1. ICD-10 Transition
October 1, 2014 seems like a very long time from now. While predominantly impacting hospitals and payers, the impact of the change to a new classification scheme will be significant. The shift to ICD-10 will require provider organizations to allocate IT personnel and other management resources towards that goal. This will tie up assets that would otherwise be available for EHR implementation and upgrades, interoperability, data analytics, security, audits, and so on. Failure to complete the transition in a systemic fashion could result in significant financial penalties.
2. Meaningful Use Stage 2 Deadline
While the actual deadline is 2014 at the earliest, most providers have a great deal of work to do before they will be ready. From using CPOE and e-Rx to giving patients online access to records providers will have to make a few changes to their workflows. While a significant portion of the changes will be borne by certified EHR vendors themselves, providers will still have to operationalize many new requirements. Online access to records, transmission of health data to third parties, and secure communication may present some of the most complicated challenges.
3. Patent Cliff Shakes Up Pharma
Pharmaceutical companies are facing the loss of profitability due to the expiration of patents on many blockbuster drugs. More accurately, sales of patented drugs have suffered due to competition from generics and fewer successful drugs have gotten patent protection which has erodes profit margins. How will the industry react? Businesses will need to be redesigned in order to compete in this environment. Many companies may look to M&A as a way to boost their chances in this new marketplace.
4. Retail Clinics and Health Kiosks Get Serious
According to Merchant Medicine, the number of U.S. retail clinics is expected to climb to 2,500 in 2013, an increase of about 38% over 2012. Companies like Stayhealthy and Healthspot are accelerating this trend by providing health kiosks that offer services that would otherwise be provided in a doctor’s office. Health kiosks can used to take basic readings, perform primary care and even deliver minor urgent care. Schools, work sites, prisons, health clubs and pharmacies are all potential locations for these kiosks.
5. Electronic Health Records as the OS
Advanced programming interfaces (APIs) have been an invaluable tool in the breaking down of data siloes. In order for data to flow into and out of the operating system the doors have to open both ways. On the inbound side, data from sensors and devices is starting to get into the EHR. iHealth recently announced an integration of their blood pressure monitor and scale with PracticeFusion’s patient health record. On the outbound side, data analytics companies such as Explorys offer real time analysis that depends on timely access to the EHR.
6. Analytics Gather Steam
Made possible by the explosion of data from body sensors and devices (AgaMatrix and Scanadu) and decreases in the cost of genetic sequencing (23andMe and Life Technologies), analytics (Apixio and Humedica) will emerge as a tool to provide actionable information to clinicians. Patients with chronic diseases or those recently discharged from a hospital setting are the best candidates for this. The combination of individualized device specific data with genomic information is one example of how personalized medicine could be practiced in the future.
7. State Healthcare Exchanges Go Live
While the official deadline is January 1, 2014 for compliance with the Affordable Care Act, it appears that state and federal health insurance exchanges will go live in Q3 or Q4 of 2013. It will be interesting to see what impact these exchanges will have on the health insurance industry. It will also be interesting to see how the federal exchanges perform compared to those run by individual states.
8. Healthcare Cost Increases Slow
As noted by Peter Orszag, healthcare costs in general and Medicare, specifically, are witnessing decreasing rates of price increases year over year. At last measure, hospital price increases stood at sub 4% year over year compared to over 7% in January 2005. Medicare increases stood at about 2% year over year compared to almost 6.5% in January 2005. The length of this trend will influence the impact this trend has on budgetary discussions and healthcare policy decisions in Washington.
9. Care Coordination and Hospital Readmissions
The impending shift from a fee for services model to performance or value based compensation (e.g. ACOs) has highlighted the importance of care coordination. Stage 2 of Meaningful Use reiterates the importance of this process. The third driver was CMS’ rulemaking imposing a financial penalty on hospitals whose patients are readmitted within 30 days of discharge which took effect in 2012 (to the extent the readmissions ratio was exceeded). Combined these are powerful forces creating momentum for care coordination. The private sector has taken note and companies such as CareInSync and HealthyCircles are offering solutions to address this systemic problem.
10. Tablets in Doctors’ Labcoats
The iPad Mini and Nexus 7 are about the right size to fit in a labcoat. If history is a good indicator, then the right form factor is essential for device acceptance. While Apple and Google seem to have sized their tablets correctly for healthcare it remains to be seen how satisfied users will be. What kind of user experience will physicians have viewing images, lab results and EHRs on these mini tablets. The answer to this will influence the long-term success of these products.