My daily news routine includes listening to NPR during my morning commute and clicking on my iPhone “News” app at least once or twice during the day. Recently online news headlines have started with, “Trump’s First 100 Days”. As Diana Strubler discussed in the Acumen blog post last Monday the new administration in Washington brings a lot of uncertainty about the future of Health IT (HIT). What will the Republican administration and Congress do about healthcare, the Affordable Care Act (ACA), and MACRA? Perhaps with Tom Price, MD, in place as the new leader of the Department of Health and Human Services and Seema Verma, MPH, nominated for CMS administrator, we will soon have better visibility.
Looking to the future
The Healthcare Information and Management Systems Society (HIMSS) held its annual conference last week in Orlando and the meeting included government session discussions about the future of healthcare. Speakers Andy Slavitt, the former CMS administrator under the Obama administration, and Mark McClellan, CMS administrator during the George W. Bush administration, suggested that full-blown ACA repeal would be disruptive, and it is more likely that only parts of the ACA will be replaced. The best scenario seems to be a stepwise process with gradual change, some of which may have bipartisan support.
Dr. John Halamka also spoke at HIMSS about health IT and the Trump administration. Healthcare predictions published in his Geekdoctor blog include continued regulatory and reimbursement incentives for value-based care systems. Health IT will focus on interoperability and new provider workflow tools to support pay-for-value activities. Dr. Halamka expects HIT solutions to help patients/consumers engage in personal care plans through communication and data exchange. Artificial intelligence and machine learning systems will enable precision medicine for individualized care. Collecting, storing, and utilizing big data from the Internet of Things and patient-generated health data will be a common HIT activity.
While we are waiting for Jupiter to align with Mars in healthcare, it is hard to know what forces will push HIT innovation. Government incentives, penalties, and reimbursement have had a powerful influence in the past decade, but recent news suggests that healthcare consumers, millennials in particular, may drive rapid healthcare change. Last year USA Today published an article, “Changing the Game,” about the impact of millennials on the healthcare system. Millennials, ages 18-34, are now the largest living generation, surpassing baby boomers, and millennial expectations and demands are already influencing the healthcare market.
How do millennial expectations impact healthcare?
The USA Today article highlights how generational characteristics influence millennial behavior as healthcare consumers. Generally, millennials expect instant gratification, so they are not happy with a slowly responsive healthcare system. Millennials will not wait weeks for appointments, but expect to been seen on demand. They are willing to use telehealth and quick-service retail clinics that provide on-demand services. Millennials are not committed to a long-term physician relationship and this type of continuity of care may be less important as consumers collect, manage, and share their own healthcare data. Millennials also exhibit cost-conscious behavior, so they expect online information about cost of care and the ability to make choices about site of care based on cost.
Interestingly, the ACA is responsible for the very large number of millennials in the healthcare market today. Millennials are the healthy, previously uninsured consumers that the ACA was designed to bring in, and they are interested in preventive healthcare. As consumers, millennials expect to make use of technology in most aspects of daily life, especially smartphones. Not only do they expect online services and data access, they also expect mobile-friendly electronic billing. No more paper bills with 90- to 120-day accounts receivable.
Data security is a top priority
To meet the demands of millennials and other consumers, healthcare will have to electronically collect, store, and safely transfer vast amounts of data. So, one of the headlines from HIMSS that should not surprise you is this, “81 percent of U.S. healthcare organizations are increasing security spending this year.” Cybersecurity will be even bigger business as data is collected on mobile devices and stored in a cloud environment. In the U.S. much of the HIT security concern is due to compliance risk since HIT security risk assessments are a MACRA requirement and security audits can result in significant regulatory fines. Globally there are 2 other high priority HIT security concerns: data breaches and maintaining a trustworthy data reputation. In the future as mobile devices and the cloud are used for healthcare data management, security measures focused on network and device security will fall short. Data encryption strategies for mobile devices as well as internet-connected technologies like insulin pumps and heart rate monitors will be key. Consumers will expect to feel as trusting about their healthcare data as they do about their online banking data.
In the dawning of the age of millennial healthcare, the government will continue to impact HIT with regulations and value-based care reimbursement, but millennial healthcare consumers will drive changes in healthcare delivery. We are likely to see continued growth of new HIT technologies for mobile and personal devices, ensuring that data security will still be a high profile issue. This is the dawning of millennial healthcare—let the sunshine in!
Dugan 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.
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