WASHINGTON, D.C.—Healthcare innovators came together on Wednesday morning ostensibly to discuss how technology disruption was affecting healthcare delivery.
But a main point of focus for the panel centered instead on what didn't happen.
From obsolete technologies still in favor to long-held goals still out of reach for the industry, many of the health innovations expected in 2018 didn't happen, speakers said during a panel held by Politico and CVS Health. The speakers speculated that some of these changes might arrive in 2019—but only if the right regulatory conditions arise.
"I'm a big believer that incentives do shape the arena by which the ecosystem serves patients, so continuing to triple, quadruple down on value-based care" is crucial, said Jay Desai, CEO and co-founder of PatientPing, during the panel.
Here are five innovations that experts expected to see in 2018 but didn't.
Death of the fax
People outside the industry often express shock that the otherwise-obsolete fax machine is still so prevalent in healthcare. They may or may not be comforted to know that those inside the industry are just as aghast.
"My biggest disappointment is that we have not yet killed the fax machine. It is 2018, the fax machine is alive and well in healthcare and nowhere else. I'd love to see it go away," said Ann Hwang, M.D., director of the Center for Consumer Engagement in Health Innovation, during the event.
Healthcare is stuck with fax machines for now both because the format is enshrined in law and because there isn't really a workable alternative. Once EHR systems become fully interoperable and ubiquitous, perhaps practices can start unplugging their fax machines. But that's a far cry, even for 2019.
Value-based care arrangements
Value-based care, one of the most common promises in healthcare policy, has seen fits and starts since the Trump administration came in—particularly during the ACA repeal fight. But now, value-based care is starting to pick up speed again, panelists said.
"When Tom Price came in, I felt like we were very much in the wilderness era, and since Seema and Alez Azar ... and the new administration there, I think we're going way faster than we were moving with value-based care back then," said Desai, who during the Price era was at the Center for Medicare & Medicaid Innovation.
Still, the transition has been slow and painful.
"Healthcare is in this really awkward place where we have one foot in the value-based payment model and the other in the fee for service, and those canoes are going in two completely different directions," said Hwang.
Secure point-to-point messaging between clinicians
Though secure messaging is a well-proven and not-particularly-high-tech solution, it hasn't become ubiquitous in healthcare. But unlike some other entries on this list, that may say more about the health systems in questions than the regulations governing them.
"It's simple, useful, usable, and I was expecting by this point in time that all clinicians and health systems would be communicating with each other securely using that method. It just hasn't taken off as quickly as I had expected," said Peter Basch, M.D., senior director of IT quality and safety, research and national health IT policy at MedStar Health.
Someday, physicians will be able to directly chat with clinicians in their own care setting, separate health systems and even their patients. But hospitals simply haven't enabled the option.
Breaking out care from the hospital setting
Health IT visions are rich with remote monitoring telehealth opportunities. But according to Mona Siddiqui, M.D., HHS' chief data officer, far too much care still takes place in hospital settings.
"As a provider, 80% of what we do does not need to be done in a hospital. Apart from ICU care and surgical care, there is a lot we can do in a patient's home, and it shouldn't require having a family or a friend who is part of the healthcare system to help you navigate and coordinate all of that. And that's actually what happens right now," she said.
Regulators can do certain things to enable remote care, such as reassuring providers they won't get sued and can get paid for such services. But much of the transition is more of a logistical challenge for health systems.
"Everything is built around a hospital, right? All of the services are built around this single brick-and-mortar place. And part of it is, how do you actually change the entire way we look at the logistics of healthcare to be more focused around a patient's home? That's a really, really hard problem to solve," Siddiqui added.
Real-time pricing for individual patients
Perhaps because CVS Health was a co-sponsor of the event, the discussion also touched on real-time price information for patients—something CVS promises to provide with its platform.
In a welcome address to the panel, CVS Health CEO Thomas Moriarty described how the platform would customize to patients' coverage, allowing them to review prices and co-pays with their doctor before selecting a care pathway.
"Providers, your doctors, can now see the cost of the drug they prescribe for you based upon your coverage and clinically appropriate alternatives. As a result, prescribers are switching patients to a clinically appropriate alternative at lower costs 48% of the time, resulting to an average out-of-pocket savings to you as a patient of $125 per prescription," he said.
Full video from the panel can be found on Politico's website.