Seven healthcare IT issues that divide IT leaders, users, and patients, including Healthcare.gov, Epic Systems, ICD-10 and SNOWMED CT, and the BYOD trend.
It's time for those stories that look back at 2013. What better place to start but with those healthcare IT issues that divide us and create lots of topics for journalists like me to pick apart and try to put back together.
My top seven topics:
Healthcare.gov. Its problems were predictable, but is it salvageable? Lipstick on a pig? Now that the calendar has turned to December, mass numbers of signups must materialize for the site to be called a success—especially now that insurers have cancelled millions of old healthcare plans. The new site may do a good job (finally) of showing consumers how much each healthcare plan will cost, but as critics have pointed out, it still fails to make it simple to see exactly what you are buying for that money. How about a section showing the minimum coverage of each health insurance policy? Oh, and while we're at it, let's put all of this in plain English.
23andMe. The FDA's crackdown last week on this human genome test kit that arrives at your house in an Amazon-style box has split my friends seemingly down the middle, irrespective of their level of technical knowledge. Libertarians in general argue that the FDA should get its cotton-pickin' hands out of 23andMe's business; consumer privacy advocates rail against seen and unseen third parties getting their cotton-pickin' hands on our most personal of data; and healthcare cost-control advocates wring their cotton-pickin' hands over the medically unadvised surgeries and tests prompted by social media–driven scientific theories that don't always square with science.
Epic. Those who adopt this market-dominating EHR are legion, and some of them are willing to enumerate in excruciating detail the benefits of it, as will become clear when you read my cover story in the January-February issue of HealthLeaders magazine. Of course, those providers not in the Epic camp worry about being frozen out of the Epic ecosystem. Meanwhile, more and more doctors in small practices are waking up to find that every major hospital in town is running Epic, forcing them to make a tough decision—stay free of Epic—or an expensive one—join the crowd.
ICD-10 vs. SNOMED CT. Yeah, I know these technologies are supposed to solve different problems, complement each other, work together like peanut butter and chocolate. But in researching SNOMED CT, I am continually struck by how often ICD-10 dominates the conversation, and how many doctors are somehow expected to learn more than humanly possible about ICD-10 codes—all because ICD-10, not SNOMED CT, will pay the bills come October 1, 2014. Meanwhile, SNOMED CT addresses not just disease classification but also a range of clinical diagnoses and procedures. Clever software is out there that lets docs comfortably select medical concepts and terms that then generate SNOMED CT and ICD-10 codes under the covers. It seems too many CIOs are busy simply trying to turn the ICD-10 crank, and won't have enough SNOMED CT codes to show meaningful use Stage 2 auditors round about the same time. No wonder CHIME is screaming for relief from MU Stage 2.
Nurse practitioners and health coaches versus doctors. This one depends on whether you're still billing fee-for-service or if you've moved to risk-based payment. More and more EHR technology enables NPs and health coaches to flag and field patient care and follow-ups, medication management, or various and sundry check-ins, without bothering the doctors. But some state regulations still require doctors to sign off on virtually everything, creating a workflow traffic jam. Still other doctors are control freaks and, rules or no rules, aren't going to feel good about not micromanaging these workflows. Just because technology enables distributed care and decision-making doesn't mean healthcare is ready for it.
Patient identity. This one won't go away. We're all another year older and no closer, really, to a solution that protects privacy, assures authentication, enforces authorization, and doesn't require an IT forklift upgrade by the healthcare industry. The federal ONC is making some new baby steps in this area, but advocacy groups such as Patient Privacy Rights are watching the smallest of these gestures nervously, fearing that the very sort of biometric authentication that in theory could make healthcare ID fraud a thing of the past could also be used to harvest patients' PHI, subvert the intent of HIPAA, and exert control over the autonomy of independent physicians.
Bring-your-own-tech. Now that Amazon is delivering Microsoft desktops via a Chrome browser, the genie is well and truly out of the personal cloud bottle. Any healthcare worker who has a browser potentially is able to store PHI in the cloud. The opening BYOD debates were just skirmishes. The big battle, with Amazon and Dropbox in one corner and data loss prevention technology in the other, is bound to make its way to the square ring in 2014.
What polarizing topics are on your list? Meaningful use Stage 3? Clinical quality measures? Problem lists? Google Glass–distracted doctors? Zombie fax machines? Health information exchange business models? Please chime in below. One thing's for sure: there's no shortage of polarizing IT topics to kick around at this year's Christmas parties.
Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.