This past decade experienced a tremendous digital transformation, with one of the most significant healthcare technology trends centered on data and its increasingly vital role in everything from informing diagnoses and improving the patient experience, to driving greater operational efficiencies and informing strategies to improve clinical quality outcomes, to guiding approaches to improved economics for healthcare constituents.
In the first six months of the year, healthcare technology and healthcare data analytics have been put to a test that none of us anticipated in January. Like no other sector, the healthcare industry was confronted from all angels by the COVID-19 pandemic. Many healthcare technology trends that were making their way through the healthcare ecosystem are seeing greater advancement than anticipated so far this year, with telehealth platforms empowering virtual healthcare, as well as healthcare interoperability and social determinants of health data thrust into the spotlight as the world watches.
Already predicted by some analysts to be the standard of care option for primary care by the end of 2020, telehealth has rocketed to the top of healthcare technology trends this year because of the COVID-19 pandemic. Telehealth platforms across the industry are reporting sharp increases in use during the pandemic, as virtual health visits have become an essential initiative for health plans to address quality and risk documentation gaps that otherwise may remain unclosed because patients are unable to schedule in-person visits.
According to Forrester, a review of historical outpatient claims data “suggests that about 43% of outpatient visits could be addressed through a virtual care visit,” – a prediction that has become a reality as healthcare organizations around the country consider strategies for continuing to effectively care for their members during this era of stay-at-home orders and social distancing.
As this technology has received CMS’ approvals and as more clinicians embrace it, telehealth has begun to address some of the industry’s biggest challenges, including access to care and rising healthcare costs, while offering patients more affordable, non-traditional healthcare options.
The increase in telehealth services is driving an increase in the number of health plans that offer reimbursement for telehealth – an important shift for Medicare Advantage members who stand to benefit greatly from the availability of video consultations considering the physical and financial barriers they often face when contemplating traveling to their doctor’s office. In December 2019, Forrester predicted that providers will “conduct millions of new virtual visits in 2020,” with many of them taking place with patients who live in rural or underserved areas of the country – a number that is now expected to be far higher.
“Engaging patients in the home, workplace or other convenient locations first and helping them make a decision on the right place to seek medical care can reduce…drastic overuse of an emergency room.” – Jeff Becker, Forrester analyst
In March, the U.S. Department of Health and Human Services (HHS) finalized two rules to provide patients with greater access and control over their health data, establishing interoperability standards and new rules to prevent “Information blocking” as required by the 21st Century Cures Act. The rules also establish secure, standards-based application programming interface (API) requirements to support a patient’s access and control of their electronic health information. While HHS and CMS have announced flexibility with compliance with the new rules because of the COVID-19 pandemic, the establishment of the rules make a strong statement – the healthcare industry is moving forward with interoperability and data connectivity; it’s no longer an option.
While the healthcare industry’s technological advances still lag behind many other industries, innovative efforts to address the connectivity/interoperability challenge are progressing, with government entities and industry consortiums like the CARIN Alliance, Da Vinci and The Sequoia Project paving the way and teaming up to address hurdles that have traditionally impeded progress in this area, including those around data standards, authentication, person identity matching and more.
“Standardization efforts like Fast Healthcare Interoperability Resources, FHIR, are hugely important to the ongoing industry effort of breaking down data silos and democratizing access to health data across providers and patients.” – Dr. Tashfeen Ekram, MedCity News
The CMS Interoperability and Patient Access Rule requires CMS-regulated payers to implement and maintain a secure API using HL7 FHIR® (Fast Healthcare Interoperability Resources) data standards to support seamless, on-demand API-driven information exchange across the industry. As one of the fastest growing capabilities to standardize healthcare data exchange, HL7 FHIR® facilitates data sharing across the care continuum and enables organizations to leverage their existing systems to improve care delivery and patient outcomes. Moving forward in 2020 and beyond, healthcare organizations will need to address a range of strategic and technical considerations to ensure the development of innovative, foundational internal infrastructures that will help them achieve true interoperability and integration within – and across – the healthcare ecosystem.
Next to telehealth, it is perhaps the trend of using social determinants of health (SDOH) data to deliver high-quality, patient-centered care that has gained the most traction so far in 2020. In fact, the two trends have become intertwined, as telehealth is increasingly being used to help address non-clinical needs of patients during the COVID-19 pandemic, as many SDOH, including poverty and physical environment, can have a significant effect on COVID-19 outcomes, and knowing the risks to patients in your communities can help you manage or even mitigate the impact of the virus.
With overall health outcomes impacted more by SDOH – including demographics, environment and socioeconomic factors – accounting for 80 to 90 percent of health outcomes, the ability to identify high-risk patients and understand what non-medical supplemental resources to use for which patients is crucial to improving overall outcomes and helping organizations meet increasingly high-quality standards. Frost & Sullivan analysts predict that by the end of the year, 40 percent of health systems and payers will be using SDOH data for risk assessments, patient engagement and operational decisions.
“57% [of patients] have a moderate to high risk for financial insecurity, isolation, housing insecurity, transportation and food insecurity, among others. We believe proactively engaging the right patients based on their social determinant of health can improve health outcomes and help healthcare organizations meet quality standards.” – Kamaljit Behera, Analyst, Frost & Sullivan
With use of SDOH data expected to remain a key healthcare technology trend, healthcare organizations and payers will need tools to make sense out of this data. While there is growing consensus that SDOH are powerful influencers on outcomes, utilization and cost, there is less agreement as to how to collect and use this information in patient care, performance measurement and payment systems. New data-driven models that are delivering key insights into the impact of non-clinical factors, like food insecurity and unemployment, on patient outcomes will help organizations understand the health impact of these factors and importantly how to prioritize finite resources.
Meanwhile, predictive analytics platforms that help collect this data and then track and analyze patient outcomes will gain importance and help the industry transition from talking about the importance of SDOH data to leveraging the data to make changes that drive improvements.
Unsurprisingly, AI has played an integral role in addressing the COVID-19 pandemic, but other advancements in the technology have also made waves. In particular, there is increasing use of machine learning prediction models to address fall risk and assist in clinical interventions. According to the CDC, every year, 3 million older Americans are treated for fall-related injuries. AI technologies can help organizations identify those patients most at risk and effectively target them for interventions.
The potential of AI in healthcare remains vast, as it can help patients take better care of themselves through wearables and other devices that record personal health data that can be used by healthcare providers to deliver more patient-specific care. But perhaps the greatest potential for AI in healthcare lies in how we use the technologies to understand the uniqueness of each patient. Organizations that develop algorithms to offer deep insights can provide invaluable intelligence on everything from an individual patient’s likelihood of experiencing a stroke, heart attack, or even cancer to a hospital’s readmission rate to a health plan’s gaps in care for an entire membership – helping to bridge vital chasms in the patient care journey and enabling clinicians to intervene sooner, delivering a superior patient experience and improving the overall health of a population.
With rapid adoption of value-based care across the industry, AI and other machine learning technologies, paired with data interoperability to bridge important information silos, will improve patient outcomes while driving operational efficiency to lower the overall cost of care. By supporting healthcare providers with predictive machine learning models, clinicians will be able to more effectively forecast clinical events, like strokes, cancer, or heart attacks, and intervene early with personalized care and a superior patient experience.
Despite excitement around the ideal of leveraging AI in healthcare, like so much in the healthcare industry, many of the most promising AI applications are segmented, with individual companies making progress toward addressing a single problem. What is lacking are more comprehensive tools. That need prompted Dr. Felix Matthews, a managing director and physician leader at Deloitte to predict an uptick in alliances between tech companies and healthcare organizations.
“What I believe we will see in the next year or two is algorithms that interpret multiple data sources at the same time from different variables. Once you’ve got that, the sky is the limit.” – Dr. Felix Matthews, Managing Director, Deloitte
If AI in healthcare emerged as a top theme in 2019, increased access to patient data certainly wasn’t far behind, and that has continued to be a key theme in 2020. As briefly mentioned above, data standardization will play an integral role in the ongoing transformation of healthcare. Under the 21st Century Cure Act, organizations are required to support increasing interoperability and access to patient-level data as CMS focuses on empowering improved quality and efficiency of patient care. A key aspect of the Act pertains to supporting consumers’ access to their own patient-level data and the requirement of all health plans to support API access to the data in real time. The final rule mandates that all Medicare Advantage, Medicaid, CHIP and ACA plans provide a Patient Access API by July 1, 2021.
As the healthcare industry continues to forge efforts at interoperability, the idea that patient data belongs to patients is being championed by healthcare leaders, including CMS Administrator Seema Verma. Understanding the impact of how the healthcare ecosystem can effectively combine critical data points to improve outcomes will continue to be evaluated, with regulations like the California Consumer Privacy Act (CCPA) aiming to protect consumers’ rights and provide guidance regarding the access to, deletion of and sharing of personal health information.
Increasingly, patients are able – and quite willing – to share their health data. From digital health apps that provide health and wellness tips to wearable devices that track steps taken and vital statistics of patients to Apple’s Health Records, a personal health record feature that combines data obtained through a patient’s personal Apple device with data from an electronic health record of a healthcare organization from which they have received care, patients have never had more of their own health data literally at their fingertips. In the past year, Apple landed several key partnerships with healthcare organizations, and 2020 could be the year that this tech giant links up with an electronic health records vendor, effectively closing a key interoperability gap.
It remains to be seen if patients are truly able to manage their own healthcare data and use it in meaningful ways. Patients – especially those who may be chronically ill – may be unlikely to keep health information updated, which leads to concerns on data quality and accuracy. Without being able to ensure the integrity of data, the industry is still a good distance from being able to derive deep analytics from consumer-provided data.
Organizations that have already taken strides to explore data partnerships with patients are driving “innovative solutions and noteworthy results,” according to article in the New England Journal of Medicine.
“It is imperative that we leverage the expertise of a group of stakeholders who know a tremendous amount about bending the health care cost curve: the high-need, high-cost patients themselves.” – Lala Tanmoy Das, MS, Erika L. Abramson, MD, MSc & Rainu Kaushal, MD, MPH in the New England Journal of Medicine
Confronting a public health crisis in the form of COVID-19, the healthcare industry has faced challenges this year unlike anything we’ve seen before. It’s also created great opportunities for the industry. With monumental shifts in the way we use telehealth platforms and SDOH data, new interoperability and patient access rules, and continued advancements in AI technology, it’s unlikely that healthcare can afford to return to its slow-to-adopt nature.