The pandemic accelerated adoption of telehealth, remote monitoring and digital health capabilities by nearly a decade for some organizations.
Earlier this year, Mayo Clinic Platform President John Halamka, MD, wrote that the Rochester, Minn.-based health system's digital transformation sped up by 10 years. "We were talking about healthcare in 2030," Dr. Halamka said in a Mayo report. "But what we are seeing now is that 2030 is going to arrive in 2021 because COVID-19 has reshaped the culture and the policy around the use of technology, and anything we thought would take a decade to do is going to be an expectation for next year."
Most health systems in the U.S. experienced a similar shift in digital transformation and expanded expectations for what healthcare will look like in the next five years. Here, 20 healthcare executives and leaders share one bold prediction for health IT.
Eric Yablonka. CIO and Associate Dean of Technology and Digital Solutions at Stanford Health Care and School of Medicine (Palo Alto, Calif.): A combination of wearables and other biomedical devices, combined with machine learning and artificial intelligence will continue to transform clinical research, treatment protocols and increase the virtual care capabilities of health providers. This will challenge traditional healthcare organizations to compete with emerging retail and virtual providers in ways we have not experienced before. It will also enable healthcare delivery science and bring data scientists to the forefront of improving patient care outcomes.
BJ Moore. Executive Vice President and CIO of Providence (Renton, Wash.): Post COVID-19, we will continue to see a shift to alternative locations of care, such as telehealth, remote monitoring and in-home care. With this, we will see a corresponding shift to IoT devices, leverage of 5G, explosion of Big Data and machine learning/artificial intelligence to scale and manage these alternative forms of care.
Joel Klein, MD. Senior Vice President and CIO of University of Maryland Medical System (Baltimore): I think at least half of all healthcare in America will be virtual within five years. There are two barriers:
• Payers. They might pay less but if they pay enough, it will be enough. If we can figure out how to solve emergency department visits with widespread, cost effective on-demand care, that will make a difference.
• 'But I want to see my doctor.' That might be true for some things, but the convenience factor (especially for tertiary care… especially for millennials…) once you really start doing it overwhelms most of the physical presence upsides.
Adam Gold. Chief Technology Officer at CHOC Children's (Orange, Calif.): The next five years will bring challenges to health IT never seen before. The recent pandemic has significantly raised the bar in terms of an organization's expectations of its IT department. We have shown that we can deliver valuable solutions in record time; shown our clinicians that we are here to support them; and most importantly, shown our patients that our efforts are all centered on them and their well-being. Over the next five years, we will see IT departments start to develop 'remote first' solutions that will be focused on enabling clinical care from just about anywhere.
I'm not talking about developing solutions that start at the facility and eventually become a remote option; I foresee solutions being developed by health IT that start as remote solutions and evolve from there. We will also begin to see a change in thinking around what remote care could really look like. We have already proven during these challenging times that we can deliver just about anything using remote teams and new technologies. Now, it's going to be about how we leverage this new agility and bring a better experience to our clinicians and patients. This prediction falls outside of what traditional telehealth is to us today.
The future will be more about a true delivery model for remote care that is agile enough to adapt to the next pandemic, social uprising or whatever else the future has in store for us. The new teams that will be formed will be focused not on thinking outside the box, but on ignoring the box all together. This prediction may not seem bold now, but imagine an IT department empowered to 'ignore the box' and develop solutions that far exceed what the normal development process would have produced. The situation that we have been thrusted in has empowered us to work that way, and I don't see that changing.
Eduardo Conrado. Executive Vice President and Chief Strategy and Innovation Officer at Ascension (St. Louis): Over the next five years, we expect to see tremendous growth in the use of data in sustaining and improving the health of individuals and communities. Large-scale standardization, collection and collaboration of data, prompted in part by the COVID-19 pandemic, will provide a road-map for better care in the future.
Applying data science will improve and enhance new models for clinical trials, earlier risk detection, more accurate diagnosis, faster drug development and better treatments, all to the benefit of patients. It also will play an important role in improving operations, accelerating value-based care and enhancing models that foster collaboration in the healthcare industry.
Edward Lee, MD. CIO of The Permanente Federation (Oakland, Calif.): In five years, physicians will no longer need to manually document their notes into the EHR. Instead, artificial intelligence will capture all the pertinent information from the patient-physician encounter. This will enable physicians to spend quality time with their patients instead of worrying about writing their notes or placing orders in a computer system. Joy and meaning for physicians will increase, physician burnout will decrease, and above all, patient care will improve.
Michael Pfeffer, MD. Assistant Vice Chancellor and CIO of UCLA Health: Health IT will enable each patient to have a unified, interactive view of their health information regardless of place of care or type of clinical data (i.e. phenotypic, genomic, imaging). AI-based apps will help make sense of their data, taking into account social determinants of health and potential health disparities to improve health equity and health literacy. This intelligence will be paired with personal health preferences and data on health provider quality, access, pricing and satisfaction to help patients make truly informed decisions about their care.
Tom Andriola. Vice Chancellor of IT and Data at UC Irvine (Calif.): My bold prediction?
We've been talking about healthcare becoming a digital industry for over a decade now, but the evidence for transformation is still limited in impact, scale and equity. I have seen the pandemic put on steroids many of the current trends for technology and data-infused intelligence, a.k.a, AI or as I like to call it for healthcare 'augmented intelligence.'
What we will see in five years, and I want to see it for every citizen not just those in the upper income bracket or employer-sponsored insurance, is that all this deployed technology and the digital signals (data) it generates is actually integrated in a way that it helps me manage my health, medical condition and health journey. Let's not call it precision medicine; let's think of it more as personalization of my health journey.
Let's start with me as a patient no longer having to endure explaining to my healthcare provider who I am and my past history every time I visit. Why is Amazon a threat? Because they know more about my health and lifestyle than my healthcare provider, and most of what they know I've provided to them (imagine that Doc). How about adopting their mentality and allowing me to help build a 'digital health twin' infused with data from many different sources provided by my health provider, my insurer and, most importantly, by myself. Let's ensure that there is an integrated view of my state of health, and there are tools at my fingertips that help me make good choices and plot a health trajectory based on my goals.
In 2025, I should be in control of my data. My digital health twin should constantly be updated, like a profile leveraging all the amazing technologies in our world, both medical grade when I visit the 'formal healthcare system' and consumer-grade, which may be a ring on my finger or a hand I placed on a scanner when I'm leaving Whole Foods (by the way, those two grades may be hard to distinguish by 2025; entrepreneurs are ensuring that). I don't just 'want my data;' I want it organized and leveraging all the wonderful research on health models that have been developed over the years by our fabulous academic medical centers. I want personalization, meaning I will get a recommendation that will best help me stay healthy – maybe even gamification involved.
If I suffer from chronic diseases, I want the personalization engine to help me make decisions that manage my condition and return to leading a normal, fulfilled life. I want it to be informed by both the best pharma products but also the best diet that might contribute to my health. It should be a choice for me. And, if you haven't read, food is becoming digital too and is a primary driver of health through how you feed your microbiome.
And finally my health is not a static thing. It is constantly changing with what I eat, how hard I exercise, or how well I slept last night. The continuous inputs into my digital health twin should help track the trends and forecast my health trajectory in a much more sophisticated way than stepping on a scale every morning. It's not about the next new thing, but more about using the data we already have and can generate for each person, and start leveraging that data in a more intelligent way. In the end, if I’m a healthy person I want to stay healthy and avoid becoming 'a patient.' If I'm in recovery from cancer, I want my entire body of data, genotype, phenotype, metabolomics and whatever else you collected to be used to design my care cure and the pathway back to health.
So my bold prediction is really just that we'll start using all this data we have.
David Nash, MD. Founding Dean Emeritus of Jefferson College of Population Health (Philadelphia) and DocASAP Advisory Board Member: The COVID-19 pandemic is accelerating digital transformation in healthcare faster than ever imagined. And while we've learned a lot over the last six months, we're still just scratching the surface. In the next five years, I predict that innovations in patient engagement coupled with remote healthcare monitoring technology and AI will streamline access to care so much so that digital health will no longer be viewed in isolation.
There will be no distinction between in-person and virtual visits; instead, it will be access to appropriate care delivered by the right provider in the right care setting at the right time. We'll reach the point where calling it 'digital' health will fade from our day-to-day vernacular – do you call banking 'ebanking?' This access to care everywhere model will drive new partnerships among companies that don't currently exist. For example, genetic analysis companies and care delivery platforms will come together to remove friction and make care even more seamless and cost-effective.
Patrick McCarthy, MD. Vice President of Northwestern Medical Group at Northwestern Medicine (Chicago): The next five years will demonstrate a sharp increase in the routine use of AI in clinical practice. The applications will be widespread from transforming our most basic tool the stethoscope, to wider distribution of advanced imaging acquisition and interpretation, and applying machine learning for individual patients to identify rare diseases, predict procedural risk, and determine best care pathways.
A real-world example of AI-enhanced tools for clinical use is Eko. Eko's suite of advanced stethoscopes are powered by advanced machine learning algorithms that are FDA-cleared to detect AFib and heart murmurs. This type of practical AI analysis will greatly improve patient care, specifically by the early detection of the leading cause of death in the U.S., heart disease.
Alexa Kimball, MD. President and CEO of Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center (Boston) and President of Physician Performance: AI will dazzle but also disappoint. A lot of people are banking on AI to transform medicine and substantially solve challenges in healthcare, but I believe the impact will be far less dramatic than we think or hope, in large part because we aren't targeting the right use case. We will certainly learn a lot from this novel technology and it will power us to continue to improve our understanding of health, disease and healthcare delivery.
However, using AI as a diagnostic tool has significant limitations that aren't based in technology, but epidemiology. Common things will remain common and won't require AI, and rare things require a precise knowledge that we don't have in hand for AI to master – because they don't happen very often. As a result, the potential clinical impact in the diagnostics space is limited and it won't matter as much as other forms of testing and diagnostics that get at the underlying biology.
Rich Temple. Vice President and CIO of Deborah Heart and Lung Center (Brown Mills, N.J.): I see artificial intelligence in many forms really gaining a significant toehold in healthcare information technology. Robotic process automation will be a much bigger player to streamline the intense manual efforts by healthcare staff to perform functions such as prior authorization management and referral management. I also see AI being used to perform detailed analyses of diagnostic images, and supporting physicians in identifying patterns in images through pattern-matching with image databases from all over the world. While I know AI presents a concern to many in terms of 'computers replacing humans doing jobs', I don't see AI as a threat to human employment, but rather an enhancer of humans doing their jobs by providing predictable and dependable tools that humans can do to perform their job duties even better.
Emily Webber, MD. CMIO of Riley Children's Health (Indianapolis): Emergence of COVID-19 pushed the realm of health IT out of the hospital and clinic and into our patients' homes and communities in early 2020. That shift, coupled with the 21st century CURES act, highlights the absolute necessity of the clinical data flow will reshape how we think about health data to support different care delivery.
With that in mind, I would say that in the next five years will see a complete shift in the way we gather and share health data to support the rapidly changing needs in healthcare delivery, and the continued rise of patients and external collaborations as the key influences of health IT priorities. Many patients now expect to directly contribute data to their records and care (as well as access it) – so leaders in health IT will be rapidly adopting solutions that leverage our patients' expertise in their own health.
I anticipate this will be a break-up of the old style of partnerships and instead see more agile collaboration between health systems, public health and industry tools. Finally, the next five years will force the urgency for digital equity to truly improve health goals. Access to high quality care will rely as much on your access to WIFI, as it does on the number of bricks and mortar clinics and hospitals.
Steve Wretling. Chief Technology and Innovation Officer of HIMSS: Over the next five years, application programming interfaces and Function as a Service will fuel the development of highly customizable consumer-based digital health tools. This will result in more seamless experiences for consumers and better insights for clinical providers, thereby enabling improved patient care.
Laura Concannon, MD. Regional Chief Medical Officer of Amita Health (Lisle, Ill.): Patient engagement capabilities are going to be the biggest 'make or break' factor in clinical care. Each patient comes to us with a different background and experience, which means we need to become more nimble and meet them where they are. Whether it's streamlining their in-person care using digital charting to provide more time with a physician or engaging with patients via text or email outside of their visit to ensure care plans are understood and followed, improving communication technology from the patient's perspective will guide where healthcare will go next.
Mallory Caldwell. US Health Sector Leader at EY (New York City): Technology is going to reinvent healthcare as we know it, enabling a greater focus on wellness, customized care and the ability to incorporate health with social data. Health systems that are able to create a legislative and regulatory environment that incentivizes interoperability and connected care will leapfrog others as they see improvements in patient health and a reduction of disparities.
Further, as artificial intelligence and machine learning improve diagnoses and make treatments more effective, care will begin to migrate outside the walls of traditional hospitals and clinics. Households will have more than 50 connected devices on average that all help monitor health status, placing more control with the consumer than ever before. This also means that the family and care circle of a patient will be digitally enabled with insights, providing full visibility of the loved ones' condition and optimal treatment plans.
Deborah Visconi. President and CEO of Bergen New Bridge Medical Center (Paramus, N.J.): Remote monitoring and virtual platforms will take a significantly prominent role in the delivery of healthcare and in the management of chronic conditions. The use of remote medical technologies, like telehealth, will allow stable patients to hospital at home, and those with chronic ailments to be monitored at a distance. Wearable and mobile technology like smartphones, watches and voice activated home devices will become common healthcare tools, monitoring symptoms, analyzing results and even alerting user and health care provider of oncoming illness. A patient will receive instructions to their phone or watch to make an appointment or perhaps to head to the emergency department.
Frank Ingari. CEO of Tandigm Health (Conshohocken, Pa.): For the first time, the three major economic buyers who drive U.S. healthcare – employers, the federal government and consumers – are aligned on what they want: lower cost, better outcomes and a better consumer experience. This alignment is already driving radical reinvention of the health IT industry based on methods well understood in the rest of the economy: user-centered design, personalization and digital-first business models. Wall Street is now funding the disruptors who embrace this change at valuation levels reminiscent of the eCommerce wave in the late '90s, presenting existential 'lean in' or 'hold out' choices for entrenched healthcare giants.
Shaji Skaria, MD. ICU and Respiratory Therapy Medical Director at Mercy General (Sacramento, Calif.) and Vice President of Clinical Services and Revenue Cycle Management at VeeMed: In 2021 telehealth hospital use will rise to a new level as social distancing and safe remote care continue to be of paramount importance to healthcare providers, especially with access to specialist and healthcare being limited. Long term, we expect onsite care to be more efficiently delivered via virtual healthcare being delivered by providers to more than 90 percent of the U.S. population.
Stephanie Lahr, MD. CIO and CMIO of Monument Health (Rapid City, S.D.): Health systems and their care teams are facing unprecedented challenges as they continue to deliver high-quality patient care while addressing financial pressures, a worldwide pandemic and the ongoing need to fulfill regulatory requirements. Over the next five years, healthcare IT will continue to adapt and improve to address these challenges, reduce provider burnout and improve patient-provider relationships.
Specifically, I think many healthcare facilities, including Monument Health, will implement innovative voice-powered solutions, like ambient clinical intelligence. An example of this technology would be the Nuance Dragon Ambient eXperience (DAX) solution. Nuance DAX uses AI-powered speech recognition technology to automatically and securely convert a natural multi-party conversation between providers and their patients into complete, accurate and structured clinical documentation within the EHR. It not only captures each patient-physician encounter using sophisticated speech recognition technology, but also updates the EHR automatically, reducing administrative burden and allowing the provider to focus on the patient and not on their computer.
Over the next few years, more healthcare organizations will realize ACI's potential and invest in this critical technology that meets the needs of providers and the care expectations of patients.