Clinical systems consolidation: With enterprise systems focused on R&D for specialties, patient engagement and connectivity, the wave of MU development may slow. Ophthalmology, cardiology and bloodbank are a few examples where add-on sales may grow and niche vendors may look to be acquired. Cerner and Athena keep their eyes peeled for good catches, while Epic (as usual) stays in-house. Organizations will be hard pressed to justify too many 3rd party solutions when enterprise licenses support stable core applications. Providers may be less satisfied at first, though the lifecycle of maturity will repeat in these niche areas as happened with core systems.
Connecting health systems: MSO, extension programs and connect models have been around for some time – both in regional deployment as well as across the country with additional hosting solutions. With each agreement, however, business models need to be developed to account for every aspect of the new relationship. Payment for specific application modules, training, SLA development, access to system design, membership on governance, and many more decisions are crucial to alignment. We should not be surprised to see major EHR vendors developing better tools to support and manage the extension of core systems – from dashboards that isolate specific practice performance and cost, to design and build access that limits scope to content, fee schedules, and relevant system impacts. ‘Extender’ and ‘extendees’ are differently incentivized to form partnerships, though making an extension program financially viable requires staff optimization on both sides to reduce operating costs. We will likely hear many more contrasting stories of what enabled success in this newer market.
Change Management attention: Getting live was – the easy part? Many leaders will agree, 2-3 years post-live. Implementing upgrades, decision support, automated coding and finance reporting – these require disciplined staff, change control, content management and closer collaboration without the EHR staff on hand. Most organizations may self-report a C grade for governance and management of implementation of new features. Refill automation, patient estimate generation, automated change impact assessments, and more are all part of the new wave of change control. EHR vendors know this is hard, and they may provide more staff and more attention to helping organizations reach maturity with tools. They want to see organizations get to the post live staffing goals just as much as you do. Some may even be incentivized by it.
Patients and the EHR: Patients are accessing their charts more than clinicians. Epic speaks of this trend often, and as patient portals mature, others surely will see the same trend. Patients are savvy users and expect the same ease of use that they have with banking, consumer applications, shopping and more. They want online scheduling, payment options, health coaches, reminders, and easy communication. We’ll likely see continued investment in web integration and patient solutions that focus on more than just engagement, but complementary features to the EHR. Developing call centers that support social media outreach and knowledgeable staff that know how to best connect WITH you will influence the market and patient satisfaction.
Connected health – delay takeoff?: Connected health is an exciting space with lots of funding – from Samsung’s connected devices and platforms to the MIT media lab’s patient monitors. Consumer interest is high, though integration, standards and focus is not clear. Chronic disease management applications are gaining traction and partnerships as they have a clear ROI. Look for Medtronic, Samsung and Apple’s partnerships to give some better signs of success. Startups like Oscar in NYC will also overlap with this space as they provide personalized insurance solutions across the US. EHR vendors will open more doors as they see the consumer demand. Epic exampled their interest with a FHIR development week to close 2015.
Security is higher on the list: Data breaches are here to stay, and stakeholders will scrutinize user access, authentication and standards to stay protected. Not much will change here, or quickly perhaps. It may take catastrophic events to spur industry change – investing dollars to change infrastructure with no immediate ROI is always a battle. Audit shops and risk management may have to illustrate competitive risk to win changes here. EHR vendors may provide advice, but they typically stay away from dictating policy.
Big data is hard: Oracle, Microsoft and big vendors provide platforms, though integration, reporting knowledge, data definitions and data management are not their domain. There just aren’t enough data scientists with EHR experience to make a big dent just yet. Pharma and insurance companies will have the firepower to play with EHR data, as will academics, as will some shared population risk modelers. Look to see vendors help, though different platforms make this a pricey problem for each organization. Perhaps anonymized patient data will go up for sale more often, creating a playground for outsiders. Price schedules should be, though aren’t transparent. Real time intervention costs and outcomes should be available as well. Don’t bet your house on 2016 breakthroughs just yet.