.750 Prediction Batting Average for 2014

by | Dec 22, 2014

papiHard to believe the year is coming so quickly to a close. A year that saw ONC pretty much implode, an ACA that is garnering fans faster than detractors, an explosion in all things wearable but little clue as to what to actually do with the data beyond sharing it on facebook, finally a realization that hey, interoperability really does matter and the list goes on.

But we had our own list of predictions for 2014 and now it is time to reflect and see just how accurate those predictions were. So without further adieu…

Meaningful Use stage two (MU2) delay provides little relief to IT departments.
MIXED: While attestation numbers appear low for both eligible hospitals (EH) and eligible providers (EP), it looks like EHs are, by and large, on track. EPs, however, are the ones still struggling to attest with just over eight percent of EPs attesting as of Dec. 1st. As history has shown that EPs tend to report at last minute, the first quarter of 2015 will be a true barometer for MU2.

Best-of-breed solutions proliferate.
HIT: We are seeing no end to the number of best-of-breed companies enter the healthcare IT market. One need only look at the record levels of investment (even GOOG is placing big bets) to see that there will be no near term abatement of this trend. And why should there be? We are only just getting started on the digitization of healthcare.

Consolidation continues unabated in mid-market.
MISS: This prediction was looking at hospital M&A activity, which actually declined to levels not seen since 2009. But the story behind this decline is more nuanced. What has actually occurred is not acquisitions of small hospitals, but larger M&As which take longer to consummate and more acquisitions of outpatient clinics and small practices.

Bloom is off the rose as physician dissatisfaction with chosen EHR rises.
HIT: Almost embarrassing to call this a prediction. One need only have an EHR vendor give you a demo of their latest and greatest to see why this prediction really was a “no-brainer”.

Limitations of deployed HIE becomes increasingly apparent.
HIT: To say that providers, policy makers and just about anyone else that cares about this sector has finally come to terms with the deplorable lack of interoperability is putting it mildly. The original vision of HIEs was the ability to readily compile a longitudinal patient record when needed. What we have created instead is Godzilla – not sharing discrete elements of EHR data but documents often so big, so gargantuan so Godzilla-like, that few can extract value from it.

Re-prioritization moves patient engagement to back-burner.
MORE HIT THAN MISS: Actually quite a bit of investment in patient portal technology and efforts to meet MU2 view, download and transmit (VDT) requirements. But this is a regulatory driven activity. True realignment of priorities on the part of healthcare organizations (HCOs) to support deep patient engagement remains a back-burner issue as they first need to more deeply and effectively engage their clinician network.

One third of stage one, MU-certified EHRs do not or choose not to certify for stage two.
MISS: Nearly impossible to tell at this point. Our belief is that virtually all EHRs for inpatient setting are MU2 certified, but we are far less confident in the ambulatory sector, which is what the original prediction focused on. Unfortunately, nearly impossible to ascertain from the CMS database who has jumped through the certification hoop so far and who has not, so we’ll call it a miss for now.

Clinical analytics remains a hot, yet immature market.
HIT: Our latest market trends report on the healthcare analytics found a market abounding with upstarts looking to capitalize on the strong need of HCOs to better understand the populations they will be managing under VBR contracts. But despite all the buzz, relatively few have gained significant market traction as most HCOs struggle to get their clinical data in order and therefore still highly dependent on billing and claims data.

Cloud-based EHRs become de facto standard for small, ambulatory practices.
HIT: Not too hard to nail this prediction as small practices migrate away from the client-server systems of yore (Practice Fusion now claims over 100K users of its SaaS EHR). Amazing Charts is one EHR company that is also making a move SaaS model with launch of InLight. In recent conversation they informed us that their customers are more than happy with move. What did surprise us, however, is how quickly small community hospitals are also adopting SaaS as evidenced by strong sales for Cerner’s CommunityWorks.

Payers increasingly become part of HIE fabric.
MIXED: Yes, payers are involved in countless HIE initiatives across the country and their interest in participation continues to grow, but how quickly is there involvement producing real results, real value for clinician end users is still a big question mark as many payers still hold back significant volumes of data. Will future weighing in by SCOTUS further complicate matters?

Healthcare.gov falls short – payers wring their hands.
HIT: Healthcare.gov registration numbers, especially for young, immortals were below expectations and initially, payers were quite vocal about this issue. But their concerns regarding higher medical loss ratios (MLRs) for the newly insured were mostly unfounded and in the second round of Healthcare.gov enrollment, overall premium increases have seen only very modest increases as competition grows.

Our batting average was an impressive .750 for these 2014 predictions, though one could readily argue that we received nothing but slow, easy pitches so such an average should come as no surprise.

My own reflection of these predictions – well we just didn’t stretch as far as I would have liked. Looking at them now, they just don’t seem all that profound. Our next post will look ahead to 2015 wherein we will make a few more bolder predictions  – Stay Tuned.


  1. John Kansky

    Pretty darned good predicting, Team Chilmark. No disagreement here. One comment on “Limitations of deployed HIE becomes increasingly apparent”. I agree with your assessment as a general characterization. However, here at the Indiana Health Information Exchange (trying to stand *humbly* as a model of what is possible) we have been sharing aggregated, standards-based longitudinal patient records with our participants for 20 years. In recent years, we’ve been able to share auto-queried structured data into some (sophisticated) customers EHRs. Not bragging…we have a long way to go in expanding adoption and use cases. Just offering a hopefully encouraging example to any discouraged HIE warriors.

    • John

      Thanks for the comment John. Do agree with you that there are a few Exchanges out there doing exemplary work. IHIE is certainly one of them and I would also add Inland Health in California as another example. But unfortunately, you, Inland and a few others are more exceptions to the rule – just wish more of your Exchange brethren would follow your example(s) rather than twaddle.

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