Without further adieu, here are our predictions:
Consumer/Patient Engagement – Not What it Seems
Despite the best efforts of the team at ONC to beat the consumer/patient engagement drum, providers by and large are still struggling with such basic issues of taking live their certified EHRs, making the transition to ICD-10, meeting physician demands to have everything served up on their new iPad and of course mapping out future strategies in anticipation of payment reform. Thus, we foresee consumer engagement remaining a tertiary issue in 2012. Just too many other pressing priorities at the moment. WebMD’s implosion on Jan. 10th may portend that this is not such a bad move – at least in the near term.
Bloom is Off the Rose, EHR Market Plateaus
Going out on a limb, we see 2012 as the year when we start talking of the post EHR-era. Yes, there will be plenty more EHR sales in the year to come but over 2012 we will also see EHR sales growth begin to plateau and level off by end of Q4’12. You heard it here first folks, it is time to collect your EHR winnings and seek new places to invest.
Finally, We’ll See Some Fairly Competent Tablet Apps from Legacy Vendors
Though physicians continue to adopt iPads at a rapid rate, they struggle to effectively use them in the hospitals to which they are affiliated simply because most hospital HIS cannot serve up an application effectively on an iPad. Sure, many have tried using Citrix as a stop-gap measure but this is just isn’t cutting it. In speaking to one CIO of a major IDN recently, he was so frustrated with his core EHR vendor’s slow pace of development that he is about ready to self-fund the development of an App for his physicians. Fear not CIOs and frustrated physicians, we have had the opportunity to see several alpha versions of iPad Apps that major EHR vendors are developing and they actually look pretty good. Look to Q2-Q3 ’12 for general availability release of these touch-screen native (mostly iPad-centric) Apps.
At Gunpoint, Direct Project Gains Traction
In 2011, the message came down from on high, or at least from the feds, that all State HIEs must include the use of Direct in their strategic plan. Pretty clear that this was politically motivated as to date, for the $500M plus we, as taxpayers are spending on these public HIEs, there is very little to show for it and we are now running headlong into an election year and this administration needs to show something, anything, in the way of success as it pertains to health information exchange. Sure Direct facilitates health information exchange (the verb), but so does a fax machine and frankly, Direct is only a modest step beyond faxing. Therefore, Direct will gain traction in these “forced” instances but we do not see it extending its reach into the much larger market of private, enterprise HIEs (does not sufficiently support care coordination, population health and analytics) and thus Direct’s overall impact in the market will be small and fade to nothing in three years time.
First CPT Codes for mHealth Apps Issued
mHealth Apps for care provisioning have not seen any significant adoption beyond pilot studies, studies which typically show some efficacy in their use. The big hang-up is a simple one, the risk to reward ratio for physicians to adopt and use mHealth Apps as part of the care process is too low. What might change that risk-reward ratio though is a CPT code whereby a physician actually gets paid to use, or have a patient use an App as part of the care process. WellDoc is one of the few mHealth App companies that is quite aggressive in moving the ball forward and we would not be too surprised if WellDoc did industry ground-breaking work to secure the first CPT codes for their diabetes management App.
Train has Left the Station as Supreme Court Rules on ACA
Though the Supreme Court will hear arguments for and against the constitutionality of the Affordable Care Act (ACA), it is unlikely that their subsequent ruling will throw out all of ACA (they may prune it). More importantly, the move to value-based reimbursement models is already in full swing, which is something that will not be reversed. Whatever the Supreme Court rules, its impact will be minimal and the numerous changes we are seeing take place today (move to accountable care models, patient centered medical home, etc.) will continue as the train has already left the station.
Changing of the Guard as Dynamic Duo Departs
Last year we predicted the departure of ONC head, Dr. David Blumenthal. This year is an election year and it is expected that there will be a significant changing of the guard across the administration. We predict that the dynamic duo that is Aneesh Chopra, White House CTO and Todd Park, HHS CTO will both be leaving their posts by end of the year.
M&A Continues, but at far more Reasonable Valuations
Okay, yes we have had this prediction for three years running, but we just can’t help ourselves as we see far too many vendors in this market (some 300+ EHR vendors alone!) and some rationalization must enter at some point. We are seeing rationalization on valuations (e.g., no one was willing to pay what Thomson Reuters wanted for their healthcare business unit despite there being a sizable number of bidders) and this will create an opportunity for acceleration in M&A activity in 2012.
Floundering HITECH Initiatives Attract Political Spotlight
Yes, we are seeing some modest success and adoption of EHRs as a result of the HITECH Act but the preponderance of such success is at hospitals that first have had some form of EHR already in place and also have a lot to lose if proposed reimbursement cuts from CMS come to fruition at the end this multi-year march to certified EHR adoption and meaningful use. Yet, under the covers we are still not seeing wide-spread EHR adoption at the ambulatory level, especially among smaller practices, State HIE initiatives struggle to define what they’ll actually be when the grow-up, the Beacon programs have not reached the promise land, and the RECs, well we were never a big fan of these for obvious reasons we outlined previously. As this is an election year, healthcare and anything with the stamp of the Obama administration on it, will become fair game and dragged into the limelight. Get ready for healthcare to become the political piñata of 2012
HIE Vendors Stumble
By the end of 2012, the final awards for State HIEs will conclude and with it the evaporation of the $500M plus honey-pot that attracted so many vendors into this space. What’s next for these vendors? Some will stumble out of the market with little to show for their efforts. Others will work with their public clients to stand-up these public HIEs in order that they provide value to their respective communities, which will not be easy and lead to more stumbling. And of course HIE vendors who have traditionally been focused on public markets will reposition themselves for the private, enterprise market. Some of these vendors are now stumbling in this transition to the enterprise market (requires different sales resources and tactics, technology requirements, etc.). This will result in yet another shakeout in this niche industry sector. (Our forthcoming HIE Market Report will provide further details)
The funny thing about doing these predictions is that as one actually goes through the process of thinking about this market, which is currently going through nearly unprecedented change, one ponders so many other predictions that just end up on the cutting room floor. Some of those include:
Payers continue to struggle with exactly what they’ll offer on the State Health Insurance Exchange.
Pharma companies look to insert themselves directly into physician workflow, via HIT.
Despite rising cost share, consumers still struggle to make intelligent, informed decisions.
Telehealth gets some wind under its wings as big telecoms start aggressive lobbying efforts.
You get the idea, plenty of turmoil, no lack of potential trajectories in technology adoption and use within the healthcare sector and we here at Chilmark Research look forward to continuing to provide thoughtful insight on this ever evolving market in 2012.
So now it’s your turn. Are we on the mark with our predictions? Did we reach too far? Is there a particular prediction that you have which we totally missed? It is you, the community of readers that make this site far richer than we ever could do on our own and we look forward to your feedback.
John, as always, appreciate your perspective. Any comment on the $1 Billion CMS Healthcare Innovation Challenge?
Zweena continues to have good consumer growth and find more traction in the consumer marketplace.
Best to you in 2012!
Re: At Gunpoint, Direct Project Gains Traction
I would agree that Direct offers little benefit and would extend the prediction that private HIEs will drive state HIEs to adopt Connect with its design better suited for the clinical workflow. XD* will dictate whether states succede or fail with the provider community.
Hello John,
Your 2012 predictions are interesting, as always. I agree with many of them, but I strongly disagree with your predictions about Direct. (Full disclosure: I was involved in the creation of the Direct specification, and am a member of the HIT Standards Committee, and of the workgroup which recommended to ONC that Direct is a secure and readily deployable exchange mechanism.)
I believe that Direct is the easiest and least expensive way to enable widespread, cross-community, secure, point to point transmission of patient data. Direct is more than “just fax” in the same way that e-mail is more than “just mail.”
Direct can carry simple text or as much structured data as the sender is able to include, such as CCDs, DICOM images, etc. As the HITPC Tiger Team recognized, Direct minimizes complicated patient consent issues because the decision to “push” the data is always made by the patient’s provider, in the context of the care setting.
I also find it odd that you would disparage ONC’s push for Direct as a “political” maneuver. Direct is simple, inexpensive, secure, and could quickly become nearly universally available. Isn’t that the kind of standard that ONC ought to be pushing under ARRA? Isn’t that the best way to use the taxpayer’s money?
Nothing recommended by ONC precludes the use of more complicated, more sophisticated exchange mechanisms. In addition to ONC’s endorsement, the EHRA has also recommended Direct as “Step 1” in their Transport Framework white paper. It’s a good way to get started.
Finally, though not yet realized, Direct has the potential to radically change the way that consumers get access to their health records, since Direct enables a universal way to push data from the provider’s EHR to the consumer’s designated PHR. That alone makes Direct worth the effort.
Hello David,
Thank you for your thoughtful input regarding Direct and it’s potential to address information exchange among practicing physicians. We continue to admire your work and that of others to advance the use of HIT to improve health.
While in strong agreement with you regarding Direct’s ability to offer a simple, low cost mechanism for secure point to point exchange of health information, do not agree that Direct is, from a policy perspective, is the trend we should be heading in. In fact, see such strong policy support of Direct more as a capitulation on the part of ONC/HHS that the initial goal of sharing codified clinical data to truly foster care coordination and improve population/community health isn’t going to happen anytime soon. That led the administration to do a proverbial punt on information exchange (they’ve watered down this requirement in MU to the point of near meaninglessness), going with Direct and forcing all SDEs to include Direct as part of their strategic plan. We see this as more a muddying of theaters of health information exchange then bringing clarity.
So while Direct is a quick, stop-gap measure our prediction stands that the use of Direct will unlikely move much beyond those SDEs and as enterprise HIEs establish themselves to do true care coordination and population health management, Direct will fade from view and use.