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A wealth of new technology is knocking on the door of the healthcare industry and with the current pace of development, 2015 promises to be a very exciting year.
Last year we saw health technology develop at a tremendous pace. In 2014 alone, investment in health technology topped $5 million; more than double the investment of the previous year.
However, rapidly escalating costs, fast reducing budgets and more stringent regulations are putting the industry under more pressure than ever before, and the strain is starting to show. Cost cutting while improving treatment outcomes and complying with HIPAA, HITECH and Meaningful Use creates the biggest challenge for the healthcare industry in 2015.
The use of big data, powerful analytics, predictive technologies, the Internet of Things and 3D printing are all expected to have a major impact in 2015; however, predicting the trends that will have the most significant impact on the healthcare industry – in light of the daily technological advances – is a tall order.
Some of the major issues, innovative technologies and HIT trends to impact the healthcare industry over the course of the next 12 months – and beyond – have been listed below:
Preparations to Start for ICD-10 Compliance
In 1978 the final draft of the International Classification of Diseases (ICD) was accepted by the International Conference for the Ninth Revision of the International Classification of Diseases and became the new standard for monitoring progress, assessing disease control and evaluating medical care. It did not take long for the limitations of the classification system to be realized and five years later in 1983, work commenced on the new ICD-10 classification.
The limitation of just 17,000 codes demanded a rethink; with an expansion necessary to take into account a myriad of new procedures and diagnoses; with ICD-10 expanding the codes to 155,000. The new codes have now been adopted in numerous countries around the world, but the U.S has been slow to make the changeover. The problem now is that there are simply not enough codes and many of the ICD-9 categories are now full. The changeover to ICD-10 is overdue and now essential.
The U.S Centers for Medicare and Medicaid Services started using the new codes from April 1, 2010, although the deadline for compliance was set for October 1, 2013. Congress has not been keen to make the changeover and delayed mandatory use of ICD-10 for 12 months in 2013. Last year, with the deadline looming, congress again postponed its introduction. ICD-10 now scheduled to come into force on October 1, 2015 and a further delay, while possible, looks unlikely.
This year, all healthcare providers covered by the Health Insurance Portability and Accountability Act (HIPAA) will be required to adopt the new system and use ICD-10 diagnosis codes for all healthcare services provided in the U.S, while new procedure codes are also required for hospital inpatient procedures. Medicaid and Medicare claims for services will not be paid after the Oct 1 2015 deadline if the old codes are used.
The change to ICD-10-CM diagnosis codes is more straightforward as the codes are similar to the previous standard; however for medical procedures the change to ICD-10-PCS presents more of a challenge since the coding is substantially different.
The American Medical Association has pushed for full end to end testing which will be run between January 26-30, 2015, with a second sample to be assessed between April 26, 2015 and May 1, 2015 and further testing scheduled for July 20-24, 2015. The aim is to ensure claims can be submitted to Medicare under the new ICD-10 codes, that they can be properly adjudicated and also to ensure accurate remittance advices can be created.
With just over 9 months to go until the changeover, healthcare providers, clearing houses, payers and billing services will need to start testing ICD-10 products, an ICD-10 implementation plan will need to be developed – if it has not been already – costs will need to be assessed, budgets set and the plan put into action. This is sure to be a major challenge for HIPAA-covered entities in 2015, and one which can no longer be put off.
The Difficulties of Cost Alignment Will Grow
The healthcare industry has faced a continued struggle to provide affordable healthcare for as long as modern medicine has existed; however treatment costs have dramatically spiraled in recent years. Healthcare providers must now cover the cost of implementing new technology, health records need to be converted to digital formats and the industry is facing even tougher regulations.
Any healthcare providers that have struggled to stay profitable in 2014 are going to find the next 12 months extremely difficult financially. 2015 is only likely to see finances strained even more with budgets needing to be stretched further still.
Provided the cost of implementation can be covered, new technologies can be leveraged to improve patient care and can dramatically reduce costs. However, many physicians and hospital administrators have struggled to see the benefit from digitalization and changing over to EHR’s. The transition may be problematic, difficult and costly in the short term, but the long term advantages cannot be disputed. The move to EHRs facilitates more accurate reporting and the analysis of electronic data makes decision making easier.
As healthcare organizations develop their systems to provide clean and consistent data – which can be accessed through all systems – it should translate into much greater efficiency and allow for significant cost reductions to be made. This will of course be a major challenge for providers over the course of the next 12 months.
2015 is also likely to see increased collaboration between healthcare centers and greater use of electronic data to forecast expenditure, drive down costs, enhance revenues and improve patient outcomes.
EHR Meaningful Use to Continue to Frustrate
The Meaningful Use program has come under increasing criticism over the past 12 months as physicians and healthcare providers have struggled to meet its stringent reporting requirements. Many healthcare providers are now considering pulling out of the program rather than face financial penalties for missing Stage 2 targets.
This year, the reporting period to attest for Meaningful Use Stage 2 is a full calendar year, and with many healthcare providers and physicians having struggled to meet last year’s requirements, this year promises to be even tougher, requiring four times the work put in for last year’s 90 day reporting period.
One of the major problems with achieving Stage 2 requirements is the development of HIPAA-compliant patient portals, engaging patients and getting them to use them. For some healthcare providers, especially those with a large proportion of older patients, increasing patient involvement could well be one of the biggest MU challenges; one which has potential to tie up huge amounts of resources.
According to a report issued by the Centers for Medicare & Medicaid Services (CMS), 55% of physicians will not be attesting for Meaningful Use Stage 2 in 2015 and only 17% of hospitals have been able to demonstrate they have met Stage 2 requirements. More worryingly, only 4% of eligible professionals have so far met their 2014 requirements, although they do have until next month to report the progress they have made.
Healthcare providers and physicians that have already met Stage 2 requirements will need to try to maintain momentum to meet the even tougher MU requirements for 2015, and thus avoid financial penalties. Many believe the strict MU deadlines and stringent reporting requirements to be unworkable, especially with EHR systems that do not function as they should, a lack of HIT-enabled physicians and too few providers that can receive summary of care documents.
However, there is some hope that the reporting requirements may be eased. The Flexibility in Health IT Reporting (Flex-IT) Act of 2015, introduced by Representative Renee Ellmers (R-NC), would reduce the reporting period to any 90-day period this year; should the act be passed by congress. Many healthcare professionals believe this to be essential in order to meet MU requirements and avoid financial penalties in 2017, and it could even prove pivotal to the success of the program.
HIPAA Enforcement to be Ramped Up
The Office for Civil Rights delayed its proposed round of compliance audits last year, and while a timescale has not been provided for when they will recommence, OCR Director, Jocelyn Samuels, has promised they will be recommencing ‘expeditiously’.
The OCR has come under pressure from the DHHS in recent months to take a more aggressive stance and increase enforcement of both the Health Information Technology for Economic and Clinical Health Act (HITECH) and the Health Insurance Portability and Accountability Act (HIPAA). Since the passing of the Omnibus Final Rule, random audits will be conducted on healthcare providers, health plans, healthcare clearing houses and business associates.
The OCR is expected to issue more financial penalties to violators of HIPAA Privacy and Security Rules over the course of the next 12 months. Assessments are expected to cover the Security Rule, Omnibus Rule and Breach Notification Rules, in addition to Privacy Rule requirements and patient access rights.
2014 saw the highest number of OCR settlements reached to date, including the substantial $4.8 million settlement with New York Presbyterian Hospital and Columbia University. The aggressive approach of the OCR is expected to continue in 2015.
District Attorneys may have been slow to enact their rights under HITEC/HIPAA to enforce Privacy, Security and Breach Notification Rules; although four Attorney General’s Offices have now taken action against violators and more are expected to follow suit in 2015.
The Connecticut Supreme Court’s decision to allow plaintiffs to file lawsuits against healthcare providers that allow their Protected Health Information to be divulged has been seen as a game changer and is likely to act as a precedent and lead to a plethora of lawsuits against healthcare providers that fail to prevent HIPAA breaches from occurring.
With financial penalties coming from two fronts and class action lawyers eager to sign up victims of breaches, 2015 promises to be an expensive year for any healthcare provider failing to implement the appropriate technical, physical and administrative safeguards to protect the privacy of patients.
Major Growth Expected in Healthcare Wearables
2015 promises to be a year of major developments in the world of the Internet of Things. Interconnected devices that track, record, and monitor vital signs have potential to revolutionize healthcare and greatly improve patient health.
In spite of a relatively slow uptake of the devices by consumers initially, advances in technology and falling prices have seen the popularity of the devices increase dramatically over the course of the past 12 months.
Statista reports that 38% of consumers are interested in medical devices that transmit health data while 33% were interested in fitness trackers and wristband sensors to monitor their health and fitness. A PricewaterhouseCooper survey indicated that 21% of Americans have already purchased wearable tech. The figure for 2014 was 13%. Some health Insurers have already started offering the devices to policy holders in exchange for reductions in premiums.
The devices have potential to drastically change how critical or chronic patients are monitored in their home environment. Some of the most exciting advances for this year. Google’s Project Iris, for instance, promises to revolutionize diabetes care with contact lenses being developed that can read glucose levels and transmit the data directly to a Smartphone.
Wearable technology also empowers patients and enables them to take greater charge of their health. A survey conducted by PricewaterhouseCoopers’ Health Research Initiative (HRI) suggests that 42% of physicians are comfortable with prescribing medications based on home tests using the devices, while half of the medical professionals surveyed indicated that they believe electronic consultations could reduce inpatient visits by up to 10%. Home monitors and wearable devices could also help bridge the gap between patients and healthcare professionals as well as improve patient outcomes.
Solving the Problem of Telehealth and HIPAA Compliance
Telemedicine was tipped to be one of the most important areas for healthcare organizations in 2014, and 2015 is likely to see even more providers and insurers offer telemedicine services. Catholic Health Initiatives and Anthem Blue Cross have made major advances in this arena and are already offering reimbursements for physicians conducting electronic consultations with patients.
Telehealth has considerable potential to reduce running costs. Dale H. Yamamoto of Red Quill Consulting, Inc. conducted a study which indicated that e-visits save healthcare providers more than $100 per consultation, with the cost of a telehealth e-visit costing approximately $50 compared to $176 for in-person care.
Telehealth cuts down on unnecessary home visits by healthcare professionals, reduces the volume of inpatient visits to hospitals and clinics and simultaneously improves relations between healthcare professionals and patients by making healthcare services more convenient.
2015 is likely to see Telehealth services grow as many of the stumbling blocks are removed. One of the main problems faced by physicians is obtaining reimbursement for e- visits. According to a USA Today report, nearly 30 states do not allow reimbursement for e-visits, although Medicare and Medicaid are now starting to provide reimbursement for virtual consultations.
Telehealth services also raise problems of HIPAA compliance; communicating with patients via video calls, for instance, raises a number of data privacy and security issues. If PHI is transmitted via insecure channels it is a HIPAA violation and could potentially result in substantial fines issued by the OCR. There is also the problem of identifying patients if they are not physically present, which could potentially involve PHI being disclosed to the wrong individual. Power outages also have potential to result in lost medical data risking breaching the HIPAA Security Rule.
Due to the considerable benefits to both patients and providers, these issues are expected to be largely resolved over the course of the next 12 months as healthcare providers develop policies and procedures to provide telehealth services while keeping data secure.
3D Printing to Have a Major Impact on the Healthcare Industry
At CES 2015 this year, the rapid pace of development in the 3D printing arena was clearly evident, with a plethora of new printers and technology showcased. With major advances in the field and the cost of the devices falling dramatically over the past year, 3D printers have now become ubiquitous in the healthcare industry.
Today, stents, prostheses, bones and joints are being printed and used by surgeons. Dental labs are already scanning patients’ teeth and are using 3D printers to create dental implants at the press of a button. Surgeons at Morgan Stanley Children’s Hospital in New York City printed an exact replica of a child’s heart, complete with all the holes and defects, which allowed them to develop a strategy for surgery which saved the child’s life.
Perhaps one of the most exciting applications is the creation of bio-printed soft tissues. Researchers at Wake Forest University in North Carolina along with the Armed Forces Institute have made major advances in this field, having developed a 3D printer that can deposit cells directly onto wounds to speed up healing and researchers in Japan have developed the hardware and techniques to fabricate custom-made skin. Barely a day goes by without a new development in healthcare 3D printing being announced.
Over the course of the past 12 months alone, the lifespan of bioprinted tissue has been increased from just a few hours to over 40 days. Growing fully functional replacement organs is now a very real possibility, and while at least a decade away, a few years ago it would have been considered impossible.
The potential for new dental and medical applications is almost limitless and the industry is expected to top $6 Billion in the next 10 years, although with the current pace of development, major developments are expected to be seen this year.