The title of a recent article referred to the "post-EHR era" and caught my attention (see: New to-do lists loom for 'post-EHR era). It turned out to be a list of ten predictions about healthcare IT. It made reference to an IDC report (U.S. Healthcare Provider Predictions for 2014) and quoted an interview of the author of the report, Judy Hanover. Here is the list of ten predictions plus some of Hanover's remarks about each of them:
1. First-generation EHR will continue to fail
...[T]he EHR as the go-to place where providers will work, in a sense, is failing. We're seeing EHRs getting replaced with other EHRs that support broader platforms, more apps, more capabilities....The EHR as the be-all, end-all for care delivery, I think that idea has failed, and we're seeing providers continue to realize that."
2. The industrialization of healthcare will accelerate
...[We are seeing] the transition of healthcare from a one-off experience with a patient to a repeatable, standardized process of care where we have more uniform outcomes and approaches to care delivery. That translates to "better-quality care with improved productivity for providers, so we can really begin to create some value in healthcare delivery."
3. Healthcare cloud adoption will flourish
... I think the security issues that have surrounded the cloud have proven to be largely unfounded. The majority of CIOs we talked to in this survey felt that they could provide better security in the cloud than they could in their on-premise deployment. And with the HIPAA omnibus rule, and the ability to sign BAAs, that reservation about security in the cloud has decreased.
4. The criticality of analytics will grow
...The analytics we have now is not as precise as we'd like, but providers are still learning a lot about their costs, doing clinical and financial analysis. They're identifying high-risk patients to better understand their outcomes.
5. Personalized clinical decision support will become closer to reality
... [W]hat I see coming close to reality is clinical decision support moving from rules-based systems that are generalized and don't really reflect the particular patient's medical history..."So we're going to move from a rules-based CDS that fires an allergy alert for medication every time it comes up, to ones that really look at a patient's history in the system and only fire when it's appropriate.
6. Provider consolidation will continue
...One driver...has to do with "haves and have-nots" -- smaller, under-equipped hospitals being scooped up by larger organizations. I think some of the consolidation is coming from that gap: the haves consolidating with the have-nots, to cross that gap.
7. Revenue cycle management will become mission critical like never before
....We also see hospitals creating a lot of efficiencies by adding computer-assisted coding and clinical documentation improvement programs, and we think that's going to be critical. The provider organizations that have [better revenue cycle management] in place are going to do a lot better with ICD-10 than the ones that don't. I think we're going to have a major claims denial issue with the implementation of ICD-10, and those are great ways for providers to prepare to do a little bit better at ICD-10 than their peers.
8. Underinvestment in business continuity will come home to roost
...But providers, when [EHRs] break down now, are really having to stop work. As organizations mature and there's staff turnover, we see fewer and fewer staff in the hospital who know the process from when we used to do it on paper. So we've really come to depend on EHRs and we can't afford downtime....So investing in data recovery and business continuity tools – particularly as providers become more ready to use the cloud, and to access capabilities in the cloud that were very expensive or very difficult to install on-site, or even just the ability to have a second site for business continuity via the cloud is becoming very attractive.
9. Security and privacy issues will drive providers to the private cloud
This is one of the things that's driving private cloud investment: the ability to better support security requirements,....Our survey results show that 67 percent of respondent say they can offer better security than the level their own IT team can provide when they use the cloud. That's starting to solve a lot of privacy and security issues and reduce risk."
10. Compliance will cost you more than you think
With all of these investments, we see providers under-budgeting for [IT compliance]....The size of their IT budgets in general – and the amount that's pointed towards business continuity and disaster recovery, and compliance with privacy and security, in particular – is woefully small. They are going to start to see penalties, and see those problems grow in importance. And they will need to budget for it.
All of these predictions are interesting and I may return to comment about some of them later. However, I now want to focus briefly on the issue of business continuity, number eight in the list above. When I started working with LISs more than three decades ago, we viewed an unscheduled LIS "down" of an hour as a very serious problem. If an unscheduled one-hour LIS "down" is that serious, what do you call a 24-hour "down" of an EHR affecting all patient information in a hospital (see: Sutter Health System EHR Crash Reported by Nursing Union)? To quote Hanover: As organizations mature and there's staff turnover, we see fewer and fewer staff in the hospital who know the process from when we used to do it on paper. So we've really come to depend on EHRs and we can't afford downtime. So the obvious question that needs to be addressed by hospital executives is how to avoid any EHR downtime?