The Impact Advisor 2Q21
The Impact Advisor is a digital newsletter focused on healthcare IT news topics, trends, and disruptors. We hope you find this quarterly publication valuable to the work at your own organization. Please engage with us (by subscribing), so we may continue to share our industry insights and thought leadership with you.
Importance of Doubling Down on Digital Health
The annual “Digital Health Consumer Adoption Report” from Rock Health and the Stanford Center for Digital Health finds that “overall, digital health solutions played a crucial role in enabling care at a distance in 2020.” The authors add: “Necessity was the mother of adoption, particularly around telemedicine and remote health tracking. However, while more consumers used wearables to track health metrics, it is unclear how well healthcare systems have adapted to this shift in consumer interest in tracking health data, and it is unknown how much patient-generated data is being integrated into healthcare and disease management. While uncertainty remains regarding the long-term impact on adoption, the heightened use of and visibility of digital health solutions offers an opportunity for innovators to prove to consumers that technology can be an enabler throughout their wellness and healthcare journeys.” In addition to adoption of digital health tools, the survey also covered trends related to consumer trust and willingness to share health data. (See charts below.)
Why It Matters:
The survey includes a lot of great information about the use of digital health tools and virtual care – particularly from patients’ perspective – so we highly recommend reading the full report. One item we also want to call attention to is the finding about consumer trust and willingness to share data, especially as nontraditional competitors with deep pockets and strong brand name recognition continue to aggressively try to expand their footprint in health delivery. We think the two charts above in particular underscore that one of the biggest advantages that providers have over retail clinics, independent urgent care centers, and even worksite employer clinics is the patient-physician relationship. Leveraging emerging digital health tools and offering strong virtual care options can obviously help hospitals and health systems close the gap with rapidly evolving nontraditional competitors in terms of access, convenience, and even (to a degree) price transparency. However, a robust digital health and virtual care strategy – if planned and executed correctly – can also help forge a deeper and more “personal” connection with patients, allowing health delivery organizations to double down on one of their biggest strengths.
Cyber Threats in Health Delivery Continuing to Evolve
According to CI Security’s 2020 Healthcare Data Breach Report, “the number of individual patient records that were breached in the second half of 2020 nearly tripled compared to the first half of the year,” from roughly 7.7 million records to approximately 21.4 million records. The report also finds that “nearly 75% of all records breached [in the second half of 2020] were tied to business associates and other third parties, rather than the healthcare providers, health plans or healthcare clearinghouses … up from 46% in the first half of 2020.”
Number of Records Breached and Source of Breach (2020)
Why It Matters:
Health delivery is an extremely “high value” market for cybercriminals – look no further than page 31 of this PDF– so providers should fully expect the volume, frequency, and level of sophistication of cyberattacks in healthcare to continue to increase. We think the chart above is an important reminder that cybercriminals are not just trying to infiltrate hospitals and health systems directly, though. They are also gaining access to health delivery organizations by targeting the supply chain of providers’ business partners. It is obviously paramount that hospitals and health systems continue to make their own information security a top priority. However, it is also more important than ever for health delivery organizations to evaluate the security controls and measures of their business and trading partners as well.
Analytics, Artificial Intelligence, and the Current Health Delivery Landscape
Analytics and artificial intelligence were two of the many topics covered in Healthcare Innovation’s “2021 State of the Industry Survey.” According to the article, “one of the elements that will be absolutely critical to success in the new value-based healthcare system … will be the successful leveraging of data analytics to support the population health management and care management work needed to make value-based care delivery and payment work.” To that end, 37% of responding health delivery executives characterized their organization as “advanced” in their analytics development, whereas 38% said it is still “early on” in their analytics journey. One-third of respondents have begun to adopt AI and machine learning in clinical areas, while 31% have done so in financial/revenue cycle management areas – but close to half (46%) have not started to use AI and machine learning in any areas. Other topics covered in the survey include IT budgets, value-based contracting, social determinates of health, and information security.
“Have you begun using analytics to support population health management and care management work?”
“In what areas have you begun to adopt artificial intelligence and machine learning into your operations?”
Why It Matters:
The survey covers a variety of different topics related to the current health delivery landscape, and we think this great quote in the article from Impact Advisors’ own Tim Zoph sums things up perfectly: “I feel like this is really a formative time, but also a time of real transition in health. I think this notion of where we are with virtual and digital care, we’ll see a continuing acceleration of that, and we’ll see patients interacting more virtually with their providers and health systems. I’m bullish on what that represents for health IT; we got a real push on that in terms of the pandemic, and I think that won’t go away. Analytics will continue to drive care delivery advances, and I think process automation is coming. In terms of discovery and research, we’ll see AI helping to move those forward. I’m as excited as I’ve ever been about the future of healthcare. Culture may be the biggest thing holding us back; technology moves fast, but organizations move slowly. We need to be able to respond to this era of cultural change. Those that get out in front and respond to it, instead of leaning back, will be the winners in their markets.”
Physician Burnout: A Serious Problem without an Easy Fix
The 2021 Medscape National Burnout Report finds that 42% of physicians say they are burned out, with more than 70% saying they “consider it serious enough to have at least a moderate impact on their lives.” The vast majority of physicians say their burnout began before the start of the COVID-19 pandemic. Physicians cited a variety of different factors contributing to their burnout, with the most frequent response being “too many bureaucratic tasks” (cited by 58% of physicians). “Increasing computerization of practice” was mentioned by 28% of respondents.
Why It Matters:
Although physician burnout is not “new” by any means, it is a serious problem – and something that was exacerbated even further by the pandemic. Physicians’ frustrations with the perceived “usability” of enterprise EHRs are well documented, but we think the second chart above underscores that there are a variety of different factors that contribute to burnout. The bottom line is there isn’t a quick or easy answer to the problem of physician burnout. Even identifying when burnout occurs can be difficult. Success requires implementing formalized programs to reduce clinician stress, establishing new C-level position(s) such as a chief wellness officer or a chief engagement officer, and leveraging tools and data to better understand the overall “clinician experience” (i.e., distinct pain points, frustrations, and concerns specifically from clinicians’ perspective).
Disruption Not Guaranteed
After years of massive hype and lofty expectations, Haven – the joint venture between Amazon, JPMorgan, and Berkshire Hathaway – has ended operations. According to this analysis in the Wall Street Journal, “[the three companies] set out three years ago to join and transform health care. Instead, they struggled to solve even fundamental challenges, such as understanding what some kinds of care actually cost.” The WSJ adds: “From its inception, Haven faced challenges obtaining data, staff turnover, fuzzy goals and unexpected competition.”
Why It Matters:
The news is notable given the massive (and ultimately unrealistic) hype that surrounded the initial announcement of the partnership three years ago. If nothing else, the article is a good reminder that while high-profile attempts to fundamentally change traditional models and approaches in healthcare make for good headlines, actually achieving disruption is by no means guaranteed. Hospitals and health systems should fully expect disruption attempts to continue, though, whether from large employers, payers, national pharmacy chains, retail stores, tech giants, or other key players. The reality is that if traditional providers cannot successfully adapt to a changing market – i.e., by helping drive down the costs of care while also satisfying evolving patient expectations – other stakeholders eventually will.
Q: Is it time to get my EHR out of my data center?
A: Historically, the vast majority of electronic health record (EHR) systems have been deployed within healthcare organizations’ data centers and are maintained by internal resources. Today’s technology advancements and disruptive business models provide organizations with multiple infrastructure hosting options that should be considered before an EHR implementation or upgrade. EHR infrastructure requirements are substantial, as are their typical three-year upgrade costs. Understanding the pros and cons of each alternative is key to defining the correct strategy and path forward for each organization.
Traditionally, healthcare organizations have made capital investments in physical server and storage platforms, hosting these components in owned data centers. These decisions were made based on factors that, at the time, best supported business and financial economics. However, the healthcare industry infrastructure landscape continues to evolve. Advancements in infrastructure technology, combined with new operational financials models, offer healthcare entities new options to consider that not only support existing business and financial economics, but also position them to better meet customer and consumer needs in the future.
EHR architectures are complex and infrastructure requirements are significant. Unlike typical information technology (IT) infrastructure lifecycles, EHR infrastructures typically require upgrades as often as every three years in accordance with vendor best practices and support agreements. Organizations planning a new EHR implementation are faced with multimillion-dollar initial infrastructure investments, and EHR hardware upgrades along with system and feature expansion add to this initial investment over time. Sustaining costs such as maintenance, power, cooling, and ongoing personnel training also add to the overall expense.
Organizations can mitigate these large capital investments by moving to infrastructure as a service (IaaS) models, which shift cost from static, pay-in-advance capital investments to pay-as-you-go operational costs. These models, provided by EHR vendors and several third-party cloud vendors, can support some or all EHR infrastructure workloads and can accommodate additional non-EHR infrastructure components as well to drive further cost-savings.
It is important to note that the market for cloud and cloud-based IaaS is rapidly changing. To avoid unexpected downstream costs and impact, organizations must not only gather current information on available options and business requirements, but also define the complete roadmap for each option considered.
(Response provided by Erik Gerard, Principal at Impact Advisors)