February 08, 2021
By Chris Hobson, MD, Chief Medical Officer at Orion Health
2020 is a year we won’t soon forget. COVID-19 and political uncertainty placed immense pressure across the entirety of the health care industry as organizations were tasked with balancing an already overloaded system with limited resources and shifting priorities to respond effectively to a global pandemic. As we look ahead, what will 2021 hold for the health care IT landscape across the US?
A New Administration in Washington
As the US welcomed a new president on January 20, 2021, a new direction and focus are highly likely. Biden’s pledge during the campaign was to work on a bipartisan basis to strengthen and build on the Affordable Care Act, implement a detailed, unified coronavirus strategy, and attempt to expand broad access to health insurance. Thanks in no small part to COVID-19, health care will be a top priority for the incoming administration, and health care data a key underpinning to effective policy development and decision-making at all levels of government and industry.
Focus on the Importance of Data and Interoperability
Effective interoperability and high-quality, real-time data are crucial as organizations and jurisdictions continue the fight against COVID-19. Making informed decisions at the federal, state and local level to balance managing the spread of the disease, vaccinating the right people at the right time and keeping the economy as open as possible requires unprecedented access to high-quality data and soundly based predictive models.
To do this effectively, health care organizations and jurisdictions will need to interoperate with public health data, as well as data from traditional clinical sources and find ways to include relevant social determinants of health data (SDoH). Health information exchanges (HIEs) should play a major role as a tool to aid in the pandemic response, coordinating the efficient aggregation and access to data and support forward planning. For example, HIEs could be leveraged to play a major role in the development of a “Big Data Immunization registry.” HIEs have data relating to all the key components of an effective response to COVID-19 across a population including test results, treatments, comorbidities and immunizations.
Continued Expansion of Access to Virtual Care Models
Before COVID-19, virtual care technologies were an emerging, though somewhat future, priority for many health care organizations. However, with the urgent demands of the COVID-19 crisis and in-person medical services shutdown, health systems quickly implemented and expanded virtual care solutions, including telehealth and remote monitoring tools, to become a major arm of health care delivery across the country.
Providers and patients have proven out of necessity that virtual care models are convenient and work well, opening the door to finally reducing the dominant paradigm of compulsory in-person visits. The longer the current situation continues, the more virtual care will become accepted and perceived as a valuable option for the delivery of clinical care. A major question is whether payers will continue to fund and support virtual care, as we saw in 2020, when the crisis is finally behind us. Thanks to strong patient demand and the now improved technical infrastructure, the answer is likely to be yes. Expect to see the continuation of virtual care friendly payer policies, with payers reimbursing at full rate for telehealth consultations, and the emergence of additional virtual care models, such as the digital front door, all serving to enhance the evolution of personalized consumer-centric experiences to meet patient demand.
Prepare for Increased Demand for Mental Health Support
As we continue to navigate these extraordinary times, and in addition to the pressing issues of COVID-19 testing and vaccination challenges, an emerging mental health crisis demands our urgent attention. The Centers for Disease Control and Prevention (CDC) released staggering new data showing the severe negative impact of the COVID-19 pandemic on the nation’s mental health. The CDC found that among people ages 18-24, one in four “seriously considered suicide in the past 30 days.” Furthermore, 40% of US adults reported struggling with mental health or substance use in the prior 30 days.
As we look to 2021, the system needs to plan for hugely increased demand for mental health support and services. Virtual care models closely aligned with the new telehealth capabilities are ready to play a significant role. Telemental health is a highly effective alternative to traditional models of care delivery offering 24/7 remote access to qualified resources.
Protecting the Health Care Workforce
Thanks to COVID-19, our highly professional, well-trained and respected health care workforce is now significantly distressed and just barely able to cope with the demands being made of it. Clinician burnout was already a concern prior to March 2020, and the prospects of relief from COVID-19 are slim before at least the summer of 2021. There is a dire need to address providers’ immediate and long-term well-being.
How can we better support health care workers in managing and preventing burnout? Health care IT solutions, done well and with adequate attention to detail, have the potential to help significantly here. Today, especially with cumbersome EHRs frequently perceived as adding to the problem of clinician burnout, we need to adopt a better approach. Ideal technologies include clinical workflow optimization tools, virtual care, remote monitoring and care coordination solutions as well as HIEs and interoperability providing rapid access to complete information about patients in crisis situations.
Possible Introduction of a 21st Century Cures Act Version 2.0
In 2020, two House Representatives introduced the concept of a Cures 2.0 to build on the successes of the 21st Century Cures Act passed in 2016 and increase the focus on patient-centered care. The Cures Act 2.0 will likely focus on six key areas: public health and pandemic preparedness; caregiver integration; patient engagement in health care decision-making; diversity in clinical trials; US Food and Drug Administration (FDA) modernization; and Centers for Medicare and Medicaid Services (CMS) modernization. The proposed legislation’s priorities make sense as we emerge from the pandemic and absorb the lessons learned into a new and improved, modernized health system.
Unique Patient Identifier in the US
Congress recently reversed the longtime ban on funding for a National Patient Identifier (NPI). When looking at the art of the possible, a unique NPI would be very high on the wish list of most health care payers and providers in the US The health care system still struggles with correctly identifying patients and matching the right records to the right patient. This makes interoperability a much harder problem in the US when compared to other countries, most of whom have a longstanding unique identifier for all patients in place. Additionally, an NPI is a key requirement for better public health integration with the health care provider sector, and would streamline virtually all processes across the system. It would help to protect patients by eliminating mix-ups and ensuring patients are accurately linked to the correct record at every touchpoint, thereby reducing major safety risks and their associated costs. We remain cautiously optimistic that a unique identifier will be implemented in the near term as there is no denying it would be a game-changer for the entire health care landscape across the US.
Other Key Areas of the Health System Requiring Attention
There are other key areas of the health system that require attention and should be prioritized in 2021: continuing the drive for value-based care and reducing misplaced incentives; addressing the capacity and capabilities of public health agencies; addressing the fragmentation of clinical information and our non-coordinated delivery system; support for Medicaid; improved understanding and application of the SDoH; and lastly, preparedness for future pandemics. Although COVID-19 will be a reality throughout 2021, how can the nation better prepare for future similar events? Highly regarded experts in this area warn that COVID-19 may not even be the most severe epidemic we will have to address within our practicing lifetimes.
Change is necessary in times of great adversity. The COVID-19 pandemic called for many fast-track changes and adaptations in the health care IT industry, however many of these changes will be here to stay. It will be interesting to see what 2021 holds for health care but it seems we are in store for another year we won’t soon forget.