect to see. We then started digging more deeply into the data and were able to examine the social determinants of health to see commonalities in patients. This allows us to know where to expect another outbreak, as well as the background of the patients we were seeing so we could respond with the right clinical course of care.”

3. Integrating non-traditional healthcare data. It’s a strategic priority for most health systems to collect, standardize and deploy non-traditional data such as patient-generated healthcare information through wearables and other mobile health-enabled products. The non-traditional information could also include data gathered as part of social determinants of health initiatives and during the pandemic, mobile phone location data to understand social distancing. Health systems may now struggle to figure out how to store, integrate and present this information in a meaningful way for clinicians and the community.

“As these assets become stockpiled, the integration of this data remains to be a challenge for many,” said Mr. Shah. “How can organizations maximize the benefits from these various sources to better paint a holistic picture of the individual? Most organizations have collected the information and are beginning to deploy solutions, while others are still determining the applicability and actionability.”

4. Lack of data scientists in healthcare. There aren’t enough data scientists in healthcare to ensure these organizations are effectively gathering and reporting data. The pandemic exposed gaps many healthcare organizations have in interpreting and reporting data; a new report from former CDC Director Tom Frieden, MD, shows at the state level there are inconsistencies in gathering and reporting data, and many aren’t using best practices. Hospitals in many states have had to update the way they publicly report data after outside individuals pointed out inconsistencies and inaccuracies in the way data was presented.

Governors, lawmakers and public safety experts are making crucial decisions about how to open local economies based on the data and are depending on nuanced accuracy. Large health systems such as Yale New Haven Health that have existing data science teams will likely bring on more data scientists in the future; will smaller organizations be able to keep up? Glassdoor reports that data scientists are the No. 1 highest paid entry level job right now, which could put them out of reach for hospitals already struggling financially.

5. Human error in data entry. The HHS Protect COVID-19 data portal requires many hospitals to manually enter data, which exposes it to the risk of human error. HHS now ties distribution of the COVID-19 treatment drugs to the data reported and continues to allocate resources based on it, which places additional emphasis on the individuals entering information. Even after the pandemic subsides, hospitals and health system will rely on manual data entry to make important clinical and operational decisions. Some health systems are moving toward more automated data entry, but not everyone will be able to make the switch.

6. The uncertain landscape of point solutions. The pandemic has affected all organizations, including many vendors. Health systems are re-prioritizing projects and what was an imperative last November is no longer on the organization’s radar. Travel to health systems, live events and in-person meetings that many companies relied on to generate business have been scrapped. Some point solution vendors are struggling to stay afloat financially as the landscape changes.

“This may mean a strategic pivot as these vendors are faced with client-created alternate offerings, an inability to scale while keeping costs low, or simply a lack of funding to maintain their business,” said Mr. Shah. “What was once considered an integrated core offering may be one of the first areas that get defunded by many healthcare organizations during these uncertain times.”

7. The emphasis on telehealth without a permanent policy changes. Hospitals and health systems were thrown into telehealth during the early days of the pandemic after years of fits and starts with virtual care, in many cases. The percentage of daily telehealth visits increased by the thousands in some instances and many patients as well as physicians predict it’s here to stay as the preferred mode of care. However, CMS and many payers have not formalized reimbursement for telehealth and reverting back to pre-pandemic access and rates would make telehealth programs unsustainable.

Health systems are investing more in telemedicine on the assumption that it will stay accessible in the long term, and CMS Administrator Seema Verma as well as President Donald Trump have indicated they would like it to continue. Senior Vice President of Clinical Strategy and Development and Associate Chief Medical Officer of New Hyde Park, N.Y.-based Northwell Health Martin Doerfler, MD, said rolling back policies would limit access to care.

“If [the CMS waiver of geographic limitations to coverage] is not made permanent telehealth to fee-for-service Medicare patients will become a non-covered service. We will have no choice but to notify FFS Medicare patients and offer telehealth services as self-pay,” he said. Otherwise, New York has coverage parity for Medicaid and commercial coverage excluding ERISA covered plans, for office-based services and said since the latter part of 2019 the health system was paid at negotiated rates that are similar to office-based and telehealth services.

8. People using online care and virtual care for problems they could solve themselves. Health systems rapidly expanded telehealth and virtual care capabilities when the pandemic hit and were able to support those visits because CMS and insurance companies changed reimbursement policies and rates to make telehealth viable. However, in some cases individuals may overload the system by engaging with healthcare providers, either through text or virtual visits, for common problems that don’t need expert advice.

“A big trend I see is that people are not using healthcare online for their real problems, but more for things that could be solved themselves,” said Giuseppe Aragona, MD, a family doctor and general practitioner at Prescription Doctor M.D. Patients can utilize telehealth for more complex problems and should feel welcome to do so, he said.

There is a danger in over-utilizing telehealth; CMS and private payers are reviewing utilization during the pandemic to develop permanent policies. Extending access will increase costs if patients use it unnecessarily or if they engage in telehealth that eventually leads to an office visit anyway.

9. Budget cuts for tech upgrades and innovation. Hospitals and health systems are taking a huge financial hit during the pandemic and many are struggling to balance their budgets. Technology and innovation spend may be on the chopping block, which could spell trouble for organizations in the future. The pandemic has highlighted the need for investing in IT to improve access to care, data analytics, precision medicine and innovation for more efficiency within the organization and better quality care.

Lisa Stump, senior vice president and CIO of Yale New Haven (Conn.) Health said her system reorganized to make rapid decisions during the height of COVID-19 cases in the region, but thinks the process for innovation will likely revert back to what it was pre-pandemic in the future.

“We deployed in three months what would have taken three to five years,” said Ms. Stump. “All of the careful planning, business case and return-on-investment analysis took a back seat. We typically would have planned, developed a plan B, and a back-out strategy if the technology didn’t work, but we didn’t have time for that. We had to operate on our instinct and make quick decisions. Now that the dust is settling, we’ll revert back to a happy medium, still moving with agility and flexibility and we will need a solid business case now more than ever. But people now see the value of technology in a new way and trust it.”

10. Relying on technology to replace interpersonal relationships. It was necessary to transition many interactions to the virtual space during the pandemic to prevent the spread of the virus. CIOs rapidly supported the shift to remote work among their teams as well as telehealth for clinical visits, and while there have been efficiencies realized, virtual interactions lack the human connection to build trust with patients and among teams as well as generate the random encounters that lead to innovation. While some companies have been successful in moving to a completely remote work model, healthcare will likely need to develop a hybrid remote and in-person work model for both clinical and operational purposes as a high-touch, empathetic industry.

More articles on health IT:
The Amazon Web Services-Cerner collaboration 1 year in: What they’ve accomplished and where they’re headed
HHS reveals COVID-19 hospitalization data website: 6 details
10 things to know about Palantir and TeleTracking, which power the HHS COVID-19 data system

 


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