HIT Think

Four trends that may steal the show at HIMSS19

In less that two weeks, 45,000 health IT professionals, clinicians, executives and “technology superheroes” (a HIMSS’ term, not ours, but one we’re going to run with) will descend on Orlando for the annual HIMSS conference.

Viewed as the pinnacle for new product launches in digital health, the exhibition floor at HIMSS also offers a glimpse of the future and a reflection of the state of healthcare IT today.

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As the HIMSS organizers galvanize attendees with their call “champions of health unite,” we channel our inner healthcare IT superhero to give you our take on the top trends we expect to see taking center stage at the show.

Analytics: Age of Ultron
As analysts, we try to tread carefully when touting the buzzwords vendors love to include in their press releases. Big data, blockchain and AI will undoubtedly be used across the consortium of vendors at HIMSS, as was the case last year. While many announced the use of AI algorithms to support their population health management tools, particularly in relation to analytics, there has been little evidence of wide-scale installations, let alone a significant impact on overall business.

Risk stratification is a core function of a PHM solution, separating a population into cohorts to allow tailored care management to better manage a group’s health (and ultimately its healthcare costs). This is arguably one of the most promising use-cases for AI when supporting value-based care. A well-trained machine learning algorithm can provide insight into patient risks well beyond that provided by EHR clinical data alone.

Supplementing clinical data with social determinants of health (SDOH) data (the other buzzword of 2018), claims data or a patients’ activation score adds additional layers of granularity to support the stratification process, but AI adds a dynamic element to the process, allowing the stratification tools to adapt depending on the dataset it is presented with. Many risk stratification solutions currently have a static parameter to highlight a population which fits a “status quo” of a disease. A refined model, able to identify outliers, can drive additional savings and better outcomes.

While no vendor has been able to establish itself as a clear market leader yet, and with a handful of new entrants within this space attending HIMSS this year, there is still room for innovation. There were many announcements relating to products that used AI as part of the stratification process in 2018, and we expect more in 2019.

In addition to improving analytics tools with the use of AI, genomics also has the potential to supplement the datasets used during the risk stratification process, whilst at the same time advancing precision and personalized medicine. Some vendors, such as Allscripts with its 2bPrecise solution, are already advanced in terms of developing platforms to address this opportunity, expect to see more announcements during HIMSS this year.

UI improvements: The ever-recurring reboot
Poor UI, long-winded data entry procedures, workflow tools that don’t speed up processes but slow them down, IT that gets in the way of the clinician-patient relationship instead of supporting it, have all contributed to much of the EHR investment seen across the US over recent years being viewed by clinicians with resentment.

Don’t expect a revolution at HIMSS in terms of progress in addressing these issues, but instead small steps accompanied by a lot of noise. Expect announcements, particularly in relation to EHR tools that use AI to reduce and simplify data entry and workflow processes, natural language processing (NLP) tools to support voice data entry, increased use of mobile OS (e.g. Android, iOS) to enable data entry using tablets and mobile devices at the point of care. These will be the high-profile themes at HIMSS, but they’re the ones that will also take considerable time to effect change.

Some of the lower-profile themes will be perhaps more influential short term, such as increased usability testing and design, vendor support for training and best practice, task-based design structures, reduced complexity, common style guides across product portfolios, better research and collaboration with clinicians during the product development phase and more. It all sounds a bit boring, but these are likely to be the improvements that will have more short-term impact than the above high-profile themes.

Telehealth: The dark knight returns
Telehealth has been a key theme at HIMSS for many years now; that said, it has never quite lived up to its own hype. The back-end of 2018 and start of 2019 saw developments that are likely to change this.

The Centers for Medicare & Medicaid Services (CMS) update several of its guidance models and the 2019 physician fee schedule in relation to providers treating Medicare Advantage patients using telehealth. The result is that many of the reimbursement restrictions relating to geography, service type, virtual check-ins, remote pre-evaluations, telehealth in SNFs, provider to provider consultation, etc. will lessen significantly over the coming 12 months, allowing telehealth to become increasingly central to care delivery.

Reimbursement has been a huge limiting factor for telehealth market development in the US, and the impact of these changes is likely to be felt at HIMSS as traditional telehealth leaders (such as American Well, Teladoc, InTouch Health, Cisco and Redisio/Honeywell) push their advantage and those adjacent to the market (for example, EMR, population health management and patient engagement vendors) pivot to ensure they’re also positioned to capture share, either directly or via partnerships.

Avengers: Diversify
With a lackluster recent performance from many of the digital health’s core EHR segments, it will be interesting to see what solutions take the spotlight at each stand. Many of the larger EHR vendors had pegged their long-term growth on upselling innovative PHM solutions driven by the US shift towards VBC. However, a slowdown in PHM market growth through 2018 and uncertainty around Medicare Shared Savings Program (MSSP) reforms in 2019 has painted a worrying outlook in the run-up to HIMSS, leading to many EHR and related digital health vendors reporting lower levels of growth than expected and looking elsewhere for future growth opportunities.

One of the unsung superheroes of the financial statements in 2018 came from revenue cycle management (RCM) solutions, particularly within those working in smaller hospitals/ practice groups. Providers looking to meet meaningful use criteria and hit financial targets are increasingly looking for more complex and innovative RCM solutions and this is something we certainly expect many EHR vendors to be championing at HIMSS.

The future promise of VBC and PHM led to many vendors developing sophisticated analytics and reporting tools to support VBC reporting requirements. The lower than expected growth for PHM has led to some of these vendors repositioning many of these tools as broader enterprise performance management solutions, expanding beyond the boundaries of measuring success with VBC, to a wider set of domains within hospital and enterprise management, particularly around operational and financial performance. To some extent this is a relatively new dynamic and may only have limited visibility at HIMSS 2019, but we expect it to become a big theme in 2020.

Diversification is also expected to extend to vertical market diversification, again particularly for EHR vendors attempting to maintain historic growth levels. Think Cerner’s push into the payer vertical with its investment in Lumeris and its plans to launch a Medicare Advantage product as just one example. Less dramatic, but still a development that underlines the theme is Allscripts recent development of Sunrise for the 100-bed and under market, a vertical it’s not particularly focused on historically. Meditech and its partnership with Arcadia to drive PHM across its installed base, another example.

As core EHR markets saturate in the US, the only option for vendors that are looking to maintain historic growth rates is product and vertical market diversification. Expect to see lots of this in Orlando.

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