Consumerism Will Spark Change Across the Industry: My Top Seven Health IT Predictions for 2019

As we prepare to take on the challenges and opportunities of a new year, let’s lay out some of the industry’s macro trends and what they might mean to us in 2019.

This year, there is a theme. As patients, we have an increasingly consumer-oriented mindset—and rightfully so. We’re paying closer attention to the quality and value we’re getting for the money we’re spending. This “consumerization” of healthcare, along with constant technology innovation, is driving a tectonic shift across the industry, and it’s easy to be excited about what the future holds. 

After nearly 40 years in this business, I’d better be getting good at reading between the lines to understand what’s coming next. So without further ado, here are my top seven health IT predictions for 2019.

1. Consumerization of healthcare reaches tipping point
2. Telehealth, mobility and millennials will upend the who and where of care delivery
3. Consumers will demand healthcare price transparency
4. People will insist on the ability to easily share their health data -- forcing the industry to accelerate interoperability solutions
5. Increased interoperability will propel value-based care
6. Initially driven by government regulations, the health IT industry will take the lead on battling the opioid epidemic
7. The healthcare market will demand easier, more appropriate access to high cost specialty drugs

The full Surescripts article can be viewed at this link.  

How blockchain technology will reshape health care

Blockchain advocates say a breakthrough “killer app” is imminent that will change the business of healthcare as we know it. In the meantime, however, there are at least five practical uses for the technology that permits the distribution of digital information, but not the copying of that information.

These include:

• “Smart” contracts. Contracts automatically go into effect when certain previously agreed upon conditions are met.
• Supply chain processes. The new technology could make supply chains more efficient and transparent, improving the warehousing and delivery of medical goods and supplies.
• Physician credentialing. A company called ProCredEx recently launched Professional Credentials Exchange to do this with a private Medicare claims processor, a private provider of Medicaid managed care and Medicare Advantage plans, and the Michigan-based Spectrum Health System.
• Peer-to-peer data exchange. A system with features that can include preventing people from getting multiple opioid prescriptions and verifying clinical trial data. The hope is that this function can also be used to shrink processing time for prior-authorization requests down to less than five minutes.
• Proof of work. In medical liability cases where attorneys may claim that physician defendants have altered their records, clinical notes entered in blockchain time-stamped blocks create a tamper-proof ledger of what a physician did and when.

The full article from the American Medical Association can be found at this link.  

The simple idea that could help end America’s opioid epidemic

I spent a lot of 2018 reporting on complex systems and policies that could help end the opioid epidemic, which is now the US’s deadliest drug overdose crisis ever.

But behind all the reporting that I did was a simple idea: America needs to see addiction as a medical condition, and approach addiction treatment like any other form of health care.

The full Vox article can be viewed at this link.  

Diagnosing rare diseases can take 30 years – but world’s largest medical database could speed it up

Currently, there is no global database that collects all the information doctors require when diagnosing a patient with a rare – and often unknown – disease.

Mendelian says it is building the world’s largest repository of medical information to address this issue.

The full Compelo article can be found at this link.  

Diagnostic diversity – an indicator of institutional and regional healthcare quality

Our aim was to estimate the diagnostic performance of institutions and healthcare regions from a nationwide hospitalisation database.

The Shannon diversity index was used as an indicator of diagnostic performance based on the International Classification of Disease, 10th revision, German Modification (ICD-10-GM codes). The dataset included a total of 9,325,326 hospitalisation cases from 2009 to 2015 and was provided by the Swiss Federal Office for Statistics. A total of 16,435 diagnostic items from the ICD-10-GM codes were taken as the basis for the calculation of the diagnostic diversity index (DDI). Numerical simulations were performed to evaluate the effect of misdiagnoses in the DDI. We arbitrarily defined the minimum clinically important difference (MCID) as 10% misdiagnoses. The R statistical software was used for all analyses.

Diagnostic performance of institutions and healthcare regions as measured by the DDI were strongly associated with caseload and number of inhabitants, respectively. A caseload of >7217 hospitalisations per year for institutions and a population size >363,522 for healthcare regions were indicators of an acceptable diagnostic performance. Among hospitals, there was notable heterogeneity of diagnostic diversity, which was strongly associated with caseload. Application of misdiagnosis-thresholds within each ICD-10-GM category allowed classification of hospitals in four distinct groups: high-volume hospitals with an all-over comprehensive diagnostic performance; high- to mid-volume hospitals with extensive to relevant basic diagnostic performance in most categories; low-volume specialised hospitals with a high diagnostic performance in a single category; and low-volume hospitals with inadequate diagnostic performance in all categories. The diagnostic diversity observed in the 26 Swiss healthcare regions showed relevant heterogeneity, an association with ICD-10-GM code utilisation, and was strongly associated with the size of the healthcare region. The limited diagnostic performance in small healthcare regions was partially, but not fully, compensated for by consumption of health services outside of their own healthcare region.

Calculation of the DDI from ICD-10 codes is easy and complements the information derived from other quality indicators as it sheds a light on the fitness of the institutionalised interplay between primary and specialised medical inpatient care.

The full article can be downloaded below.  

Mean Body Weight, Height, Waist Circumference, and Body Mass Index Among Adults: United States, 1999–2000 Through 2015–2016 

This report presents trends in mean weight, height, waist circumference, and body mass index (BMI) among adults in the United States from 1999–2000 through 2015–2016.

Data were obtained from physical examinations of a nationally representative sample of adults aged 20 and over in the National Health and Nutrition Examination Surveys during 1999–2016. The tables present means and standard errors of the mean for weight (n = 45,047), height (n = 46,481), waist circumference (n = 43,169), and BMI (n = 44,859) separately for men and women overall, by age group, and by race and Hispanic origin for each 2-year survey period. Changes in these body measures over time were evaluated using linear regression.

Since 1999, mean weight, waist circumference, and BMI increased for all age groups, for non-Hispanic white and Mexican-American men and women, and for non-Hispanic black women. Among non-Hispanic black men, weight, waist circumference, and BMI increased until 2005–2006 and then remained level. No change in height was seen over time except for a decrease in crude estimates among all women, a decrease among men and women aged 40–59, and an increase in both crude and age-adjusted estimates of mean height for men followed by a decrease after 2003–2004. No significant trends were seen in any of the four body measures for non-Hispanic Asian men and women (data available only for 2011–2016).

Mean weight, waist circumference, and BMI in adults have increased over the past 18 years. Conversely, mean height did not change in many demographic subgroups and, in some groups, was lower in 2015–2016 than in 1999–2000.

The full National Health Statistics Reports article can be downloaded below.  

Slides and link to recording from 12.12.18 webinar from eHI and Manatt.

In 2016, 11.5 million Americans were misusing prescription opioids, with the abuse reaching epidemic levels in 2017. The opioid crisis has accelerated the need for healthcare stakeholders to play a more active role in managing behavioral health—and patient care to transition from siloed to integrated models. 

A new webinar from Manatt Health and the eHealth Initiative (eHI) examines health information technology’s role in sharing and protecting behavioral health data as all the healthcare players—from traditional plans and providers to emerging telehealth companies—join forces in response to the crisis.

The session explores privacy and security issues in the context of the epidemic, explains the policies and regulations that hinder the sharing of sensitive patient data, and discusses how technology is affecting the use of behavioral health information.

Key topics include: 

• An analysis of current state and federal regulations related to sharing behavioral health and substance abuse data
• An overview of the types of sensitive patient health information—including behavioral and substance abuse data—tracked and shared among providers and payers
• The obstacles providers face in exchanging sensitive data while remaining compliant with the Health Insurance Portability and Accountability Act (HIPAA) and 42 Code of Federal Regulations Part 2 (42 CFR 2)
• The ways regulations interfere with care delivery, the types of information not exchanged because of privacy and security concerns, and changes that might address the challenges
• The innovative OhioHealth initiative to help providers identify those at risk of substance use disorders—and the data strategies in place to remain compliant with HIPAA, 42 CFR 2 and the Prescription Drug Monitoring Program 
• The technology innovations driving the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Targeted Capacity Expansion/Technology-Assisted Care Program, created to address the opioid crisis in states with the most dramatic increases in addiction 
• The challenges and opportunities of telehealth programs in rural communities—and lessons learned from current efforts

Even if you can’t make the original airing on December 12, click here to register free now and you’ll receive a link to view the program on demand.

Presenters:

• Robert Belfort, Partner, Manatt Health
• Alex Dworkowitz, Associate, Manatt Health
• Kathy Jobes, Vice President, Chief Information Security Officer, OhioHealth
• Winston J. Washington J r., Senior Public Health Advisor, Center for Substance Use Treatment, SAMHSA

Use of Electronic Health Data in Clinical Development

In clinical research and development, the scientific possibilities for analyzing large volumes of data are still not used to the extent that it is possible in other sectors (e.g. finance, consumer behavior). Health data are often widely distributed and locked in individual databases, standards are highly inconsistent, and data privacy protection complicates data consolidation and data use. This results in complex clinical protocols with often unrealistic selection criteria, and trials are still too often assigned to inappropriate sites. Furthermore, patient recruitment continues to be one of the major problems in the execution of clinical trials. The use of electronic health data (real world data) allows alignment of protocols to actual medical conditions, formulation of realistic inclusion and exclusion criteria and testing their effects on recruitment using real data. In addition, trials can be assigned to sites that have a proven number of patients in their databases, and patients can be identified at the site. Various providers are players in the field of “big data” and it is not always easy to assess which system is best suited to meet the demands of clinical development. Therefore, a requirements specification is presented in the following.

The full article can be downloaded below.  

IMPLANT FILES

Health authorities across the globe have failed to protect millions of patients from poorly tested implants, the first-ever global examination of the medical device industry reveals.

These articles from the International Consortium of Investigative Journalists (ICIJ) can be viewed at this link.  

Health insurance on demand? Some are betting on it

People with health insurance often pay for coverage they never use. A startup wants to shake that up.

It’s a radical idea: On-demand insurance that lets customers buy some of their coverage only if and when they need it, similar to how TV viewers might rent a new release from Amazon instead of paying every month for a pricey cable package they rarely use.

This approach from Bind Benefits is one of the latest wrinkles in a yearslong push by companies and insurers to control costs and make patients smarter health care shoppers. And it’s drawing attention from the nation’s largest health insurer, UnitedHealthcare, and some sizeable employers.

The full Associated Press article can be viewed at this link.