12/31/2015 informationweek.com
10:06 AM
Healthcare
IT: Hot Trends For 2016, Part 2
In the second of this two-part
series on healthcare IT, we look at the influx of healthcare data and what it
will mean for practitioners and IT professionals. In part one, we explored the
ways in which advances in patient-focused data collection, wearables, and the
Internet of Things will change how doctors and patients communicate.
In the next 12 months we'll see a continued influx of data from
myriad sources flooding into healthcare organizations and
medical research institutes. Much of it will be siloed, and concerns about security and
meeting regulatory requirements could hamper how much progress is made. Still,
healthcare IT leaders and others in the industry are optimistic about what lies
ahead -- and how healthcare will improve as a result.
[ In part one of this two-part
series, we explored the ways in which advances in patient-focused data
collection, wearables, and the Internet of Things will change how doctors and
patients communicate. Read Healthcare IT: Hot Trends For
2016, Part 1. ]
"The US averaged 1 billion physician
office visits in 2010, with over 332 visits per 100 persons.
The most frequent illness reported was a cough. How do we make doctors' office
visits more beneficial to the patient, while allowing doctors the ability to
spend time with patients who need it most? The mining and sharing of big
data," said Cedars-Sinai CIO Darren Dworkin.
Mark Goldstein, president of the International
Research Center (IRC), is looking forward to more and better
data. For instance, Goldstein is excited by personalized or precision medicine.
"The intersection of low-cost genomic and proteomic sequencing for
patients, combined with molecular-level cancer and other disease diagnostics,
run through high performance computing centers, can be compared with big data
aggregated from past patient characteristics, disease specifics, treatment
protocols, and outcomes to allow much greater treatment design and
success," he said.
Among the projects underway,
Goldstein cited Dr. Patrick Soon-Shiong'sInstitute for Advanced Health and
a startup, Systems Imagination. Another complementary
trend, according to Goldstein, is AI applied to medical diagnostics. IBM's Watson has
been demonstrated for such uses. "It's not just for playing
Jeopardy," said Goldstein.
[Healthcare is one of them. Read 11 Cool Ways to Use Machine
Learning.]
Big data is a challenge for any
enterprise -- especially in figuring out how to handle it. "In 2016, the
challenge for healthcare enterprises will be how to make sense of the data, as
well as how to develop the infrastructure needed so they can continue to scale
up," said PerfectServe's CEO, Terry Edwards. For
example, Edwards said he expects more use of relationship algorithms that
formulate inferences, allowing decisions to be made in real-time.
However,
there's more than a single (large) dataset to be protected, integrated with
other systems, and monitored. Medical data comes from every type of medical
record, each of which is governed by a host of individual characteristics and
regulations. There's also a dizzying array of vendors vying to provide software
and services to manage medical records.
"There is a tremendous amount
of data that's being generated by monitoring technology that needs to be part
of the patient record. This data needs to be viewed across the entire continuum
of patient care," said Janet Dillione, CEO of Bernoulli, one of those many vendors (this
one with attention on clinical alarm management). Your takeaway: That's a lot
of oversight for any IT department. How can anyone do it well?
Plus,
all that data is pushing healthcare IT into the cloud in 2016. "Healthcare
has, perhaps rightly so, been late to embrace the cloud, when compared to other
industries," said Dr. Rasu Shrestha, chief innovation officer at the
University of Pittsburgh Medical Center. "But cloud computing has matured
today to bring healthcare into the 21st century." Shrestha predicted cloud
computing will enable healthcare organizations to reduce waste, decrease
delays, and improve care collaboration and outcomes.
Wes
Wright, CTO of Sutter Health, agreed. "Healthcare organizations have two
primary issues forcing the use of cloud resources," he said.
"Healthcare entities can no longer afford to build and maintain the type
of compute and storage that is necessary in the new digital healthcare world.
The volume and velocity of the data that is currently available in healthcare,
while great, is nothing compared to what's coming. That surge of current and
coming data can only be handled in the cloud, with the elastic compute and
storage that's available there."
The
Austin Radiological Association (ARA) shares the storage and scalability
concern, storing the vast majority of central Texas's imaging studies. "We
add more than 900,000 radiological exams annually to our archive, and, as of
2014, had 450TB of images under management," said CIO, R. Todd Thomas.
"But our growth is not static. In mammography, one of many types of the
radiology exams we perform, images are moving from two-dimensional to
three-dimensional images, which are 20 times larger than their two-dimensional
counterpart. If ARA continued with a traditional, on-premises storage refresh
cycle, in 2018, we would face a 555TB migration in mammography images alone,
and by 2022 would need to migrate a petabyte of mammography images. By 2024, we
are projecting to ingest 3PB annually on mammography alone. I simply can't do a
traditional storage migration on that scale."
That makes interoperability
essential. Healthcare IT departments need to work to defragment data.
"Healthcare is plagued with siloed data repositories owned by parties who
have little to no incentive to make their data interoperable," said Sean
Mehra, head of product for HealthTap. "A
lot of value is lost in providing better treatment and creating better
outcomes."
For
example, data from your fitness wearable should be seen by your doctor. Heart
rate data isn't as useful without data about your exercise activity. "What
good is your medical record when it's split across four different
organizations?" Mehra asked.
Privacy vs. Usability
That means changes are necessary --
and coming soon -- in the way healthcare providers share patient health information.
"Protecting personal health information is important, and healthcare
providers should constantly look at stepping up their efforts to do so. At the
same time, healthcare organizations need to look at the value that is inherent
in sharing information," says Tom Bizzaro, VP of health policy and
industry relations atFirst Databank.
In the best case? "We'll see
the development of patient-facing applications that enable patients and
consumers to take advantage of the big data aspects of this new freedom to mash
up content from multiple locations and services, creating yet-to-be-imagined
enrichments in both personal and professional uses," said Dr. David C.
Kibbe, CEO of DirectTrust, a healthcare industry alliance
created by and for participants in the Direct Exchange network, which is used
for secure, interoperable exchange of personal health information (PHI).
"This will not happen linearly. Rather, it will grow explosively, and then
suffer hiccups and setbacks as the privacy and security risks of such systems
are first exposed and then dealt with," said Kibbe. "But it is going
to happen."
Don't expect immediate acceptance.
"Electronic Health Records (EHR) interoperability will remain elusive.
While EHR interoperability exists within accountable care organizations and
health information exchange networks, outside of these organizations the
business case is weak, and active participation in sharing data is relatively
low," said John Squire, president and COO of Amazing
Charts. "Until the industry as a whole embraces the need for
true interoperability and places population health and seamless exchange of
data ahead of corporate silos, the full potential of interoperability will not
be realized."
Healthcare
IT is simultaneously spurred on and held back by security and privacy concerns,
as well as by the (sometimes time-consuming) policies and technologies put in
place to respond to those issues.
It's
a whole new world of exposure and risk, said IRC's Goldstein, when you combine
government communications monitoring, bank/credit record access, marketing
data/Web tracking, and personal medical records.
One single scary data point: Health
apps are high-value targets of cyberattacks, and all-too-common ones. In the 15
months from January 2014 to March 2015, the healthcare industry had 15 separate major breaches of
protected health information that affected more than 100,000
individuals.
The
healthcare industry is well aware of these challenges, and of the repercussions
if they're not addressed. Concerns about data security are likely to lead to
(even more) government oversight and policies. For example, Clinical Decision
Support (CDS) tools to help physicians navigate the appropriateness criteria
are required by January 2017 as part of the Protecting Access to Medicare Act
of 2014. Active enforcement of HIPAA finally began in 2015, according to Patrick
Everett, founder of Digital Doctor and an independent consultant in healthcare
informatics.
Regulatory issues and security
concerns are going to slow down adoption of the tools and software needed to
collect and analyze healthcare data. "A lot of great work in the field of
genetics and genomics has been done in an effort to shift the practice of
medicine away from trial and error towards a future where patients receive
treatments based on their individually diagnosed pathology," said Steve Kraus, partner at Bessemer Venture
Partners, who leads the firm's healthcare investments.
But,
Kraus added, the FDA looks to be cracking down on Laboratory Developed Tests
(LDTs), with heavier regulation expected sometime in 2016. "We fear the
repercussions this will have on the overall diagnostics industry and
specifically dampening further development in personalized medicine," said
Krauss.
How Much Innovation Is Too Much?
Technology
only helps us if it gets used, and if the change does not add more time and
complexity to the process. Is the pace of change in healthcare technology so
overwhelming that we won't move forward?
Healthcare workers spend as much as
half their time looking at a computer screen, even during exams, said Dr. Bryan
Laskin, DDS, the creator ofOperaDDS, a HIPAA-compliant communications
system. "The next wave will increase efficiency further, but allow for
more direct communication between healthcare providers and patients," he
added.
The infrastructure to aggregate,
organize, and share medical data will make solid progress in 2016, said Travis
Bond, CEO of CareSync. But, he said, "Change will
still be incremental. The US healthcare machine is over $3 trillion in size and
scope, with countless variables."
According
to Bond, the size of the problem creates the opportunity. "The forces of
costs containment, with expectations of increased outcomes from care, will
continue to impact changes in the industry," he said.
Ultimately,
2016 will be a busy year in healthcare IT. We are blessed with a remarkable
number of life-saving technologies, and smart people working to bring them to
patients. With some luck, many of these innovations will reach us soon.
Esther Schindler has been
writing for the tech press since 1992
10:06 AM
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