Health Informatics Forum

A report from the Center for Connected Medicine (CCM) and The Health Management Academy entitled "Top of Mind for Top Health Systems 2019, Insights from health systems on IT priorities for the year ahead" has predicted that cybersecurity, telehealth and interoperability will be the most significant areas of health IT in terms of impact on health care in 2019. 

These areas were identified following consultation with health IT executives from some of the US's largest health systems, and quantitative and qualitative data was subsequently collected to explore each of these three areas further.

Improvement in cybersecurity programs was found to be the top priority for these executives. Breaches, and the potential exposure to harm that they pose to institutions (in terms of finance and reputation) are, however, being limited via network segmentation.

Maximising connectivity within the bounds of enhanced security, is the mission for health systems as data access requirements and use of connected devices and the Internet of Things increases. Health systems are spending on staff education and on security elements including firewalls, intruder detection software, and dual authentication to combat phishing, spear phishing (which employs targeting to a greater extent), malware and ransomware, these being the more common forms of attack seen over the past year according to this report. Regarding staff education one CMIO explained that in their view now: “An aspect of being a good clinician is stewardship of electronic patient data.” 

The potential advantages of telehealth, in terms of delivery of logistically appropriate care at low cost, make it, in terms of impact, the second ranking area of health IT in this study. Health IT executives unanimously envisaged an increased adoption of telehealth in 2019 with lack of reimbursement being cited as the greatest restriction to this currently, although there is an expectation that commercial and government payers will increase their contributions over the coming three years.“Integration with the clinical workflow” and “ease of patient triage and virtual follow-up” were the key features, identified in this report, that health executives are looking for in telehealth systems.

Although most health institutions in this study were not yet utilising advanced tools such as artificial intelligence (A.I).and machine learning (ML), the data from telehealth projects (and in particular those that involve remote patient monitoring) offer scope for analysis in order to create algorithms that could assist in prevention by predicting which patients are at greater risk i.e. the potential for machine learning to be employed to assist in prevention.

Interoperability was the third area identified in this report as significant, indeed, indicative of this sentiment is that fact that the Centers for Medicare and Medicaid Services (CMS), who helped to drive the digitalisation of health systems through it's Meaningful Use requirements have, this year, changed the name of this program to "Promoting Interoperability".

Goals for interoperability in health care include data being easily accessed and downloaded by patients but also data being available for use in appropriate applications. Conversely inability to easily exchange data was described in this report, as having made it harder for health systems to address particular priorities, these being most commonly: improved efficiency / cost reduction, and advanced analytics, with the later being valuable as it in turn offers scope the areas of network integration, efficiency, identifying cost reductions and better patient care delivery. Addressing care gap closure, longitudinal patient data, and integration with non-owned partners were also identified as elements of the industry that are hampered by poor interoperability.

Interoperability has also been described as important in terms of innovation in healthcare technology because when a health system employs EHR from a larger vendor, looking outside of that vendors offerings for additional functionality becomes less appealing.

While the large technology companies, Apple, Amazon, and Google for example have prevailed other industries, they are relatively recently bringing their consumer-centred style to the healthcare industry. However 70% of informatics executives reported being “somewhat concerned” about Big Tech companies,
such as Apple, Amazon, and Google, entering the health care space with 10% "very concerned" according to this report. Despite this, health system executives were also reportedly aware of the potential for partnership with these “Big Tech” companies. 

With data centers an impractical answer to massive data volume storage in the longer term, most respondents in the report view a move to the cloud as certain eventually. However when asked to consider the next three years and where they expected the majority of their organisation's health care data to be stored , most executives (60%) answered in hybrid/private cloud, with 20% predicting that data centers will as the main location and only 10% envisaging storage in public cloud.

Looking beyond 2019 and over the coming five years, according to the contributors to this report we can expect artificial intelligence (AI), consumer technology, and genomics to provide the greatest impact health care.

The constant pressure to reduce costs associated with health care delivery and concurrently improve services drives innovation in in the healthcare industry: From digital data management to innovative medical devices and diagnostic tools, appropriate use of technology has the potential to facilitate better care while also reducing the cost of it's delivery.

As such it is no surprise that healthcare technology adoption is gathering momentum globally despite barriers to their use: not just those associated with efficacy and cost, but also privacy and security concerns.

As technology assumes a greater and more widespread role in healthcare, the patient experience and clinician's workflows will changed. But, as the various constraints surrounding technology adoption are resolved, to what extent can clinicians and their patients expect their daily lives to be altered over the coming years?

A recent article entitled "Is Alexa About to Become a Doctor’s Assistant?" discusses a podcast with John Halamka, MD, CIO of the Beth Israel Deaconess Healthcare System and professor of international healthcare innovation at Harvard Medical School, where he predicts that mobile devices will dominate data access in terms of records, schedules, medications and more for both clinicians and patients. They will be used along with apps that integrate Internet of Things (IoT) data, allowing more individualised care as patients interact with their own electronic health record (EHR). He envisages reduced face to face contact between patients and clinicians (with accompanying reduction it the associated of time and monetary burden), this being replaced by telemedicine where appropriate and he expects the majority of healthcare applications to use the cloud.

In Prof Halamka's view, over the next year and a half we will also see blockchain technology assisting with patient consent for data sharing in two significant ways. He says: "It can host patient consent preferences in smart contracts that any application can access, clarifying how data can flow among stakeholders while respecting patient privacy preferences. Blockchain can also provide audit trails that ensure integrity of a medical record and track where data was exchanged. Blockchain will not replace EHRs—it’s not a database—but it will help build trust for health data sharing"

A CNBC article earlier this year reported that Amazon is bolstering it's position in the healthcare industry with creation of a health and wellness group for Alexa: Focusing initially on postpartum and diabetes services and with particular attention given to regulatory and data privacy provisions. In order for both patients and clinicians to interact with EMR via voice assistance, trust is paramount and therefore compliance with HIPAA necessary.

Prof Halamka predicts increasing use of voice assistance and added in the article "By the end of 2018, I predict Amazon Alexa will be covered by business associate agreements so that healthcare organizations can design Alexa skills that interact with EHRs and practice management systems while managing privacy." and goes on to say "We’ll even be able to use sentiment analysis to assess voices for stress, anxiety and depression."

With regards to artificial intelligence and machine learnings Prof Halamka predicts that the healthcare industry will need to improve stored data quality in order for it to be of a grade that enables training of machine learning algorithms. Increased use of machine learning in place of traditional methods of data analysis would also be his expectation and he comments in this article that: "Artificial intelligence will not replace clinicians; it will augment them. Although algorithms can identify patterns, they cannot apply emotional or human factors. If your doctor can be replaced by a computer, then he or she should be."

Earlier this year a Google cloud blog entry detailed "How Chrome Enterprise is helping healthcare companies provide better patient experiences", and described healthcare organisations as rapidly adopting Chrome OS due to it potentially being faster, more secure and also "integrated with critical virtualization solutions". Indeed In the longer term Prof Halamka agrees that Windows desktop will be replaced by Chromebooks running cloud hosted tools .

While the big or global players, Apple, Microsoft, Amazon and Google, for example, dominate the news relating to advances in healthcare delivery, new startups creating discrete projects have also proved successful and innovative services that integrate with current EHR hold particular promise moving forwards. So we can conclude that the only certainly in terms of the future of healthcare experience is that of constant evolution.