The first part of this article set a general context for health IT in 2017 and started through the year with a review of interesting articles and studies. We’ll finish the review here.
A thoughtful article suggests a positive approach toward health care quality. The author stresses the value of organic change, although using data for accountability has value too.
An article extolling digital payments actually said more about the out-of-control complexity of the US reimbursement system. It may or not be coincidental that her article appeared one day after the CommonWell Health Alliance announced an API whose main purpose seems to be to facilitate payment and other data exchanges related to law and regulation.
A survey by KLAS asked health care providers what they want in connected apps. Most apps currently just display data from a health record.
A controlled study revived the concept of Health Information Exchanges as stand-alone institutions, examining the effects of emergency departments using one HIE in New York State.
In contrast to many leaders in the new Administration, Dr. Donald Rucker received positive comments upon acceding to the position of National Coordinator. More alarm was raised about the appointment of Scott Gottlieb as head of the FDA, but a later assessment gave him high marks for his first few months.
Before Dr. Gottlieb got there, the FDA was already loosening up. The 21st Century Cures Act instructed it to keep its hands off many health-related digital technologies. After kneecapping consumer access to genetic testing and then allowing it back into the ring in 2015, the FDA advanced consumer genetics another step this year with approval for 23andMe tests about risks for seven diseases. A close look at another DNA site’s privacy policy, meanwhile, warns that their use of data exploits loopholes in the laws and could end up hurting consumers. Another critique of the Genetic Information Nondiscrimination Act has been written by Dr. Deborah Peel of Patient Privacy Rights.
Little noticed was a bill authorizing the FDA to be more flexible in its regulation of digital apps. Shortly after, the FDA announced its principles for approving digital apps, stressing good software development practices over clinical trials.
No improvement has been seen in the regard clinicians have for electronic records. Subjective reports condemned the notorious number of clicks required. A study showed they spend as much time on computer work as they do seeing patients. Another study found the ratio to be even worse. Shoving the job onto scribes may introduce inaccuracies.
The time spent might actually pay off if the resulting data could generate new treatments, increase personalized care, and lower costs. But the analytics that are critical to these advances have stumbled in health care institutions, in large part because of the perennial barrier of interoperability. But analytics are showing scattered successes, being used to:
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Lower the costs of cardiac surgery
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Develop more tailored treatments for diabetes patients, based on comparisons with cohorts
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Diagnose eye disease through a combination of machine learning and machine vision
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Determine the right level of care in oncology
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Identify risk of hypertension (one impact of the research was to show that CDC underestimated its prevalence)
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Predict the onset of dementia
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Combine significant data from an echocardiogram and EHR data to find high risk of heart failure
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Prove that health is affected by one’s environment, such as exercise opportunities and fast-food restaurants
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Derive cost savings from population health data
Deloitte published a guide to implementing health care analytics. And finally, a clarion signal that analytics in health care has arrived: WIRED covers it.
A government cybersecurity report warns that health technology will likely soon contribute to the stream of breaches in health care.
Dr. Joseph Kvedar identified fruitful areas for applying digital technology to clinical research.
The Government Accountability Office, terror of many US bureaucracies, cam out with a report criticizing the sloppiness of quality measures at the VA.
A report by leaders of the SMART platform listed barriers to interoperability and the use of analytics to change health care.
To improve the lower outcomes seen by marginalized communities, the NIH is recruiting people from those populations to trust the government with their health data. A policy analyst calls on digital health companies to diversify their staff as well. Google’s parent company, Alphabet, is also getting into the act.
Specific technologies
Digital apps are part of most modern health efforts, of course. A few articles focused on the apps themselves. One study found that digital apps can improve depression. Another found that an app can improve ADHD.
Lots of intriguing devices are being developed:
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A new pacemaker “does not require any wires or leads, or a surgical pocket under the skin, like traditional pacemakers.”
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A headset detects early signs of brain disease.
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Devices embedded into all sorts of clothing bring a new meaning to the phrase “seamless integration.”
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Analyst Fard Johnmar looks at growth areas for wearables, finding that sweat sensors are quickly rising in importance
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Devices can detect frustration, boredom, and stress.
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A mobile phone can detect certain respiratory conditions by changes in voice.
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Radio waves can collect sleep data without physical contact.
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Devices help diagnose cancer and plan more efficient treatment.
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Diagnoses can be generated by analyzing a cough or tone of voice.
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Apple is planning to develop an EKG monitor for its digital watch.
Remote monitoring and telehealth have also been in the news.
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One system reduces the costs of care for very ill chronic patients. Note that it had to compensate for incorrect health records.
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A study found that that telehealth can hold down the rising use of emergency room visits (although usage still increased among monitored patients).
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The Department of Veterans Affairs gave a boost to remote treatment for mental health. They also found a way to extend their telehealth efforts nationwide without regard for state laws.
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Sometimes it takes disasters like Hurricane Harvey (which will become more common in an age of climate disruption) to boost the use of telehealth.
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On the other hand, telehealth makes it so easy to request a doctor that it may lead to higher utilization.
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A summary of research and trends mentioned the progress of state legislation in allowing telehealth.
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The American Telemedicine Association found extensive enthusiasm among health care providers for telehealth.
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But Medicare announced that it will require in-patient visits for reimbursement of diabetes treatment in shared savings programs, because they don’t trust patient reports of their own weights.
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A telehealth application known as the Patient-Centered Medical Home (PCMH), the hope of many health IT advocates, came in for disappointing results in a survey. Although it’s better for scattered impacts, there are few statistically significant findings.
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And Google Glass lives!
Natural language processing and voice interfaces are becoming a critical part of spreading health care:
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Alexa is already in use at HealthTap and in several applications that were part of a challenge. There are applications for reminders, education, and monitoring.
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An article extols NLP while calling for more refinements to increase its value.
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A study found that NLP can efficiently turn physicians’ dictated speed into structured data.
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An Atlantic Monthly article promoted computer interviews to identify at-risk patients who don’t show their tell-tale signs to psychotherapists.
Facial recognition is another potentially useful technology. It can replace passwords or devices to enable quick access to medical records.
Virtual reality and augmented reality seem to have some limited applications to health care. They are useful foremost in education, but also for pain management, physical therapy, and relaxation.
A number of articles hold out the tantalizing promise that interoperability headaches can be cured through blockchain, the newest hot application of cryptography. But one analysis warned that blockchain will be difficult and expensive to adopt.
3D printing can be used to produce models for training purposes as well as surgical tools and implants customized to the patient.
A number of other interesting companies in digital health can be found in a Fortune article.
We’ll end the year with a news item similar to one that began the article: serious good news about the ability of Accountable Care Organizations (ACOs) to save money. I would also like to mention three major articles of my own:
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On the limits of regulation to control costs and the importance of reinventing clinical care
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On possible scenarios for achieving this reinvention of care
I hope this review of the year’s articles and studies in health IT has helped you recall key advances or challenges, and perhaps flagged some valuable topics for you to follow. 2018 will continue to be a year of adjustment to new reimbursement realities touched off by the tax bill, so health IT may once again languish somewhat.
