25 Years Of Health IT: A Complicated Journey
Policy changes and consumer pressures have spurred huge changes in health IT. Take a look back at how we got here -- and where we're going.
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During the past quarter-century, healthcare's adoption of information technology has gone from a virtual standstill to a fast-paced marathon, started by government mandates and fueled by a potent mix of financial incentives, consumer demand, shifting payment models, and strapped margins.
Denise Fletcher, VP and chief innovation officer, Healthcare Payer & Pharma, at Xerox, said:
Over the past 25 years, we've gone from healthcare delivery centered on the patient-doctor relationship with very little technology in the primary care office, some in the hospital, and more in surgery. Now with the advent of health reform, the Internet, social media, and more health consumers entering the market, we are seeing a convergence in information sharing, spurring ideas and creating solutions to meet the market. Every day, new ideas, solutions and stories emerge that tell me healthcare delivery and how we monitor our wellness is about to change. This convergence, along with the ability to communicate globally in seconds on a topic, has given consumers and providers the ability to research and address critical health issues.
Whereas thoughts about healthcare technology were once relegated to the basement, locked away among the boilers and mainframes, CIOs today often sit in the boardroom, viewed as integral parts of healthcare providers' strategy, success, and ability to serve patients. Now, healthcare recognizes it needs analytics, metrics, tech tools, and quality data, said Lorren Pettit, HIMSS Analytics' VP of market research, who recently wrote a retrospective to accompany the organization's 25th annual HIMSS leadership survey.
The healthcare industry must respond to both government and consumer forces, he said. And technology helps healthcare organizations do that faster and at lower costs, said Pettit. "We have to have IT if we're going to be a quality organization. We have to have clarity," he said. "We have to have metrics around where we're moving towards this end goal. Before, we'd been sort of bumbling around rudderless and [technology is] giving us more purpose, more direction."
As in every other industry, the advent of the PC and the Internet transformed healthcare, albeit more slowly than in other markets, which were faster to transition from terminals to desktops. Keyboards and mice took clinicians away from patients, said Dr. Nick van Terheyden, chief medical informatics officer at Nuance Communications. Lack of long-term vision, lack of financial incentives (internal or government), and pushback from clinicians prevented many organizations from investing in electronic health records (EHRs) and other tools viewed as the foundation of modern health IT. Those that did implement EHRs operated in a vacuum, seeing results within their organizations but unable to share data beyond their walls.
That changed, of course, when the federal government -- first under President George W. Bush, then in an expanded way under President Barack Obama -- launched a series of agencies and initiatives to encourage providers to adopt EHRs and specific capabilities by a variety of deadlines and funded mandates. Providers began discussing and implementing EHRs, mulling the ICD-10, considering how to install computerized physician order entry (CPOE) systems, and contemplating the multiple layers of Meaningful Use regulations, among others.
To accomplish these and other goals, including value-based care, patient engagement, and population health -- from a rapidly shifting market that grew to feature accountable care organizations (ACOs), health insurance exchanges (HIEs), and a flurry of newly insured consumers -- health systems recognized they needed new or tailored tools. They tasked IT for mobile health apps; portals; and productivity, cloud, and analytics solutions, sometimes turning to expertise from financial or tech providers in their quest for insight.
A couple of decades ago, the industry focused on payment technologies to cut costs and simplify processes, said Doug Fielding, VP of product strategy and founding member of ZirMed:
It's hard to imagine now, but there was a time when everything was done on paper. Then there was a time, the late 80s and early 90s, when we first began to explore electronic claims ... but we did everything via point-to-point modems and even electronic cartridge tapes. The highlight in this case was how the industry as a whole championed the model established by early innovators. When it came time to scale the new process, the administrative simplification of HIPAA effectively standardized EDI [electronic data exchange] across healthcare with the X12 transaction. That helped push all providers to adopt EDI.
Today's newly accessible, often cloud-based and mobile, data, is attractive -- and lucrative -- to cyber criminals. Providers had to protect data and safeguard patient information against employees who lost hardware or used lackluster security, particularly because government simultaneously increased regulatory controls and penalties across a broad spectrum of healthcare organizations.
But the data and new technology doesn't just fuel thieves' imaginations. It also is fueling researchers' creativity -- sparking new theories, treatments, and cures for a spectrum of conditions. During the last 25 years, cancer treatment alone has been transformed. Now available is 4D technology to verify exact dosage, computerized treatment planning, and radiation beams shaped to almost exactly mold the tumor, said Görgen Nilsson, CEO of Swedish healthcare IT company ScandiDos.
Let's take a look back at some of the highlights that have shaped modern healthcare IT, and look ahead to where the industry is heading.
In 2004, President George W. Bush created the National Health Information Coordinator position and doubled funding to $100 million as part of a plan to encourage widespread adoption of electronic health records (EHRs). The 10-year plan to incentivize EHRs ultimately was implemented under the American Recovery and Reinvestment Act of 2009 (ARRA), enacted by President Barack Obama.
The era also ushered in a plethora of government agencies (and acronyms). Also in 2009, the HITECH Act authorized $19.2 billion for enhanced Medicare and Medicare payments to those healthcare providers who adopted "meaningful use" of health IT technologies between 2011 and 2015, via preset steps and deadlines.
Image: Then-President George W. Bush discusses healthcare IT reform at Vanderbilt University in 2004.
Part of the American Recovery and Reinvestment Act of 2009 (ARRA), the HITECH Act -- or Health Information Technology for Economic and Clinical Health Act -- broadened the scope of privacy and security protections available under HIPAA; increased the potential legal liability for non-compliance; and expanded enforcement. It also contained incentives related to healthcare IT, which sparked a flurry of spending among providers, payers, and business associates.
Confusion continues to this day: Although the industry initially viewed HIPAA as a toothless protection, today the government actively pursues those it believes violated patient privacy. And some developers cite HIPAA as one reason they are slow to develop apps for healthcare.
Whether viewed as a carrot or a stick, the HITECH Act encouraged many healthcare providers to adopt EHRs, or replace aging precursors with newer, more sophisticated models. In 2005, only 15% to 20% of doctors' offices and 20% to 25% of hospitals used EHRs. Today, 78% of physicians have an EHR system and about 94% of hospitals use one.
However, some hospitals are not reaping full value from these investments, experts caution.
"The introduction of the electronic health record has really allowed physicians to evolve from a cottage industry to a very sophisticated business, allowing us to share data across time and space in ways we previously could not," said Dr. Terry Fouts, chief medical officer at MedeAnalytics. "EHRs are also a bit of a lowlight because they have lagged in adoption since they are expensive to implement and often decrease efficiency. We hoped they would reduce errors, but through cut and paste and other functions, errors have in fact likely increased."
Image: EHRs in the 1990s were not user friendly.
(Source: Cleveland Clinic)
When President Barack Obama signed the Affordable Care Act, also known as Obamacare, into law in 2010, he paved the way for many IT-related changes. In addition to inking HIT bills and funding, ACA was designed to reduce the number of uninsured seeking treatment, often late in their illness's stage, at hospital emergency rooms.
The act was partly responsible for the formation of new healthcare systems such as accountable care organizations (ACOs) and health insurance exchanges (HIEs), and the expansion of Medicare, which now covers many of those once-uninsured people.
Image: President Obama signs health insurance legislation into law.
(Source: Pete Souza, Official White House photograph. )
The availability of inexpensive smartphones, tablets, apps, and wearables sparked a mobile health app revolution, creating and furthering the drive for consumers to take greater control over their health, forge tighter bonds with clinicians, and gather personal health data around the clock.
"Mobile and consumer-driven health applications [and] devices have led to opportunities to make the consumer or patient a key driver of healthcare data collection and analysis and decision-making," said Dr. Anil Jain, founder, senior VP, and chief medical officer at Explorys, and consulting staff member at the Department of Internal Medicine at Cleveland Clinic.
Less costly software, the advent of the cloud, and tools that provide users with insight into a domain once available exclusively to data scientists are unlocking big data across the spectrum of healthcare. Organizations use analytics and big data to gain insights into everything from billing and cost savings to new treatments and cures, and most experts acknowledge the industry is only at the very beginning of adoption and success.
"Hospitals now have immediate access to years of up-to-date patient records that can additionally be used by data-driven methods, such as analytics, to help dramatically improve and apply our understanding of disease progression, hospital practices, quality and financial implications, and more," Denise Fletcher, chief innovation officer, Healthcare Payer & Pharma, at Xerox, told InformationWeek. "We are now also seeing a wealth of healthcare analytics solutions emerge that can improve efficiency and recommendations for care through advanced algorithms, better data visualizations, and better integration in care workflows."
The surge in protected health information (PHI) from wearables, smartphones, websites, and databases across healthcare, consumer, financial, and other industries, and the market's charter to keep this information private and secure, can butt against other organizations' desire to use this data for other means. De-identified or anonymized information -- typically used for a broad array of research -- can frustrate researchers who want to marry their studies to key information such as demographics for critical insight.
"Finding a balance between the use of information to improve healthcare [and] the individuals' rights to privacy will continue to challenge the industry," John Bair, chief technology officer at Launchpoint, told InformationWeek.
From cleaning rooms to performing surgery, robots have transformed healthcare -- and the technology has far, far to go.
"In the future, we will have bionics that will include robotics and artificial organs and limbs that will be 3D-printed custom and made to order for individuals," said Dr. Nick van Terheyden, chief medical informatics officer at Nuance Communications.
As the model shifts to value-based, not fee-based, payments, providers are being rewarded for keeping patients out of the hospital via proactive preventative care and treating them correctly the first time. By having access to all patients' records, providers can view every test result, diagnostic scan, and other image, reducing the need for expensive duplicate testing, which might pose a risk to patients and their pocketbooks. Shifting payment models encourage providers to rethink workflows and invest in IT.
Consumers, too, are taking on more fiscal responsibility through bigger co-payments and larger deductibles, forcing more price transparency on providers, especially those in competitive markets.
Internet of Things (IoT) technologies such as sensors, smartwatches and other wearables, cameras, and other networked devices are transforming healthcare by improving costs and care and enhancing productivity. IoT also alarms privacy advocates because of its potential invasiveness -- although others point to its ability to protect us via the expanded use of biometrics.
"The steady adoption of the Internet of Things (IoT), along with innovations in wearable technologies, will also continue to disrupt the traditional practice of healthcare," said Chris Hester, founder and president of Kinnser Software. "By integrating data from wearables like the Apple Watch or other devices, physicians and patients themselves will get a fuller understanding of their body's behaviors, paving the way for a new diagnostic and disease management landscape."
Since Charles "Chuck" Hull invented the 3D printer in 1983, the technology has promised to reshape healthcare. Medical professionals can print customized splints, human organs, and human tissues.
This year, about 98,065 3D printers priced at less than $100,000 are expected to ship worldwide, compared with 56,507 in 2013, according to Gartner.
Image: Today, most false teeth and dentures are made with 3D printers.
(Source: NAIT Denturist Technology/Flickr)
As health systems grow through mergers, acquisitions, or partnerships with small practices, the combination of cloud and as-a-service offerings enables them to cost-effectively share information and collaborate in near or real time.
While security concerns have hindered cloud's growth in some healthcare organizations, the technology is making inroads -- especially in a private or hybrid model, experts say. And demand for cloud is only expected to grow. Some early cloud adopters are already reaping the rewards.
"Embracing the cloud has allowed for even greater shareability, aiding smaller, more rural clinics who would have otherwise not had access to the resources of larger, more established medical institutions," said Ron Emerson, global director of healthcare at Polycom.
With the first draft of the human genome, scientists turned a new page in human history, ushering in brave new worlds of technology, ethics, and health, and the dawn of companies such as 23andMe and Navigenics, recently acquired by Life Technologies.
"Faster, more reliable computers have enabled genome research to take off, enabling us to create a library of information on human DNA, which will lead to a better understanding of the human race," Christopher Poelker, VP of enterprise solutions at FalconStor Software, told InformationWeek.
Once a paternalistic business where doctor knew best, healthcare has become an arena where consumers increasingly are put in charge of their own welfare -- willingly or not.
Since email became prevalent, physicians have wondered whether to respond to patients' electronic missives. Add social media queries, phone calls, and insecure text messages, and confusion grows. Secure portals provide one way to communicate with patients; 50% of hospitals and 40% of physicians had some sort of portal as part of their EHR in 2013, according to Frost & Sullivan's "US Patient Portal Market for Hospitals and Physicians: Overview and Outlook, 2012-2017."
Mobile devices, including smartphones, tablets, and the growing array of wearables extend consumers' ability, need, and desire to access data about their own health. Add in a growing financial responsibility and healthcare providers' incentives to focus on population health and prevention, and democratization of healthcare will continue to grow.
During the past 25 years, healthcare systems replaced bulky X-ray film with digital images, sometimes stored in shareable, easily searchable cloud systems. Less expensive, easily expanded, and increasingly shared among departments, these systems eliminate the need for costly physical storage areas and allow clinicians to view patients' images over time. Images are also crisper and three-dimensional.
Today, picture archive and communications systems (PACS) are the norm. In 2001, experts touted PACS' speed and sensitivity. Today, IT professionals work with different internal hospital departments to integrate PACS so cardiology and radiology, for example, can share images.
During the past 25 years, healthcare systems replaced bulky X-ray film with digital images, sometimes stored in shareable, easily searchable cloud systems. Less expensive, easily expanded, and increasingly shared among departments, these systems eliminate the need for costly physical storage areas and allow clinicians to view patients' images over time. Images are also crisper and three-dimensional.
Today, picture archive and communications systems (PACS) are the norm. In 2001, experts touted PACS' speed and sensitivity. Today, IT professionals work with different internal hospital departments to integrate PACS so cardiology and radiology, for example, can share images.
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