Federal legislation, economic market realities and technology-supported patient-centered health care shape what 2013 will hold for health IT.?
The fiscal cliff's effect on health and HITECH. The first, and most potentially painful, point in this 2013 health IT forecast is the fiscal cliff's effect on health care. The U.S. Congress and President Obama are struggling to cobble together $600 billion to cover the impending January 1, 2013, expiration of the Bush tax cuts and planned spending cuts under the Budget Control Act of 2011. There's a threat to health providers of further cuts to Medicaid and Medicare funding, which represents a large cache of spending that, to some in Congress, is ripe for reducing. Furthermore, four members of?the House Ways and Means Committee wrote HHS Secretary Kathleen Sebelius in October criticizing the HITECH meaningful use incentive program and asking her to suspend incentive payments until she promulgated interoperability standards. Their concern was that after already allocating $8 billion to health providers who have met meaningful use criteria, a satisfactory return-on-taxpayer-investment hadn't yet been achieved based on the lack of interoperability.
HITECH in 2013. CMS has already paid out several billion dollars to 82,500 clinicians and 1,500 hospitals who claim to have met meaningful use Stage 1 criteria. A November report from HHS' Office of Inspector General pointed to CMS payment missteps in the EHR incentive program, which could strengthen the argument for reducing incentive payments in favor of freeing up funds for the fiscal cliff negotiations. Assuming the HITECH program continues to be funded, 2013 will move providers into the next stage of meaningful use. But while two-thirds of providers have applied or plan to apply for incentives, only one in four was able to support the Stage 1 core objectives. 2013 could bring with it greater scrutiny of providers to ensure their compliance with meaningful use criteria.
New regulation will further spur health IT adoption and innovation. The Healthcare Innovation and Marketplace Technologies Act was introduced in December to promote health IT innovation through grants, incentives, prizes (designed like the XPrize) and retraining the labor force to meet growing demands for health IT talent, which is a limiting factor for hospitals looking to hire, according to a 2012 College of Healthcare Information Management Executives survey. Rep. Mike Honda (D-Calif.) sponsored the bill, which also would create a new Office of Wireless Health at FDA to manage regulation of mobile health -- a growing concern for both developers and users of mealth applications.
Accountable and value-based care will drive health IT adoption and innovation among providers and payers. Payers in both the private and public sectors are adopting accountable and value-based payment regimes, moving away from fee-for-service reimbursement. As health outcomes get measured and episodes of illness are bundled, health providers will adopt technologies and processes that support population health management and data analytics to help keep patients well at home and prevent them from being readmitted to hospital. Providers will prescribe remote health monitoring and mobile health tools that support patients in self-care, thus enlarging the footprint of health care delivery to the home and workplace through novel and nimble health IT tools. Telehealth and e-visits will ease access challenges for patients in medically underserved areas, as well as those needing specialty consults. Payers are vertically integrating to get closer to clinicians and build infrastructure for health information exchange: Aetna's recent purchase of iTriage and Medicity, and Humana's buying Certify Data Systems, point to this trend for 2013.
mHealth will begin to scale with multiscreen use. As patients play greater roles in their health care and the financing of it, they are taking on the part of health consumer. Just as consumers use multiple screens in daily life -- such as managing personal finances via smartphone apps and arranging travel through airline websites -- people are also deploying multiscreen strategies for digital health. In 2013, patients' digital health activities will quickly move away from desktops and laptops toward mobile phones and tablets, according to Manhattan Research. The number of U.S. adults using mobile phones for health purposes grew from 61 million in 2011 to 75 million in 2012, and health activities done with tablets doubled from 15 million to 29 million during that same period. Among consumers who own three digital devices (e.g., tablets, smartphones and desktops/laptops), 60% use all three screens for digital health activities.
Digital self-care is moving from wellness and fitness to sickness. In 2012, one in two U.S. online consumers used a fitness technology. In 2013, one-third of people plan to buy a fitness technology. These devices include pedometers first and foremost, along with fitness video games, which are quickly growing in popularity. Demonstrating growing interest in these devices, the Consumer Electronics Show -- which is being held in Las Vegas in January 2013 -- will see 25% growth in health and fitness technology vendors. A growing portion of exhibit space at the CES in 2013 will be devoted to medical, and not just fitness, apps, as prevention of readmissions and financial incentives refocus the role of self-care technology for people managing chronic conditions.
Retail health interactions will grow and collect information on consumers' health. The retail sector has embraced mobile technology for shoppers. This has been particularly pronounced among retail pharmacy chains. National companies such as CVS, Rite Aid and Walgreens and regional chains like Pharmaca all offer mobile apps that feature both health tools (such as prescription refill requests and pill identifiers) and convenience features such as photo development. Pharmacists will be playing a growing role in supporting patients' self-care. Two in five pharmacists are spending more time than they did two years ago supporting patients, such as recommending a health app or pharmaceutical company website to their patients. In particular, pharmacists are focusing on diabetes, heart disease, pain, respiratory and mental health conditions. The challenge will be how to link these new pharmacy interactions -- which look more like observations of daily living than traditional pharmacy claims data -- with patient EHRs so that clinicians and consumers can view a 24/7 profile of patient health.
The upside of BYOD: physicians engaging more with information via mobile platforms. Clinicians have adopted smartphones and tablets at a faster rate than the general public, and they're bringing their personal devices to work with them -- hence the acronym BYOD, which is shorthand for "bring your own device." Manhattan Research found that physician tablet adoption for professional purposes nearly doubled between 2011 and 2012, hitting 62% this year. One in two doctors with tablets uses the device at the point of care. Like the general public, doctors are multiscreen digital health consumers and those who use three screens spend more time online than those using only one or two.
The downside of BYOD: information insecurity. While physicians seeking to keep up with clinical information through digital platforms is a positive trend, KLAS Research found that providers are worried about information security in the BYOD era. KLAS estimates that 70%?of providers (CIOs, IT staff and physicians) use mobile devices to access electronic health records. While 86% of provider organizations have developed a BYOD policy, there remain concerns about access controls, security of storage sites and policies for protecting data. This concern will grow in 2013, as more physicians use smartphones and tablets to access EHR data in the increasingly mobile data environment via BYOD.
Patient engagement: the importance of design . The most brilliantly written health IT legislation, fully utilized EHRs and Big Data engines won't bend the health cost curve and improve public health if patients aren't engaged in their own care. 2013 could be the year where millions of patients take on starring roles in their own health care. In the U.S., insured individuals' out-of-pocket and premium share costs will exceed $8,500 -- real money for a family of four in America with an average household income of $50,000 in 2011. As patients' financial "skin in the game" grows, some enlightened commercial health plans are designing value-based approaches that incorporate behavioral economics strategies and health IT tools that nudge people toward greater self-care, prevention and mindfulness in daily micro-choices for their health and the health of their loved ones. In addition, personal health records and patient portals based on user-centered design would help to get people comfortable with their "numbers" and with tracking health data beyond weight and exercise over time.
Until U.S. health care puts the patient at the center in terms of design (of tools, health plans, and numbers), the promise of health IT will be limited and the potential return on these substantial investments in a time of national fiscal austerity will fall flat.
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