With the New Year off to a fast start, the use of information technology by physicians will evolve in 2017. Here are some predictions for what lies ahead by Practice Fusion, a company that’s developed a cloud-based electronic health record platform for physicians and patients.
EHR usability will become a critical success factor for providers as the burden of quality reporting continues to grow in an increasingly fee-for-value world. Practices already spend $40,000 per doctor per year —$15.4 billion nationwide—on collecting and reporting information about their care to Medicare, payers and others. These costs will increase further in 2017 and will likely disproportionately affect small practices—for these offices, it may well become financially impossible to continue their practice without a user-friendly EHR.
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ONC requirements for 2015 Health IT certification
There are currently more than 400 EHR vendors in the market, with the top five companies taking more than 40 percent of the overall EHR market share. This greater concentration of market share among a smaller number of EHR vendors will continue in 2017, as many smaller vendors will be forced leave the industry because of the added complexities from ONC’s requirements for 2015 Certified EHR Technology (CERHT). On the other hand, some of the larger EHR vendors will see their relative market shares decrease as more niche EHRs grow because of the usability issues and costs associated with these larger vendors’ systems. Overall, EHR vendors will continue to face pressure on multiple fronts in 2017 because of increasing regulatory complexities like ONC’s CEHRT, as well as the rise of these niche, specialty-focused EHR systems.
EHR move to the cloud
The EHRs that survive the ongoing consolidation of the industry will increasingly be cloud-based. Outside of healthcare, IT systems are almost entirely cloud-based now because of all the benefits the cloud brings. To stay relevant and cost-effective in a shifting market, more vendors will turn to offering primarily cloud-based EHR solutions.
Meaningful measures of interoperability
The way we measure interoperability today will not be sustainable for providers in the long-term, especially those in small private practices. Rather than trying to develop measures to address the many ways interoperability may be occurring or taking the draconian approach of mandating a uniform standard, it would be more beneficial to explore where interoperability is needed for providers, assess the degree to which that interoperability is happening, and determine how it can be expanded and improved on to fulfill unmet needs. Industry organizations such as the Electronic Health Record Association (EHRA) will have to lead the way in establishing interoperability standards and adoption. More so, the most important measure around usefulness of interoperability will be how much time a provider is able to save finding salient health information across disparate health IT systems that they can then use to better inform their clinical decision-making.
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Electronic prescribing of controlled substances
The dominoes will start to fall as more states follow the lead pioneering states. New York now requires all prescriptions to be written electronically and with additional controls on prescribing controlled substances. Maine requires e-prescribing of controlled substances beginning in 2017. To ensure greater monitoring and tighter controls around prescribing of controlled substances, providers in most states will increasingly be required to shift to e-prescribing.
Small practices renaissance
Independent solo and small practices have been shown to have a lower average cost per patient, with fewer preventable hospital admissions and a lower readmission rate among their patient populations. In a value-based care world, they will be the leaders in driving value, compared with hospitals and health systems. Small practices will become more influential starting in 2017 as CMS comes to more fully understand how important these practices are in driving value-based care.
Policy-making input for small practices
When the MACRA proposed rule was released by CMS in April 2016, the nuances for scoring and compensation were detailed across several hundred pages. In the proposed rule, CMS estimated that 87 percent of participating solo practices would face a negative financial adjustment in year one. For practices with two to nine eligible clinicians, nearly 70 percent would face a negative adjustment. After receiving feedback on the severe burden this would place on small practices, the head of CMS outlined an expanded range of reporting options for participating in the Quality Payment Program (QPP) in 2017, some of which require minimal effort from a practice. For HHS and CMS to make further progress toward a value-based care system, they will need to recognize and offer greater support to small practices in 2017.
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Real World Evidence
Real World Evidence (RWE) will begin to be considered as part of the criteria for conditional FDA approval for marketing new drugs. As a result, this will require drug manufacturers to perform further investigation through one or more RWE studies. Although randomized clinical trials continue to be the gold standard for establishing efficacy and safety, they may not reflect typical patient care or day-to-day experiences. RWE studies can include larger sample sizes, a greater breadth of patient demographics and clinical circumstances, which can help supplement the data derived from pre-clinical phase studies and clinical trial studies. The FDA has already signaled their interest in RWE, and we’ll see it come to fruition in 2017.
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Practice Fusion offers other views of IT and medical practice on its web site.