In the next 12 months we'll see a continued influx of data from myriad sources flooding into healthcare organizations and medical research institutes. Much of it will be siloed, and concerns about security and meeting regulatory requirements could hamper how much progress is made. Still, healthcare IT leaders and others in the industry are optimistic about what lies ahead -- and how healthcare will improve as a result.
[ In part one of this two-part series, we explored the ways in which advances in patient-focused data collection, wearables, and the Internet of Things will change how doctors and patients communicate. Read Healthcare IT: Hot Trends For 2016, Part 1. ]
"The US averaged 1 billion physician office visits in 2010, with over 332 visits per 100 persons. The most frequent illness reported was a cough. How do we make doctors' office visits more beneficial to the patient, while allowing doctors the ability to spend time with patients who need it most? The mining and sharing of big data," said Cedars-Sinai CIO Darren Dworkin.
Mark Goldstein, president of the International Research Center (IRC), is looking forward to more and better data. For instance, Goldstein is excited by personalized or precision medicine. "The intersection of low-cost genomic and proteomic sequencing for patients, combined with molecular-level cancer and other disease diagnostics, run through high performance computing centers, can be compared with big data aggregated from past patient characteristics, disease specifics, treatment protocols, and outcomes to allow much greater treatment design and success," he said.
Among the projects underway, Goldstein cited Dr. Patrick Soon-Shiong's Institute for Advanced Health and a startup, Systems Imagination. Another complementary trend, according to Goldstein, is AI applied to medical diagnostics. IBM's Watson has been demonstrated for such uses. "It's not just for playing Jeopardy," said Goldstein.
[Healthcare is one of them. Read 11 Cool Ways to Use Machine Learning.]
Big data is a challenge for any enterprise -- especially in figuring out how to handle it. "In 2016, the challenge for healthcare enterprises will be how to make sense of the data, as well as how to develop the infrastructure needed so they can continue to scale up," said PerfectServe's CEO, Terry Edwards. For example, Edwards said he expects more use of relationship algorithms that formulate inferences, allowing decisions to be made in real-time.
However, there's more than a single (large) dataset to be protected, integrated with other systems, and monitored. Medical data comes from every type of medical record, each of which is governed by a host of individual characteristics and regulations. There's also a dizzying array of vendors vying to provide software and services to manage medical records.
"There is a tremendous amount of data that's being generated by monitoring technology that needs to be part of the patient record. This data needs to be viewed across the entire continuum of patient care," said Janet Dillione, CEO of Bernoulli, one of those many vendors (this one with attention on clinical alarm management). Your takeaway: That's a lot of oversight for any IT department. How can anyone do it well?
Plus, all that data is pushing healthcare IT into the cloud in 2016. "Healthcare has, perhaps rightly so, been late to embrace the cloud, when compared to other industries," said Dr. Rasu Shrestha, chief innovation officer at the University of Pittsburgh Medical Center. "But cloud computing has matured today to bring healthcare into the 21st century." Shrestha predicted cloud computing will enable healthcare organizations to reduce waste, decrease delays, and improve care collaboration and outcomes.
Wes Wright, CTO of Sutter Health, agreed. "Healthcare organizations have two primary issues forcing the use of cloud resources," he said. "Healthcare entities can no longer afford to build and maintain the type of compute and storage that is necessary in the new digital healthcare world. The volume and velocity of the data that is currently available in healthcare, while great, is nothing compared to what's coming. That surge of current and coming data can only be handled in the cloud, with the elastic compute and storage that's available there."
The Austin Radiological Association (ARA) shares the storage and scalability concern, storing the vast majority of central Texas's imaging studies. "We add more than 900,000 radiological exams annually to our archive, and, as of 2014, had 450TB of images under management," said CIO, R. Todd Thomas. "But our growth is not static. In mammography, one of many types of the radiology exams we perform, images are moving from two-dimensional to three-dimensional images, which are 20 times larger than their two-dimensional counterpart. If ARA continued with a traditional, on-premises storage refresh cycle, in 2018, we would face a 555TB migration in mammography images alone, and by 2022 would need to migrate a petabyte of mammography images. By 2024, we are projecting to ingest 3PB annually on mammography alone. I simply can't do a traditional storage migration on that scale."
That makes interoperability essential. Healthcare IT departments need to work to defragment data. "Healthcare is plagued with siloed data repositories owned by parties who have little to no incentive to make their data interoperable," said Sean Mehra, head of product for HealthTap. "A lot of value is lost in providing better treatment and creating better outcomes."
For example, data from your fitness wearable should be seen by your doctor. Heart rate data isn't as useful without data about your exercise activity. "What good is your medical record when it's split across four different organizations?" Mehra asked.
Privacy vs. Usability
That means changes are necessary -- and coming soon -- in the way healthcare providers share patient health information. "Protecting personal health information is important, and healthcare providers should constantly look at stepping up their efforts to do so. At the same time, healthcare organizations need to look at the value that is inherent in sharing information," says Tom Bizzaro, VP of health policy and industry relations at First Databank.
In the best case? "We'll see the development of patient-facing applications that enable patients and consumers to take advantage of the big data aspects of this new freedom to mash up content from multiple locations and services, creating yet-to-be-imagined enrichments in both personal and professional uses," said Dr. David C. Kibbe, CEO of DirectTrust, a healthcare industry alliance created by and for participants in the Direct Exchange network, which is used for secure, interoperable exchange of personal health information (PHI). "This will not happen linearly. Rather, it will grow explosively, and then suffer hiccups and setbacks as the privacy and security risks of such systems are first exposed and then dealt with," said Kibbe. "But it is going to happen."
Don't expect immediate acceptance. "Electronic Health Records (EHR) interoperability will remain elusive. While EHR interoperability exists within accountable care organizations and health information exchange networks, outside of these organizations the business case is weak, and active participation in sharing data is relatively low," said John Squire, president and COO of Amazing Charts. "Until the industry as a whole embraces the need for true interoperability and places population health and seamless exchange of data ahead of corporate silos, the full potential of interoperability will not be realized."
Healthcare IT is simultaneously spurred on and held back by security and privacy concerns, as well as by the (sometimes time-consuming) policies and technologies put in place to respond to those issues.
It's a whole new world of exposure and risk, said IRC's Goldstein, when you combine government communications monitoring, bank/credit record access, marketing data/Web tracking, and personal medical records.
One single scary data point: Health apps are high-value targets of cyberattacks, and all-too-common ones. In the 15 months from January 2014 to March 2015, the healthcare industry had 15 separate major breaches of protected health information that affected more than 100,000 individuals.
The healthcare industry is well aware of these challenges, and of the repercussions if they're not addressed. Concerns about data security are likely to lead to (even more) government oversight and policies. For example, Clinical Decision Support (CDS) tools to help physicians navigate the appropriateness criteria are required by January 2017 as part of the Protecting Access to Medicare Act of 2014. Active enforcement of HIPAA finally began in 2015, according to Patrick Everett, founder of Digital Doctor and an independent consultant in healthcare informatics.
Regulatory issues and security concerns are going to slow down adoption of the tools and software needed to collect and analyze healthcare data. "A lot of great work in the field of genetics and genomics has been done in an effort to shift the practice of medicine away from trial and error towards a future where patients receive treatments based on their individually diagnosed pathology," said Steve Kraus, partner at Bessemer Venture Partners, who leads the firm's healthcare investments.
But, Kraus added, the FDA looks to be cracking down on Laboratory Developed Tests (LDTs), with heavier regulation expected sometime in 2016. "We fear the repercussions this will have on the overall diagnostics industry and specifically dampening further development in personalized medicine," said Krauss.
How Much Innovation Is Too Much?
Technology only helps us if it gets used, and if the change does not add more time and complexity to the process. Is the pace of change in healthcare technology so overwhelming that we won't move forward?
Healthcare workers spend as much as half their time looking at a computer screen, even during exams, said Dr. Bryan Laskin, DDS, the creator of OperaDDS, a HIPAA-compliant communications system. "The next wave will increase efficiency further, but allow for more direct communication between healthcare providers and patients," he added.
The infrastructure to aggregate, organize, and share medical data will make solid progress in 2016, said Travis Bond, CEO of CareSync. But, he said, "Change will still be incremental. The US healthcare machine is over $3 trillion in size and scope, with countless variables."
According to Bond, the size of the problem creates the opportunity. "The forces of costs containment, with expectations of increased outcomes from care, will continue to impact changes in the industry," he said.
Ultimately, 2016 will be a busy year in healthcare IT. We are blessed with a remarkable number of life-saving technologies, and smart people working to bring them to patients. With some luck, many of these innovations will reach us soon.
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