2019 Health Information Technology and Medical Innovation Predictions

Pat Stricker, RN, MEd
Senior Vice President
TCS Healthcare Technologies

It’s that time of year again – time to look at the healthcare trends and predictions for 2019. It’s always interesting to look at what the healthcare experts think will be the “hot topics” for the coming year. Since there are numerous areas in healthcare that publish predictions, I chose to focus on the health information technology (HIT) and medical innovations areas. The following lists were created by reviewing numerous websites, studies, surveys, and articles.

Health Information Technology Predictions
• Artificial Intelligence (AI) and Machine Learning
• Innovative New Drugs, Precision Medicine, Therapies, Devices and Wearables
• Blockchain
• Big Data and Data Ownership
• Digital Health and Patient Experience
• Healthcare Insurance Changes
• Value-Based Care
• Cybersecurity

Medical Innovations
• Stroke Screening and Intervention
• Robotic Surgery
• 3D Printing
• Virtual and Mixed Reality

I can’t say many of these were surprises, but there were a couple that I did not think would make the list and others that I was surprised to see not on the list.

In a survey conducted by Frost and Sullivan 244 healthcare industry participants were asked the following question: “Tell us ONE key technology you believe will have the most profound impact on the healthcare industry during 2019?” 80 percent of the participants mentioned four technologies they felt would be game-changers in 2019: artificial intelligence (AI), big data analytics, mHealth, and wearables. AI and big data analytics were not a surprise, since they have been hot topics for the past few years and probably will be for years to come. However, even though mHealth and wearables seem to be garnering a lot of interest, they did not make any of the prediction lists I reviewed.

HEALTH INFORMATION TECHNOLOGY PREDICTIONS
Let’s take a look at each of the health information technology predictions in more detail.

ARTIFICIAL INTELLIGENCE (AI) AND MACHINE LEARNING (ML)
These were mentioned in numerous prediction lists. AI has been and will continue to be a major innovation in the years to come, not just in healthcare, but in every aspect of our lives. It is being compared to inventions like electricity, the car and others that completely changed the world. It suffers from over-inflated promises made by vendors and has had challenges and setbacks when it could not handle the complexities of clinical care (example – IBM Watson Health), but it is slated to revolutionize healthcare. I can’t wait to see what lies ahead.

• AI will make steady progress even though it will struggle with adoption gaps. It is a mature technology that can handle large, diverse data sources, due to improvements in machine learning and natural language processing algorithms. Healthcare enterprises can choose from a variety of clinical, educational, technical and analytical solutions.
• A survey found that 75 percent of healthcare organizations plan to execute an AI strategy.
• 25 percent of business processes will be impacted by the adoption of AI technologies by 2020.
• Forbes predicts AI in healthcare IT will reach $1.7 billion and that AI platforms used to change healthcare workflows will result in a 10-15 percent increase in productivity over the next 2-3 years. However, the cost of AI is a critical concern. Evidence must be presented that proves a solid ROI. AI is currently used in diagnostic imaging, drug discovery, and risk analytics applications.
• AI and ML research and applications continue to grow, with health related startups seeing a steady increase in the number of deals and equity funding. Healthcare is currently the largest industry for AI deal activity.
     o Expect to see several major acquisitions of AI and ML startups that will significantly reshape the
        industry.
• AI and ML will be used by 40 percent of healthcare providers by 2022 to improve their cybersecurity capabilities and combat ransomware.
• AI is changing healthcare by helping physicians make better decisions, improving the accuracy in viewing patient scans, improving the triage process, allowing the quick analysis of massive amounts of data in an EMR system and reducing physician burnout.
• AI will be used to support the expected 50 percent of clinical applications that will include ambient interfaces (sensors, speech and gesture recognition) by 2022. These changes are predicted to increase data quality by 40 percent.
• The merging of AI and analytics will move analytic capabilities to mainstream adoption in the next 2-3 years.

NEW DRUGS, PRECISION MEDICINE, THERAPIES, DEVICES, AND WEARABLES
• New Drugs and Devices: At least five new drugs and 10 new medical devices are expected to be approved by 2023, due to the growth of patient advocacy and favorable regulatory guidelines.
• Opioid Epidemic: One of the most important goals this year will be to find a solution to the opioid epidemic. More than 130 people die each day in the United States from opioid-related drug overdoses. The cost for treatment of prescription opioid abuse alone is over $28.9 billion annually. The opioid crisis is a public health emergency, with chronic pain being the leading cause of opioid prescriptions. Efforts to find new processes and technology to prevent potential misuse of opioids and alternatives to the drugs will be a major effort.
     o Even though there are alternative therapies for chronic pain, none have made a significant effect on the crisis. However there is a new innovative pharmacogenomics test, based on a patient’s genetic makeup that is expected to make a difference. It identifies the way an individual metabolizes drugs and can be used to eliminate unnecessary and ineffective prescriptions, predict an individual’s level of pain relief or non-relief from opiate-based analgesics and specifically tailor medication therapy to an individual. Pharmacogenomics has the potential to make significant changes that could end to the crisis.
• Behavioral Health Epidemic: The U.S. is facing a major behavioral health epidemic, with issues ranging from eating disorders, anxiety and depression to suicidal tendencies. Yet the U.S. healthcare system isn’t equipped to quickly and accurately assess a patient’s mental health at all care access points. Costs for the treatment of behavioral health issues continue to mount, so we need to get better at identifying and treating behavioral issues before they become a problem.
o Expect to see an increase this year in mandated behavioral health screenings and technology designed to better manage medication dosages.
• Precision Medicine: The rise of precision medicine or pharmacogenomics is another trend that will greatly impact pharmaceutical research and healthcare technology this year. This approach to patient care has been successful in oncology by focusing on a patient’s protein interaction and genetic makeup for a better treatment protocol. Researchers can study the cancer and determine where it may be most vulnerable for treatment by comparing the DNA from a patient’s tumor to normal cells. By tracking the patient’s genetic profiles, physicians can also learn which treatments work best for which patients. A study found that 65 percent of patients prescribed the world’s top five selling drugs didn’t respond to the therapy. Precision medicine can have an immediate impact by helping to identify new ways to reduce overspending on prescription and pharmaceutical costs for medications that are not working.
     o In 2019, precision medicine will continue to expand beyond oncology. It is currently being used for genetic profiling of joint tissue in rheumatoid arthritis patients to see which drugs work best for individual patients. Stem cell studies are also presenting completely new ways to tailor specific patient treatments. Multiple sclerosis researchers are now able to track the course of an individual’s disease and predict the most effective treatment.
     o Look for pharmaceutical companies to invest heavily in precision medicine this year.
• Advances in Immunotherapy for Cancer Treatment: Cancer immunotherapy (biologic therapy) uses the body’s own immune system to fight cancer. These immunotherapies have existed for some time, and the work continues to highlight new and novel immunotherapeutic targets.
     o New immunotherapeutic targets and biomarkers are discovered almost daily, so effective therapies may soon exist for all tumor profiles.
     o Other cancer treatments were mentioned above in the Precision Medicine section.
• RNA-Based Therapies: These therapies, similar to DNA-based gene therapies, are the newest innovation and are showing immense potential. By interfering with genetic data at the ribonucleic acid (RNA) level, a patient’s genetic abnormality can be intercepted before it is translated into functioning (or nonfunctioning) proteins. They are being used to explore a variety of rare genetic diseases, e.g., Huntington’s disease, as well as in cancer and neurologic diseases. These new therapies offer immense opportunities.
• Smartphone and Smart Watch Applications: Apple will continue to make significant progress as they have done in integrating the iPhone with other data sources, including EHR systems (EPIC).
     o Currently, they are working on making their Apple watch into an ECG app.
     o 20-30 percent of acute care providers will deploy smartwatch-based apps by 2022, which will provide a 50 percent increase in clinician productivity.
     o 50 percent of pharmaceutical reps will be able to accomplish all field duties on one device (a smartphone) by 2022.
• Procedures in Outpatient Centers: There is a continued trend to treat patients at outpatient surgical facilities, rather than inpatient facilities. Several studies have shown that ambulatory surgery centers have significantly better outcomes, lower infection rates and save millions annually. Expect to see continued expansion of complex surgical procedures in the outpatient area and new innovations that cater to the needs of these specialized centers.
• Asia becoming the New Local Innovation Hub for Global Drugs and Devices: Historically, the majority of medical innovation flowed from West to East. That is now changing. Forbes is predicting that in 2019, up to 10 percent of healthcare R&D will be done in Asia.

BLOCKCHAIN
Blockchain is described as: (1) a system in which a record of transactions is maintained across several computers that are linked in a peer-to-peer network; (2) a digital database (or the technology used to create the database) containing information, such as financial transactions, that can be simultaneously used and shared within a large decentralized, publicly accessible network; and (3) an open, distributed ledger that can record transactions between two parties efficiently and in a verifiable and permanent way.

• Future Model: While blockchain is currently used in financial areas, it is not widely known, understood or used in healthcare at this time. However, that is beginning to change. It is being used in at least one large-scale effort, an initiative addressing the $2 billion a year problem of provider data management by a consortium involving Quest, Humana, and Multiplan, Aetna and Ascension. This could be the model for the future.
• Use Expected to Increase: Blockchain is expected to increase to eight times its current use by 2022, due to the ever-increasing need to share large volumes of data and solve “big data” analytic issues.
• ROI: Blockchain is now moving from “hype” to real commercial use across enterprise initiatives. Forbes predicts that by end of 2019, 5 percent to 10 percent of healthcare blockchain applications will move from the pilot stage to partial/limited commercial availability. Companies will continue to expand their current use and other companies, who have waited, will finally jump in. The focus will move to exploring HOW and WHERE Blockchain can be used in the healthcare space.

BIG DATA AND DATA OWNERSHIP
Organizations are engaged in a battle to determine who owns the consumer’s data. Large tech companies have made progress in aggregating and analyzing large, diverse data sources, but the challenge is how to apply what has been learned to make a difference in real-time delivery of care and how to engage more meaningfully with healthcare consumers.

• Analytics is expected to shift big data to meaningful small data by specialty
• Personal data ownership will triple globally by 2023, as digitally engaged patients bring their own data, and industry and government organizations develop more data-driven programs.
• As healthcare embraces data management workflows, Forbes expects specialty-specific analytic solutions to be popular with organizations who want to investigate drug utilization, treatment variability, clinical trial eligibility, billing discrepancy and self-care programs dealing with major chronic conditions. Forbes predicts that by end of 2019, 50 percent of all healthcare companies will have resources dedicated to accessing, sharing and analyzing real-world evidence for use across their organizations. In the future, the primary goals will include: identifying and determining risk for individuals in population health management programs, identification and use of the best treatment pathways (lowest cost, best outcomes) and operational automation by patients, payers, physicians and procedures.

DIGITAL HEALTH AND PATIENT EXPERIENCE
A 2019 health industry research report conducted by International Data Corporation (IDC), a global provider of market intelligence, advisory services and events for IT, telecommunications and consumer technology markets, provides a detailed analysis of healthcare trends and issues. It stressed that the number one goal for healthcare organizations, if they want to remain competitive in 2019 and beyond, must be to optimize a personalized, natural, digital experience for patients. This must include connecting with patients through online healthcare portals that allow patients to view and interact with healthcare organizations/personnel at any time and from any internet-connected device. IDC’s research director stated “the future belongs to visionary leaders and forward-thinking organizations that are able to break the shackles of legacy systems and accelerate mastering digital-first strategies.” This includes building health IT programs that focus on “data-driven, experiential, and personalized approaches.” If healthcare organizations do not aggressively work at digitally transforming their companies, IDC warns that they could see a decline of over two-thirds of their markets by 2022.

Health systems are heavily investing in EHRs, which means smaller digital health companies and startups are struggling to compete. They typically do not provide a high return on investment, due to slow enterprise-wide adoption rates and newer reimbursement models. In addition, they need to pilot and implement their products quickly to gain traction, to alleviate being crushed by big tech companies with similar offerings. Healthcare enterprises are helping to set up innovation funds to assist startups to pilot their solutions. In some instances, the enterprises are taking equity stakes in some of the companies.

• 60 percent of healthcare providers will optimize the digital patient experience by 2020, making it a key strategic initiative.
• Outpatient digital health technology will grow by 30 percent, reaching $25 billion. It will continue to empower individuals to feel confident in managing their own health.
• Increased costs from chronic health conditions and the aging population will drive digital health solutions, such as devices, telehealth platforms and mHealth applications.
• Reimbursement policies related to clinically relevant digital health applications will expand care delivery models beyond physical conditions to include behavioral health, digital wellness, dentistry, nutrition and prescription management.

HEALTHCARE INSURANCE CHANGES
• Innovative Private Insurance Models Shake up Healthcare Payer Industry: Health insurance policies fail to meet the personalized needs of individuals. A number of insurance companies are now providing data and digital-driven services to personalize the experience and reduce the cost. Forbes expects 5-10 percent of health insurance plans to link to lifestyle and health data-driven interactive policies by the end of 2019. This interactive policy will enable insurance companies to leverage individual data and use it to personalize premiums and discounts/rewards.
• 30 percent of Fortune 500 companies will offer employer-direct healthcare instead of traditional health insurance by 2021, due to the cost of specialty drugs and negotiated bundled procedures.

VALUE-BASED CARE
Forbes predicts this year will be the “year of value-based-care.” They expect economic, reimbursement models to continue to transition to models that are based on outcomes and value. They will be data-driven and provide risk-sharing that will lead to more value for all parties.
• Up to 15 percent of global healthcare spending will be tied to value/outcome based care models by the end of 2019.

CYBERSECURITY
The 2019 health industry research report conducted by IDC includes a cybersecurity assessment that shows its ever-increasing important role, as more and more technology applications and databases are developed and used in the general population. Cyber-attacks continue to increase, yet healthcare organizations still lag far behind cybersecurity standards in the finance and retail industries.
A report found that during the last year, the healthcare industry saw an average of 32,000 intrusion attacks per day per organization, compared to only 14,300 per organization in other industries. And considering stolen health credentials can be worth 10 to 20 times more than credit card information on the black market, this is a major issue. In addition, breaches over the past year have increased every quarter, with 4.39 million medical records exposed in Q3 alone.
• Expect healthcare organizations to try to close the gap between healthcare cybersecurity standards and the standards of other industries.
• AI and machine learning will be used to improve cybersecurity capabilities and combat ransomware by 40 percent of healthcare providers by 2022.

MEDICAL INNOVATIONS
While I did not conduct an exhaustive search of medical innovations, I used the “Top 10 Medical Innovations for 2019”from the Cleveland Clinic that was unveiled at their 2018 Medical Innovation Summit in October, 2018. The innovations were selected by a panel of Cleveland Clinic physicians and scientists. I have already included these medical innovations in the above technical predictions, so I will not repeat that information here:
• Alternative Therapy for Pain: Fighting the Opioid Crisis
• AI in Healthcare
• Advances in Immunotherapy for Cancer Treatment
• RNA Based Therapies

STROKE SCREENING AND INTERVENTION
• Visor for Prehospital Stroke Diagnosis: Hemorrhagic strokes, during which blood escapes from a ruptured blood vessel in the brain, requires rapid diagnosis for effective treatment, as uncontrolled bleeding can lead to swelling, brain damage, and/or death. Nearly 40 percent of hemorrhagic strokes result in death. A visor is now available for healthcare professionals to use to scan for bleeding in the brain. It can be used anywhere and is an efficient prehospital diagnostic tool to speed up diagnosis and reduce the time to treatment.
• Expanded Window for Acute Stroke Intervention: A timely response is critical in stroke intervention, as prolonged lack of blood flow can cause irreversible damage, often resulting in disability. Interventions are available, but only if they are done within a limited window of time. New guidelines now provide an expanded treatment window, which has the potential to lower the risk of disability and provide recovery to an increased number of future stroke patients.

ROBOTIC SURGERY
• Innovation in Robotic Surgery: Robots in the operating room offer surgeons guidance for extreme precision surgeries, while providing the shortest and least invasive surgeries. Surgical platforms are highly advanced and are used for a variety of surgeries. Shortened recovery time, limited post-surgical pain and improved surgical outcomes are additional benefits of minimally invasive robotized surgery.
• Mitral and Tricuspid Valve Percutaneous Replacement and Repair: Today, cardiac surgery is less invasive, more routine and more effective than in the past. It is performed via a catheter through the skin, and many cardiac procedures no longer require open heart surgery. That is a major benefit. In addition to aortic valve percutaneous intervention, percutaneous mitral and tricuspid valve intervention has yielded significant positive outcomes and post-op results. This innovation has significant implications for the future of cardiac care.

3D PRINTING
• Patient-Specific Products Achieved with 3D Printing: Medical devices can be made to exact patient specifications using 3D printing technology. These devices are more compatible, comfortable, better accepted by the body and provide better performance outcomes than other devices. The versatility of 3D printing provides advanced care, while minimizing the risk of complications. The most significant work includes external prosthetics, cranial/orthopedic implants, and customized airway stents. Prosthetics and other bodily implants will soon be available on the commercial market. The technology has also been used for complicated heart surgeries and the most recent total face transplant. This is an amazing innovation.

VIRTUAL AND MIXED REALITY
• Virtual and Mixed Reality for Medical Education: Virtual and mixed reality (VR/MR) uses computer technology to create simulated and hybrid environments that astound gaming users. However, VR/MR technology is much more than a game and is being used in medical education programs to provide life-like simulation training. This unique, immersive learning appeals to audio, visual and kinesthetic learners.

Definitions:
Virtual Reality is an artificial environment that is experienced through sensory stimuli (such as sights and sounds) provided by a computer and in which one's actions partially determine what happens in the environment.
Mixed Reality is a hybrid reality that merges the real and virtual worlds to produce new environments and visualizations where physical and digital objects co-exist and interact in real time. Mixed Reality augments the real world with virtual objects that aim to look as if they are really placed within that world. Mixed Reality takes place not only in the physical world or the virtual world, but is a mix of reality and virtual reality.

Healthcare is always going through substantive changes. This make it a moving target to try to determine what will happen in the next year, so it will be interesting to see if these predictions are accurate.
If there are any specific topics you would like me to address in future articles, please feel free to email me at pstricker@tcshealthcare.com. I’m always looking for ideas.

Pat Stricker, RN, MEd, is senior vice president of Clinical Services at TCS Healthcare Technologies. She can be reached at pstricker@tcshealthcare.com.