HIT Perspectives – February 2017
10 Trends to Watch in 2017
By Tony Schueth, Editor-in-Chief
It’s traditional this time of year to look ahead at the trends that will be shaping health care and health information technology (health IT) in particular. We haven’t seen as many prognostications as we usually do. We suspect folks are waiting to see what happens with the fate of the Affordable Care Act (ACA), which will be all-consuming in many ways. In the meantime, the business of health care will go on 24/7, with health IT as both a driver and enabler. With that in mind, here’s our take (in alphabetical order) on 10 trends to watch in 2017.
- Biosimilars. In 2017, we will see the federal government and states continue their efforts to establish the needed infrastructure for approval and adoption of biologics and biosimilars. For example, the Food and Drug Administration recently issued a final rule on naming conventions. This is part of establishing necessary regulatory and pharmacovigilance frameworks. States are moving ahead with legislation on product substitution.
- Consumer-directed health information exchange. The power of consumerism will play a large role in 2017. Patient engagement is picking up traction. A related topic is consumer-directed health information exchange (HIE). In fact, many participants in private- and public-sector initiatives — including the Medlist Effort from the Office of the National Coordinator for Health IT (ONC) and the federal Precision Medicine initiative — are beginning to share information using consumer-directed exchange. To be sure, giving consumers the ability to direct the flow of their personal health information will require changes to technology and infrastructure. However, we’ll start to see that getting off the ground in 2017. For example, the creation of a trusted data exchange framework will begin as part of the 21st Century Cures Act. Private-sector initiatives already are under way. Developers will continue to create and support safe exchange with consumer-authorized thirdparty applications and systems. Expect to see innovation and growth in these areas in 2017.
- Electronic prescribing (ePrescribing). 2017 should be an active year for ePrescribing. We expect to see growth in automating specialty prescribing, with costs and volume of specialty medications fueling the trend. The ePrescribing infrastructure is in place and use cases have emerged that will facilitate adoption. Canada and other countries are looking to the United States for ways to implement ePrescribing; we should hear more about that in the next few months. Electronic prescribing of controlled substances (EPCS) also should experience an uptick in adoption, continuing the rapid acceleration in controlled substance prescription volume seen over the past couple years. Providers are finally beginning to invest in and use EPCS infrastructure — because it’s time; it will help them meet required quality reporting targets. Also, an increasing number of states are requiring that all such prescriptions be sent electronically as a tool to fight the opioid epidemic.
- Electronic prior authorization (ePA). The ePA standard is maturing. As an example, the National Council for Prescription Drug Programs (NCPDP) ePA Task Group, led by Point-of-Care Partners (POCP), has received no requests for tweaks to the standard because payers and others are moving toward adoption. We’re seeing implementation involving the ability of many electronic health records (EHRs) and pharmacy benefit managers to accept and exchange basic information for prior authorizations (PAs). Expect that to increase in 2017, but also look for adoption to start moving to the next level. Other indicators are also signaling that ePA is poised to take off. For example, CoverMyMeds — a large ePA platform that uses the NCPDP ePA standard to help automate and accelerate PA requests and approvals — recently was bought for $1.4 billion by McKesson. This shows market recognition of the value and opportunities inherent in ePA. New use cases are emerging, such as in pharmacy-initiated ePA in the long-term care (LTC) arena. Pharmacists already have information to process PAs in that environment, and others still. As pharmacy moves to become instrumental in the care process, we expect to see efforts to facilitate ways pharmacists can become involved in ePA for LTC patients.
- Fast Healthcare Interoperability Resources (FHIR). FHIR is one of the latest in the HL7 family of standards. It underpins the movement toward open, standardized application programming interfaces (APIs), which are getting a further boost under the 21st Century Cures Act. Providers and pharmaceutical companies are considering how to use innovative APIs to communicate with patients and partners. Increased adoption of FHIR-based APIs is expected in 2017. FHIR also is becoming key to Internet-based information exchange networks. Its accelerating momentum continues with public backing. For example, Anthem joins Independence Blue Cross in using the FHIR standard to build out value-based data exchange work flows with providers.
- Health information exchanges (HIEs). States will continue to step up efforts to initiate and improve HIEs in 2017. This will be fueled in part by funding and guidance from ONC. Since 2010, 56 states, eligible territories, and qualified state-designated entities received awards totaling $547.7 million. The agency is making additional funding available through its HIE Challenge Grants. The exchange of health information is key to cutting costs, improving quality and giving patients better access to their health information. It also is central to value-based health care. Moreover, the “interconnectedness of connectors” will be important in a couple of years if insurance is sold across state lines and if millions of people potentially move off “Obamacare” and on to new insurance plans. That said, connecting individual physicians is still a challenge and essentially taking place one at a time. There are opportunities for consolidating provider-to-provider connectivity and easing the onramps to data exchange.
- Interoperability. Interoperability is no longer a buzzword but a concept that is being put in place. Drivers for 2017 include requirements of the Medicare Access and CHIP Reauthorization Act (MACRA) and existing ONC programs. There also will be downstream impetus from the 21st Century Cures Act. According to a recent survey, interoperability projects on which health care organizations will be working in 2017 include connecting to external databases, such as HIEs (65%), connecting applications within the organization (58%) and adding connections from medical devices to existing systems (37%). Emphasis also will be placed on greater integration of EHRs and provider work flows.
- Prescription drug monitoring programs (PDMPs). Sadly, the opioid epidemic will show few signs of abating in 2017. In response, states will continue to enact legislation mandating that prescribers and pharmacists consult PDMPs. These are independent, state-run databases of controlled substance prescriptions that exist in all states except Missouri. Research by the Pew Charitable Trusts and others indicate that consultation of PDMPs before controlled substances are prescribed or dispensed can be effective in reducing overdose-related deaths. Emphasis also will be placed on making PDMPs more interoperable — both with each other and with EHRs by integrating access into prescriber work flows. For more information, see the article in this issue of HIT Perspectives.
- Telehealth. Telehealth seems to be everywhere these days. It has many benefits, including filling gaps in care transcending geographic barriers to care and reducing costs. Legislators are working to remove such barriers as licensing. There are efforts to expand its use in Medicare and Medicaid, not to mention increasing coverage by employers and private insurers. During his campaign, telehealth was cited as a key piece of President Trump’s plans to reform the Department of Veterans Affairs. That marker is likely to be cashed in. According to one expert, telehealth is fast becoming a major focus of the annual meeting of the Healthcare Information and Management Systems Society, as well as a key business initiative among health care leaders. All in all, we expect to see a lot more about telehealth in 2017.
- Value-based care. The shift from volume to value will continue in 2017, with a growing emphasis on consumers. This will be driven in part by MACRA and the 21st Century Cures Act. EHRs will be essential in supporting the data collection and analyses needed to support increased population health, quality initiatives and improved patient outcomes. In order to compete and comply with federal mandates, health care organizations must increase access to consumer-friendly services while decreasing costs. Also, expect to see high-level interest in addressing drug costs.
There’s no doubt about it: 2017 will be a year of change, but also a year of continued hard work on previous initiatives. Many of the trends covered in this article are explored in detail in previous issues of HIT Perspectives and blogs. We also closely monitor regulatory trends. To learn more, visit our Regulatory Resource Center or contact its director, Connie Sinclair, at firstname.lastname@example.org.