10 Healthcare IT Predictions

In honor of National Health IT Week next week, here are my top 10 predictions for healthcare IT for the next 12 months—none of them involving Meaningful Use or ICD-10!

1. Patients ask, where's my data? Patients will organize a single-day national event called Where's My Medical Data, in which providers and payers will be besieged by emails and phone calls from patients wanting their medical records. Patients will complain loudly at the slowness of the responses, the outright refusal by some providers, and the complexity of the records received.

While the scenario might not play out exactly in this form, I heard this proposal floated at the recent Healthcare Unbound conference in San Francisco, where it received the encouragement of Farzad Mostashari, the National Coordinator for Health Information Technology within the federal Office of the National Coordinator for Health Information Technology. It hasn't yet become an ONC initiative (they are a little busy right now), but patients might lead the way.

2. Higher software prices allow EMR makers to staff up. Providers in turn will call upon software makers of electronic medical records to redesign their products to allow easy generation of records for patient use. A rise in the cost of such products, due to a supply squeeze, will enable EMR software makers to raid the ranks of other high-tech companies such as Google and Microsoft in order to staff up. But the principles embodied in Fred Brooks' timeless book, The Mythical Man-Month, will slow progress; adding designers and programmers still doesn't produce linear progress in software.

3. The human touch becomes a major tech issue. A bumper sticker spotted where I live in Berkeley, CA, says, "It's become appallingly clear that our technology has surpassed our humanity." We are running a risk of losing the human touch in an age of health tech marvels. Teams may be communicating better than ever, but from the patient's point of view it's a blur of emails, messages, phone calls, and faces. The medical home is one response to the depersonalization of medicine. Can tech provide other "repersonalizing" experiences? Examples include videoconferencing, social networking, technology-mediated support groups, and simple time on the phone with a physician.

4. Tablets replace expensive videoconferencing gear. Too much of the videoconferencing gear in hospitals today looks like the giant screens of the original Star Trek series. If you want to know where it's going, look at what Captain Jean-Luc Picard used in Star Trek: The Next Generation: a small screen in his quarters, for more confidential communications without losing that face-to-face factor. A telecommunications executive recently told me he had informally checked the usage logs of expensive videoconferencing systems at hospitals—and found them woefully underutilized. Now that tablets are proliferating, look for those to be employed, perhaps even in group settings, as the videoconferencing system of choice.

5. Identity crisis. Information flows at the speed of trust. If massive EHR use is to avoid massive fraud, a national patient ID (and provider ID) system is a requirement. For example, there is a huge number of women named Maria Gonzales in Los Angeles County. With multiple payers, providers, and government agencies trying to keep track of all of them, there's also huge potential for fraud as medical records are automated.

Will a standard U.S. healthcare ID happen, and if so, how? What are the risks to healthcare leaders if it doesn't happen soon? We have President Bill Clinton to thank for signing a law that prohibits establishment of a national healthcare ID system, but we'll either need to amend that or use some technological tricks to achieve the effect of an ID system without violating the existing law. Patients themselves may have to assert their digital identities. For more on this concept, check out the Personal Data Ecosystem Consortium, an industry effort that brings together the best thinking over the past 20 years about how to get identity management right. And if we're lucky, it won't take a Department of Homeland Security to do it.

6. A systematic fix for alert fatigue. Devices bombard clinicians and executives with alerts, for everything from life-threatening errors to suggestions from purchasing on how to save money. Clinicians say enough! But quality mavens insist on many of the alerts. IT systems can be redesigned around human factors, but a systems approach is also needed. In the technology world, the network management folks unified all alerts starting in 1988 with the Simple Network Management Protocol, or SNMP for short. SNMP and its successors are why computer networks today are manageable even though hardware still fails. Healthcare IT needs its own SNMP. Maybe this year it will get it.

7. Patient adherence for fun and profit. Technology is poised to make sure that patients take their meds as directed, get exercise, lose weight, and report changes in their conditions promptly. Lives will be saved. Accountable care won't work without it. And healthcare is starting to deliver it. More patients will see savings on their health insurance premiums if they comply with these guidelines. Clever software developers may deliver bonus secret levels of Angry Birds to successful weight-loss patients, which could be even more motivating to some than cash.

8. Medical homes and medical neighborhoods lead to medical cities. Technology these days is geo-this and geo-that. Population health efforts have liberated tons of health data, which is being analyzed at every geographic level. Look for lots more analysis of what makes entire cities healthy or sick. Walkability scores will take their place alongside other factors and could begin to factor into health insurance premiums. The data is all out there, waiting to be tapped.

9. Social network–powered, peer-to-peer training replaces older company-based, HR-style training. Executives do this already. If you are a CMIO, you go to AMDIS conferences and learn from your peers. If you are a CIO, you go to CHIME and HIMSS events. The AMA takes care of doctors, and various specialties have their own events. Distance learning is becoming dominant in universities.

There's no reason the rest of the healthcare line staff has to sit in rooms training, or retraining, on their EMRs when they could be part of a virtual classroom, mentored by a peer from somewhere else on the planet, who knows exactly what they're going through and can answer their questions. Instructors will become more like resource personnel or librarians. Didactic lecture as a method of HR-powered training becomes rare, and ceases to be a nonproductive cost center.

10. People trump technology.

Healthcare leaders are all around us. But it takes dogged determination to not get swept up in the bits and bytes. Too much technology is surrounded by a candy coating of hype. To cut through it, check out Quantified Self, a new movement of people determined to use technology in a fundamental way to track what they are doing. I attended my first Quantified Self meetup in San Francisco last week, and it was a fascinating mix of geek-love and the kind of excitement generated by a successful Weight Watchers meeting. Quantified patients, whose enthusiasm and collective tech already outweigh that of the government, may be emerging as the cutting edge of medical research a year from now. They are also figuring out some of the finer points of patient privacy versus sharing in a way that vendors, and providers, are only now getting around to understanding.

If half or more of these predictions actually come true in the next year, healthcare will be better for it. I was inspired to write this column by HIMSS, which is running a Blog Carnival to commemorate National Health IT Week.