Becker's Hospital Review touched down in Orlando last week to ask three questions of hospital, technology and advisory firm leaders. Here, respondents share their response to question No. 2: What healthcare tech did you think was the next big thing, but didn’t take off?
Read compilations for questions No. 1 and No. 3.
Jose Barreau, MD. CEO and Co-founder, Halo Communications: Artificial intelligence in radiology. I thought it was going to have a bigger impact than it has had so far. It may still, but the technology is pretty good right now and it's not being used because of some conflicts with radiologists. I thought that would be further along than it is because they can do some good work with what they have right now.
Keith Bigelow. General Manager and Senior Vice President of Analytics and AI, GE Healthcare: I think AI is going to pay off, but I think it will go through a trough of disillusionment. What I mean by that is we are going to have a lot of broken promises from small vendors, who will hold back those with large bodies of data that do make valid promises. We don't know what we don't know with respect to deep learning in terms of data variety and voracity. There will be lots of broken promises as hospitals go through the process of determining whether those claims are actually true. I'd be surprised if we didn't start to see something material by the end of this year, in terms of AI vendors overclaiming and hospitals coming back after validation tests and saying, "No, this is not working."
Paul Black. CEO, Allscripts: There's a lot of different point solutions out there, it's 1990s deja vu. In the '90s, you had a bunch of best of breed solutions by different companies and the need for all that information to be consolidated became what was originally clinical data repository. There's four or five companies that said, "We actually need to integrate all this so we'll have a single architecture." Patients don't want 15 different apps to get to their stuff. It's got to emanate from my personal health record and my portal, and then I want to be able to launch all this other stuff, like texting with my care team, televisits and scheduling. There are a billion companies for patient and consumer engagement, but they will get bought or they'll just fade away because they became irrelevant. People will say, "That's not sufficient. You need to be able to do multiple things with one platform." I predict but there will be fewer point solutions next year, and fewer the year after that.
Eric Chetwynd. General Manager of Healthcare Solutions, Everbridge: Telemedicine. There are a whole bunch of issues tied up with that — regulatory issues, payment. It's more than a technology, but it seems to make so much sense where healthcare is really focused on cutting costs and increasing access. I think it did better this past year, but it is still a struggle for a lot of organizations. Most people are doing toe dips. In regards to communication, I always wonder why smartphones haven't taken off more in hospitals.
Rhonda Collins, DNP, RN. CNO, Vocera: I've seen a lot of hot new things come and go. There are some things that stay stable forever, like medical devices. But I think anything that is a one-off, standalone solution, does not last long in this world.
Patrick Combes. Technology Leader, Healthcare & Life Sciences, Amazon Web Services: What I would say is actually a lot of the analytics stacks that people have deployed within healthcare, they've used them for a single, niche use cases. For a single question, they deployed a single stack, and it doesn't scale or adapt to any type of larger problem. Those analytics systems can't accommodate population health because the solutions weren't meant to do that. There are certainly technologies in the provider space that have worked themselves into silos, and others that have embedded themselves into the space because they are so incredibly useful and valuable.
Pete Durlach. Senior Vice President, Healthcare Strategy and New Business Development, Nuance Communications: Public Health Information Exchanges, or HIEs. They were touted for some time as the solution to value-based care, population health management and interoperability, but in recent years there have been questions about their sustainability. Policies for patients to opt-in/out vary state by state, there are major security and privacy concerns, and there seems to be a somewhat gap for scalable use cases. As interoperability improves under new regulatory standards for FHIR and Open APIs, I think we're going to see HIEs phase out.
Garri Garrison, RN. Vice President of Performance Management, 3M Health Information Systems: Big data; only because big data was used as a broad term. It became a catchphrase for what people thought they would be able to build, and it's never really materialized. If you look at the analytics firms out there the challenge that I still struggle with as a clinician is they create vertical slices of data. For me as a clinician, vertical slices of data become problematic. Here's why: Look at length of stay. If I'm focused on LOS I need to get to a number, maybe I need to get half a day out. I'm focused on that picture, but half a day is not really accomplishing anything for me. It's not going to cut your cost. It's not going to make my patients' outcomes better. If you do this in a vacuum and you're pushing that number down, are you driving up your readmissions? Are you driving up complications as a fallout of what you're doing? I don't like vertical slices of data because I want to be able to see this longitudinal view and the events that are occurring from the interactions and interdependencies of things. If I can't see that, I'm not convinced LOS is where I need to be focused.
Alan Hughes. President, NTT Data: It's tough; there's so much movement in the space. For every business problem, there seems to be 10 different technology solutions, and it's never clear if any of really them made it because companies are really great at reinventing their mission.
The whole use of this [mobile device], the personalized technology to change behaviors of consumers around healthcare, it's still not there. We might check how many steps we walked, but does it really change my behavior about how I'm engaging in healthcare? I don't think so. The system has to get better at figuring out how to link all this to change behaviors, and that's very difficult to do.
Greg Kuhen. Senior Director, Research, Advisory Board: I think there was a collective grand disappointment in HL7 Version 3 in the interoperability space. Early on, there was a lot of hope that would smooth the process and get data where it needed to go. In reality, it was a bit of an academic exercise.
Tushar Mehrotra. Senior Vice President, Analytics, Optum: I would have hoped that digital therapeutics and what you are able to do with wellness programs would have advanced much more by now. Even providers being able to prescribe a digital therapeutic, a wearable. I think the value is there, but I don't think this is integrated well into the health system.
Dan Michelson. CEO, Strata Decision Technology: I do think cost accounting was deployed incorrectly. Traditional cost accounting days are numbered. It will be ripped out and replaced. There will be enormous change in the market for people to deploy advanced cost accounting systems with a greater level of accuracy. More comprehensive risk-based contacts to reduce cost and have a source of truth on cost require advanced cost accounting systems.
Bob Monteverdi, MD. Global Healthcare Solutions Leader, Lenovo Health: Having been here so long in this space, it finally did take off, so this is a variation on your question. Twenty years ago, working on EHRs and looking on HIMSS leadership studies each year, it was absolutely imminent to have 100 percent penetration in three, four years. I'm talking back in the mid 90s. It is amazing how slow healthcare can be to adopt even technologies that are imminent and required. When regulatory compliance comes in and you get hit with a stick and penalties if you don't do it, and you get some carrots and honey if you do it, it’s amazing how the course can change and in five years time everybody jumped on the bandwagon. It got there, it just took 20 years longer than I thought it would — or should have.
Karen Murphy, PhD, RN. Executive Vice President, Chief Innovation Officer and Founding Director of the Steele Institute for Health Innovation at Geisinger: In general, I think there is some technology that hasn't taken hold. But when we try a technology application and patients don't use it, I think we make the quick decision of, "Oh, patients don't want that," when the reality is that the technology wasn't that good. We make the decision for our patients instead of asking, "Why didn't you use it?" We assume they just didn't want it. For example, say patients are not using online scheduling. We say, "They really don't want to do online scheduling!" Well, it really wasn't they didn't want to do online scheduling. However we did it, perhaps it wasn't done correctly. I don’t think we should throw out technology after one try. We should be willing to go second-, third-, fourth-generation, particularly with front-facing, patient-facing applications. It's tremendously important for us to not make assumptions and to make sure we're offering technological solutions that patients find beneficial.
Andy Nieto. Global Healthcare Solutions Manager, Lenovo Health: The healthcare technology that I thought was going to be much bigger than it turned out to be was texting. There was such a demand early on for secure texting and how do we securely text everyone. It's had fits and starts, it exists, but it appears to only be appointment reminders. There was such a ground swell for secure messaging, and I'm bundling all secure messaging into texting. All these secure messaging modalities I thought would take off and really they just did not.
Carey Officer. Operational Vice President, Nemours Care Connect, Center for Health Deliver Innovation, Nemours Children's Health System: I'd say the momentum of AI. Everybody says it's going to solve everything, but there's a lot to learn there. It's not necessarily a replacement, it's more of an augment. It's coming. Radiology is a great place to start.
Michael Peluso. Chief Technology Officer, Rectangle Health: Everybody thought that insurance billing and revenue cycle tech was the next big thing, and they certainly poured millions, if not billions, of dollars into sending a claim to an insurance company, making sure that that claim was not going to get denied, and then getting the reimbursement back from the insurance company. That was the big thing for 30 years. Now everybody is realizing OK, we've figured it out. If you can't send a claim back to an insurance company and get paid back yet, something's very wrong. The thing that we should be focused on is more the patient and the patient experience. The patient is under the same assumption that you are going to send the claim to an insurance company that insurance company is going to pay the claim. Now where the confusion comes is what does the patient owe? What is the patient experience around payment? As hospitals focused on the insurance side of things, patient out-of-pocket also grew. So now you have a two-fold problem, and hospitals don't have any solutions for how to collect from patients. That's the next big thing, how do you engage patients, and how do you engage patients about payment?
Michael Phillips, MD, MBA. Partner and Managing Director, Intermountain Ventures: EMRs. EMRs never became information systems. They had a small "e," a small "m" and a 72-point "R." They are storing containers. They are storage that looks like the file room in Hangar 51 file room from Raiders of the Lost Ark. You can put anything you want in there, but try to find it and get it out quickly. We wanted information systems, but EMRs created billing systems and systems for us to record our data into. As a caregiver, I never wanted to have to hunt for data. I thought an information system would use some intelligence in the background to present the data I needed to intelligently care for a patient.
Joe Polaris. Senior Vice President, Product and Technology, R1 RCM: The snazzy software app. We had so many apps launched for patient portal type stuff. Some people downloaded some of them, but I think we are already past the point where private equity is going to earn a return on those point solution apps. We are at a point where the only place to really turn to for value, security and convenience are much larger aggregators.
Mike Reagin. Senior Vice-President & CIO, Sentara Healthcare: Cloud technology has been the largest transformational force in HIT and many of the on premise data center technologies that manage and monitor our systems are becoming obsolete. With the transition to cloud, organizations need different security technology, automation and monitoring capabilities that on-prem solutions are not capable of providing. Cloud native solutions are rapidly becoming the standard for managing healthcare infrastructure.
Bernie Rice. Enterprise Vice President, CIO, Nemours Children's Health System: Blockchain continues to remain a buzzword. I think of it really working well in the mortgage industry and I'm wondering, even in discussions with folks at Epic, you know, how are they going to do it? I don't think we've seen the fruits of blockchain yet. It does have a lot of promise and I do think it will help, I just don't see the traction with it yet or the specific application.
Lisa Romano, MSN, RN. CNO, Vice President Clinical Services, CipherHealth: I'd say television-based patient video conferencing at hospitals. It failed due to bandwidth in hospitals, which just didn't have large enough guest internet networks.
Andrew Schall. Director of User Experience, Modernizing Medicine: Maybe it's premature, I think it's had a lot of false starts. AR/VR has a lot of potential and there is a lot of examples here where they are showcasing technology, and I think the use cases are still lacking in most medical applications. The technology has a 'cool' factor but the practical factor is still lacking.
Roy Schoenberg, MD, MPH. President and CEO, American Well: Technologies at home are still struggling, but of all the of the technologies out there, they are the ones that have the highest likelihood of moving the needle both on the dollar side as well as the patient experience side. If we can — through a combination of things like remote patient monitoring, wearable sensors, smart components and telehealth — if we are able to extend healthcare into people's homes effectively, allowing them to shift where they get care and have much more of that done at home, we're going to have to reimagine hospitals, reimagine services, reimagine how we deal with cancer patients, reimagine aging. These are technologies that have enormous potential if they are collected together and done right, to change healthcare experience and healthcare dollars for all Americans, but it hasn't left the station yet. That's the next upcoming big deal.
Zach Silverzweig. Co-founder, CipherHealth: I think there's a number of [things that were once considered] next big things that didn't take off, and I think the underlying challenge is always ROI. It might work, it might be able to do the things it claims to do — it could analyze and predict which patients are going to come back to the hospital, predict which patients are going to have a fall — but unless those can be turned into an outcome with a greater financial impact, then the giant expense on some of that technology is hard to see progress and take a foothold across the industry.
I also think that, early on, there was this idea that Fitbit was going to be a big thing — patient-collected data, key metrics data we could get from patients, and trying to drive more through that. I think there's a lot of good anecdotes where this has been valuable, but it doesn't sound like it's mainstream. I don't know if it's a question of value and ROI, if it's a question of it being tough to capture that data, hard to operationalize it or there being limited products that can really drive that type of visibility and data collection across the care continuum, but to me that still seems like a big opportunity to find a good way to leverage more of that data in the care management and care planning process. I haven't seen that happen yet, even though we kept hoping that it would.
Don Soucy. Executive Vice President, Global Sales, Spok: Looking back, I thought that when IBM Watson came out with AI that it would just be the game changer. The way it was hyped and how many millions were spent by every aspect of healthcare, whether it be hospitals and providers, payers spent a ton of money on it, big pharma spent a ton of money on it. When I think of the ROI that most of those organizations have received from that, it's probably been a bigger disappointment, at least in terms of time. I'm still a big believer in AI, but honestly as much as AI is being hyped here — and we believe in AI, we believe that's going to be a big value-add to what we do and it will be critical to improve patient care as well as business outcomes in healthcare — but everybody sort of has one eye open about how ready most of AI, especially algorithms, are today versus what's coming two to three years from now. The big question is when do people really invest.
Randy Tomlin. Chairman and CEO, Mobile Smith Health: I think it's these EMRs. It's the Cerners, the Epics, the Meditechs. They were mandated by the government, put in the hospitals and they've helped clinicians. But I think everybody thought they'd put them into hospitals and then connect them to patients, to the 330 million Americans, and that's the disappointment. They connected to the clinicians, but they didn't connect to the consumer. The good thing is we've spent the money for the critical infrastructure in these hospitals, and now the next step to consumerize them and tie in us, the 330 million Americans, to the healthcare system can be done. The consumerization now can occur.
Dan Trencher. Senior Vice President, Product and Strategy, Teladoc: I would say the combination of some of the larger hardware put into the hospital around virtual care. Kiosks, complex robots — those types of technology that I think are being passed over as hardware shrinks, connectivity grows, mobile use grows and there are more opportunities to integrate virtual care access into TV screens, screens built into beds. These smaller footprint technologies focus on the ease of experience, connectivity and mobile devices — less on special purpose hardware.
Tom Utech. Vice President of Marketing and Strategic Innovation, BD: Over the last 15 years, there's been multiple devices and software applications to help patients to remember to take their medications and be adherent because that drives a lot of the bounce back into the hospitals for readmissions. It really hasn't taken off. There is the challenge of who pays for it and everything, but I don’t think anybody has really figured out what the magic bullet is that's going to solve that problem.
Wes Wright. Chief Technology Officer, Imprivata: Blockchain. Much like Microsoft Amalga, blockchain was and is a solution looking for a problem, and that's across all industries. Normal consumers should have never known about blockchain. It is simply a back-end way to store things, and for some reason it just got a bunch of hype.
Megan Callahan. Vice President of Healthcare, Lyft: Any lower complexity workflow solution that can be automated through AI. Pieces of the revenue cycle seem to be the biggest opportunity for cannibalization. If hospitals are able to successfully replace these workflows with AI, it will increase cycle time and drive more efficient revenue collection.
Jason Considine. Senior Vice President, Patient Collections and Engagement, Experian Health: Blockchain is an exciting technology, and it can solve certain problems, but the "blockchain buzz" was being used to solve problems and ideas that it really didn't need to be used to solve. There was a lot of overhype around blockchain. I think we will continue to see that fizzle out. It is something that all technology companies need to be evaluating, and it does have use cases, but I think there was a lot of overhype around it.
This article was updated Feb. 25 at 2:40 p.m. CST.