2018 and Healthcare IT

Craig Joseph, MD
By: Craig Joseph, MD
Date: January 08, 2018

With 2017 closing out another typical, uneventful, kind of boring year, it’s incumbent upon us to predict what the next year holds. What’s that? It’s not incumbent upon us to predict the future, you say. We can simply go about our regular routine and deal with life as it comes at us? Well, sir or madam, you clearly don’t have to deal with my VP of Marketing. She says it’s incumbent, so it is, darn it. Resistance is futile.

I live in the world of healthcare IT. And if you’re reading this, you might also live in this world. While I have not rigorously reviewed what others see in the future of healthcare IT, here’s what I suspect I’d find:

  • More electronic health record (EHR) vendor consolidation
  • More hospital and clinic consolidation
  • Tax breaks for everyone (#Yippee)
  • More physician dissatisfaction with their EHRs
  • Merger between Fox News and MSNBC to create one huge, confused “news” source
  • CIOs and CMIOs trying to do more with less

Perhaps some of my predictions are not strictly related to healthcare IT, but take ‘em for what they’re worth. They’ll all happen in 2018; just you watch!

Here’s my first prediction: it is impossible to predict what the federal government will do with respect to APMs, MIPS, and whatever other QPP acronyms you want to throw around. The current administration has shown a predilection for fewer regulations and less oversight, not the opposite when it comes to payment programs. Whether you think this is good, bad, or indifferent, it’s happening. Hence, it’s reasonable to question the continued march toward a new payment system at the federal level. I’m a soccer fan, and a fan of The Men in Blazers. They have a saying: “Soccer is America’s sport of the future, as it has been since 1972.” I believe this can be said of pay for performance: it’s the future of payment for medical services in the United States, as it has been for a decade or so.

My second prediction: physicians are mad as hell, and they’re not gonna take it anymore. Doctors have been complaining about EHRs forever, even back in the day when they were EMRs! Many IT professionals have chalked this up to physicians being malcontents in general and Luddites specifically. (Remember, I’m a physician, so I can say these things out loud.) To our dismay, doctors have shown they love technology . . . when it works. iPhones? Doctors love ‘em. E-prescribing? Sign us up. Problem-oriented documentation? OMG, watch this video of Larry Weed! Yes, we doctors want technology to help us take care of patients! So, I must be ready to tell you that those incompetent EHR software vendors are to blame, right? Not so fast. Could the software be better? Sure. Should formal usability techniques have been incorporated into R&D a long time ago? Naturally. But I point my finger at the regulatory, legal, and payment schemes that we’ve created in the United States as the principal villain here. EHR vendors create the software we need to practice in America; if we could wipe away some of the underpinnings of how we pay for and regulate medicine in the U.S., I’m confident the software would improve in short order.

Physicians are angry about their EHRs. So, what’s changing in the coming years? The power to do something to improve the EHR! Third-party organizations like the AMA and KLAS are surveying doctors and comparing EHRs and how hospitals and clinics have implemented those EHRs. In fact, the KLAS Arch Collaborative surveys end-user physicians, and has found that there are definite indicators of EHR success (solid IT governance, physician personalization of the EHR, and physician participation in behind-the-scenes configuring of the EHR are the top three in my book!) The ROI on physician builders and personalization refreshers seems solid. IT leaders should expect more requests for both of them.

My final prediction for 2018 is that we will continue to struggle with interoperability. Those nasty EHR vendors again? Not so much. It’s just that it is difficult to exchange information when doctors’ hatred of standardization is so strong. Is hate a bit much? I don’t think so. At least in the U.S., the dislike of cookbook medicine remains a real obstacle. Many physicians are uncomfortable with following pre-determined pathways of care because they see many of their patients as unique and in need of a unique plan. When I’m a patient, I think this idea is grand, but without certain standards, it’s difficult to compare apples to apples. Forget about course of treatment; let’s talk about the definition of sinusitis or when it’s appropriate to use the term obesity vs. overweight. Doctors disagree about definitions, and it’s nearly impossible to exchange information when we can’t agree on what information we exchange. What’s the difference between the problem list and the past medical history? I think I know, but I realize that many fine physicians disagree with me. Hence, I posit that interoperability in the U.S. is more of an agreement-among-physicians problem than it is a straightforward IT technical problem. Exchanging bank information at an ATM on the other side of the world? No problem. Exchanging clinical information between two health systems located a block from each other? Big problem!

Follow the blog and check back in December to see if I was right. Until then, I wish you and yours a happy and prosperous new year. May your medication history have no duplicates, and may your documentation templates be precise!

Craig Joseph, MD, is the Chief Medical Officer at Avaap where he works with healthcare leaders to implement and optimize EHRs in order to increase physician satisfaction, improve efficiency, and ensure full value of the technology.

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