Even if we’ve tried to forget, everyone remembers those painfully awkward teen years when we were still getting comfortable with who we were and our place in the world.
That’s where the health IT industry finds itself now: still getting comfortable in its own skin.
Health systems have the basic IT infrastructure in place. They have an EHR system. They have analytics and population health tools. They have more data than they know what to do with. Now they’re just trying to pull it all together into a cohesive unit.
It’s not always pretty. EHRs don’t talk to one another particularly well, and physicians are constantly lamenting the time suck of data entry. Wearables appear to be an attractive tool, especially for payers looking to bring down the costs of chronic conditions, but no one has figured out the ideal model. Providers are finding pockets of success in telehealth and remote monitoring, but the payment details are still a bit cumbersome.
The foundation is there, but bringing it all together is a process that’s both painful and exhilarating. Here’s a look back at some of the highlights.
Telehealth digs in, but reimbursement is still elusive
Telehealth is no longer a luxury—it’s a competitive necessity. Even if the ROI presents a tricky calculation, executives are well aware of telehealth’s impact. Recent surveys show more than half of healthcare executives have plans to grow or expand their existing program based on the benefits of patient satisfaction and improved care coordination.
But the industry still hasn’t shaken the reimbursement monkey off its back. Multiple bills expanding reimbursement for both Medicare and Medicaid were introduced in 2017—including the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017, which unanimously passed the Senate in September. But none of them made their way to the president’s desk, in part because Congress spent much of its legislative agenda chasing an ACA repeal.
Still, telehealth has demonstrated value. It’s only a matter of time before lawmakers push through a reformed reimbursement structure.
Does healthcare need a virtual medicine specialty? “Before we start laying the lines of what could be turf war, let's just use it and explore it." https://t.co/ajQm9lAQrj by @DB_Sweeney @AmericanTelemed #telehealth pic.twitter.com/mYzGOIIbzr— Nathaniel Lacktman (@Lacktman) November 29, 2017
Two global cyberattacks underscore healthcare’s vulnerabilities
It’s not as though people haven’t been shouting out healthcare’s cyber vulnerabilities for several years, but 2017 was the first time the industry came face-to-face with the real-world repercussions of a massive global attack.
WannaCry hit in May, and Petya/NotPetya arrived the following month. Both showed just how susceptible healthcare really is. WannaCry knocked out connectivity for dozens of hospital systems at Britain’s NHS, and even weeks after the attack, the Department of Health and Human Services indicated that two multistate health systems were still dealing with operational challenges associated with the attack.
Petya, meanwhile, took out a U.S.-based drug company, forced a West Virginia hospital to replace its entire computer system and cost Nuance about $68 million after it shut down the company’s medical transcription services. The attacks directed an unsettling spotlight on the implications for healthcare, all of which were addressed in a new report released by HHS that highlighted a slew of urgent challenges, not the least of which is a “severe” lack of IT security talent in the pipeline.
EHRs enter the legal fray
The $155 million eClinicalWorks settlement with the Department of Justice shook the health IT world to its core, highlighting the potential for EHR vendors to circumvent certification criteria laid out by the Office of the National Coordinator for Health IT. Former ONC officials said eClinicalWorks pushed the envelop more than any other vendor, but noted that the company was not alone.
An attorney that represented the whistleblower in the eClinicalWorks case believes more false claims cases may be on the way, citing an OIG audit that identified $729 million in fraudulent EHR incentive payments coupled with some of the issues identified in the government’s complaint against the vendor.
More cases have cropped up in recent months. A whistleblower lawsuit against Epic was unsealed in November claiming the EHR vendor’s billing software prompted nearly 300 hospitals, health systems and physician offices to overbill Medicare for anesthesia services. Weeks later, another lawsuit claimed 62 Indiana hospitals falsified Meaningful Use data to obtain EHR incentive payments. Meanwhile, OIG is undertaking another audit focusing on incentive payments made through Medicare between 2011 and 2016.
Digital health investment is up, and the tech giants are here to play
This record-setting investment happened despite a roller coaster of regulatory uncertainty. Why? For one, investors aren’t backing away from the perceived value that analytics and digital health solutions bring to the industry. But the market forces at play have little to do with Congress or the latest ACA repeal acronym and more to do with the steady march toward value-based care and the priority of consumer-focused care.
That has caught the attention of consumer tech giants like Apple, Amazon, Google and Fitbit, all of whom fancy themselves the next great healthcare disrupter. And they very well may be. As HIMSS CEO Hal Wolf told FierceHealthcare about the prospect of more involvement from the world’s largest tech companies: “We could use all the innovation in healthcare as possible—we welcome it with open arms.”
Speaking of digital health, the FDA had quite a year
Another driver behind the growing interest in digital health: The FDA’s revamped approach to regulation. Under the leadership of Scott Gottlieb, M.D., the agency just closed out an impressive year, issuing a slew of new digital health guidance documents and rolling out a Digital Health Innovation Action Plan that featured a new precertification pilot program that aims to completely reengineer the way the FDA evaluates and approves digital health tools.
Those same tech giants looking for a way in sniffed out a unique opportunity to shape the regulator's approach. Nine high-profile companies, including Apple, Fitbit and Verily, were selected to participate in the pilot project that kicked off in September.
The FDA has faced criticism in the past for its inability to keep up with modern devices and technology—and that’s something that Gottlieb and FDA Associate Director for Digital Health Bakul Patel clearly aim to change with an approach that provides some welcomed clarity for the industry and will likely contribute to digital health’s continued growth moving forward.