Great Expectations: Health IT in 2017

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2017Happy New Year! To get our Acumen blog off to a value-based start we asked health IT (HIT) experts to give us their perspective on HIT progress in 2016 and hopes for 2017. Please enjoy these 2016 reflections and 2017 expectations.

Franklin W. Maddux, MD FACP, Executive Vice President for Clinical & Scientific Affairs and Chief Medical Officer, Fresenius Medical Care North America

 2016 reflection: 

I think the proliferation of the Internet of things and voice-activated input will ultimately be shown to have tipped into the daily lives of patients and the impact on the future of Health IT will never be the same.

2017 expectation:

Health IT will benefit from three sentinel activities in 2017. First, the demand for intense measurement and data capture of performance will influence how care is organized. Secondly, the evolution of MIPS and MACRA will foster an environment which will reduce variability of care and will provide higher value care; and thirdly, the evolution of most real-time data combined with unique data analysis about individuals will turn the concept of precision medicine into personalized medicine.

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Len Usvyat, VP of Integrated Care Analytics, Fresenius Medical Care North America

2016 reflection:

I would argue that the development of products that help all consumers monitor and improve their health is key. It was only a few years ago that the thought of measuring one’s own O2 level or continuously tracking one’s own heart rate was unthinkable—today, technological developments have made this available to everyone.

2017 expectation:

Just as we saw in 2016, Google and others will continue investing resources into applying artificial intelligence methodologies to large data sets; this will likely have real repercussions in nephrology in 2017. Making data publicly available will spearhead our understanding of kidney disease by leveraging thousands of developers through crowd-sourcing. This is similar to what Apple has done by opening up their iOS handheld platform and allowing thousands of developers to make apps for Apple handheld devices.

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Jason Holcomb, VP of Business Development, Acumen Physician Solutions

2016 reflection: 

I believe we are at the very front end of the “messy middle” of the “Fee for Service” (FFS) to “Fee for Value” (FFV) transition, and the greatest achievement in 2016 has been the efforts of many to decipher how best to navigate the sea change.

2017 expectation:

In 2017 improvements in interoperability will have the greatest impact on nephrology. As payment models evolve and nephrologists lead multi-disciplinary care teams, the ability to access, use, and share data is paramount to providing quality care. I am hopeful that projects like CommonWell and Carequality and technology investments in Acumen 2.0 will provide a new normal for accessing and using data that has been “trapped” in multiple systems. This will drive better patient outcomes for nephrology.

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Eddie Hedrick, VP, Information Technology Group, Fresenius Medical Care North America

2016 reflection:

The collaboration between the Sequoia Project’s Carequality Interoperability Framework and the CommonWell Health Alliance, a consortium of health IT vendors, represents a great opportunity to promote interoperability and boost data sharing across all of the major EHR vendors.

2017 expectation:

Increased patient data sharing will benefit the nephrology community in the delivery of care as much as any other “ology”. In 2017, progress in broad interoperability will advance to a greater degree than ever before given the national advances, focus, and commitment. One of the greatest divides in health IT today will begin to be bridged.

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Terry Ketchersid, Sr. VP & Chief Medical Officer Integrated Care Group, Fresenius Medical Care North America

2016 reflection:

Publication of the MACRA final rule in late 2016 is the most important event of the year as it will shape the direction Health IT takes in the years ahead.

2017 expectation:

Historically, as nephrologists we have viewed “quality” in terms of clinical process and outcomes measures. Moving forward, the emphasis on our patients’ experience of care will have a substantial impact on Health IT as we develop systems that focus on patient-centered care. A small manifestation of this trend can be found within the 2017 ESCO quality program where surprisingly one-third of the ESCO’s Total Quality Score is derived from our performance on the ICH CAHPS, a CMS-deployed patient satisfaction survey administered to in-center hemodialysis patients.

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Ravi Kalathil, Sr. VP and Chief Information Officer, Fresenius Medical Care North America

2016 reflection:

Interoperability might have turned the corner in 2016. If we invest in this, it could be a competitive advantage.

2017 expectation:

In 2017 we will hopefully achieve a consistent pay-for-performance/comparative effectiveness/risk management baseline. Whoever gets that right will own value-based care.

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Sam Gopal, VP, Product Management, Fresenius Kidney Care

2016 reflection:

This probably flew under the radar, but FHIR APIs are nearing mainstream readiness. While showcase apps focus on consumer use cases, the real value is in driving interoperability between physician practices, hospital systems with higher data granularity and higher data fidelity than HL7 2/3 and CCDA.

2017 expectation:

MACRA and QPP will force physician practices to transform—not just in terms of technology adoption and use, but also in terms of people and processes. Some key questions to consider for nephrology practices: Should they focus on MIPS reporting or work towards ACO/ESCO participation? What technology and tools should they invest in? How does practice staffing and process change to capture data, review analytics/insights, provide feedback to clinicians, and report to CMS?

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Hugh Gaston, VP of Operations and Support, Acumen Physician Solutions

2016 reflection:

In addition to the finalization of MACRA, I believe one of the most important health IT achievements from 2016 is the advancement in wearable health sensors (Google’s pending smart contact lens glucometer, for instance), which will improve the way people with chronic diseases are monitored, treated, and ultimately cared for.

2017 expectation:

There is a lot of pressure in the healthcare industry for true interoperability between systems, as evidenced by such actions as the recent signing of the 21st Century Cures Act. My hope is that progress towards true interoperability will make great strides in 2017, enabling the flow of information between all of the health IT systems in the different care settings within which nephrologists work. This flow of data will be essential to success in value-based care programs such as ESCOs and CSNPs as well as essential to creating an enhanced user experience for providers and patients. True interoperability should also result in improved patient care, putting more power in both the hands of the provider and the patient (and their family members) so that patients may live longer and more fulfilling lives. To me, that’s the end game in health IT…to truly help those in need of care.

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Mark E. Neumann, Editor-in-chief, Nephrology News & Issues

2016 reflection:

In my view, the focus on integrated care in 2016—as measured by the participants in the Comprehensive ESRD Care Demonstration—shows how health IT can serve as a cross-platform between provider and payer to improve kidney health and bring about savings in an at-risk population like those with ESRD.

2017 expectation:

MACRA will no doubt help doctors embrace—or at least, accept—health IT in a positive way, and perhaps allow them to influence and develop systems that accomplish what they need in a model that works at their level. Likewise, I think we are going to see greater value in telehealth: improving outcomes, increasing patient engagement, and offering improved communication between dialysis staff and patients who are constrained by location and the ability to travel.

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Ahmad Sharif MD, MPH, SCPM, VP Clinical Health Info Technology, Fresenius Medical Care North America

2016 reflection:

I think an important health IT achievement in 2016 was a focus on user-centered design for IT systems.

2017 expectation:

MACRA-related requirements will be drivers of many changes in the health IT world. Consumer access and control of their data through consumer-mediated data exchange initiatives will provide another approach to sharing of information and creation of a longitudinal health record. I will also be keeping a close eye on the 21st Century Cures Act as it relates to the telemedicine initiative. 

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Diana Strubler, Policy and Standards Senior Manager, Acumen Physician Solutions

2016 reflection:

Between the finalizing of the ONC’s 2015-edition final rule (that requires any certified EHR in 2018 to have API capabilities to respond to requests for certain patient data) and the agreement between the Sequoia project and CommonWell, it is very clear that the unblocking and exchanging of patient data made huge leaps in 2016.

2017 expectation:

It is no surprise that the new Quality Payment Program will most likely have the biggest impact on nephrology next year. The typical nephrology practice relies on Medicare for 60-70% of their total revenue (this is much higher than your average clinician!). If nephrologists are not proactive in their planning (especially starting in 2018), they may see the biggest hit to their bottom line.

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Carlos Muchiutti, Sr. Director, Product Management, Fresenius Kidney Care

2016 reflection:

In 2016 the use of technology (based on standards such as FHIR) to empower patients to take a greater and more active role in their care was one of the greatest health IT achievements in 2016—for example, by aggregating their medication list into one location.

2017 expectation:

The need and demand for the free flow of data between providers continues to grow—increasingly supported by standards such as FHIR to enable further interoperability. This now connects with the consumerization of healthcare where patients expect their doctor to have complete access to their medical records (Connected Care and the Patient Experience annual survey). Furthermore, look for innovations that expand the patient’s experience with digital interactions such as electronic messaging (between patients and their doctors) and remote visits (including video technology).

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Preety Sidhu, Head of Digital, Fresenius Medical Care North America

2016 reflection:

In 2016 new technologies inside and outside of healthcare exacerbated consumer dissatisfaction with the current healthcare system.

2017 expectation:

Consumers are bringing the same expectations about customer experience to healthcare that they bring to companies in retail, technology, and finance. Increasingly, consumers will own and manage their own clinical data, just as they manage and own their financial data. In 2017, we will see more consumers replacing basic traditional healthcare services with digital ones, such as use of emails or text messages to communicate with physicians and clinicians on a regular basis. We will also see a growing investment in digital and mobile health that will reorder the healthcare landscape and make self-service and clinical transparency tools a part of the normal interactions between consumers and providers. In the not-so-distant future, we will see IT platforms that connect disparate data and finally provide consumers with a coherent health profile.

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Dana Hensley, President, Acumen Physician Solutions

2016 reflection:

I believe the most important health IT event from 2016 will prove to be the agreement between HIT vendor groups (CommonWell and Carequality) that will allow clinicians to send and receive basic patient data in real time for the vast majority of U.S. patients.

2017 expectation:

I think the major event for nephrology HIT in 2017 will involve how provisions of the Affordable Care Act (ACA) are altered. Due to the nature and cost of ESRD, nephrology is in a unique position to take on the responsibility of managing the total healthcare spend for ESRD patients in ways that can improve patient care and reduce cost as well. I hope that governmental programs that promote this type of innovation will survive even as the political axe falls on the ACA.

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Wishing you great progress in technology solutions for 2017.

“….if this life of ours
Be a good glad thing, why should we make us merry
Because a year of it is gone? but Hope
Smiles from the threshold of the year to come
Whispering ‘It will be happier;’ and old faces
Press round us, and warm hands close with warm hands…”

Alfred Lord Tennyson—Act I, Scene III, The Outlawry

Dugan MadduxDugan Maddux, MD, FACP, is the Vice President for CKD Initiatives for FMC-NA. Before her foray into the business side of medicine, Dr. Maddux spent 18 years practicing nephrology in Danville, Virginia. During this time, she and her husband, Dr. Frank Maddux, developed a nephrology-focused Electronic Health Record. She and Frank also developed Voice Expeditions, which features the Nephrology Oral History project, a collection of interviews of the early dialysis pioneers.

Top image from www.canstockphoto.com

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