In 2014, the baby boomers (individuals born between 1946 and 1964) will turn 65 at a rate of nearly 10,000, individuals a day. Over the next five years 17 million baby boomers turn 65. That’s a lot of people retiring, joining the Medicare system developing chronic health conditions, and needing more care as they age. The question is how the healthcare system will manage the needs of this generation and of other consumers of health in 2014.
The good news is that legislative mandates passed during the Obama Administration that kick in during 2014, focus on care collaboration, care coordination, and patient-centered care as well as using technology that should result in better outcomes for everyone.
The bad news is that the Affordable Care Act website and some of the healthcare exchanges that were supposed to be ready at the start of the year, and that would provide healthcare for everyone, at a reasonable cost, are a mess, with no easy solutions available.
Notwithstanding the problems with the healthcare.gov site (which will get fixed) there are a lot of exciting trends that advance participatory medicine for 2014. These include:
New models of care such as the patient-centered medical home with a “whole person” orientation that designs care around a health team that coordinates care and brings the patient into the decision process will be one of the dominant trends.
Meaningful Use Stage 2, the statute that shifts payments to clinicians from a fee for services to performance or value-based compensation takes effect. This includes requirements that providers must electronically enter orders for in-patients and electronically write prescriptions as well as give patients access to their health data. It will bring about significant changes in patient/provider relationships particularly with more open communication.
Communication Technology is going to be pervasive in 2014. More and more sophisticated mHealth apps will roll out, including apps that offer simple, unidirectional tips via text messages and reminders, to sophisticated, bidirectional apps that track patient vital signs and interact with electronic health records (EHRs) and communicate information back to the providers for evaluation and action.
More than 86% of clinicians and physicians and 56% of all adult patients now use smartphone and tablet computers to monitor chronic conditions such as asthma, diabetes, heart disease, cancer, and even autism and insomnia.
In 2014, patients will use their smartphones and tablets to ask their doctors questions, make appointments or get medical test results, access information in their electronic health record, and monitor their health. They will also use them for chronic care management including: monitoring blood pressure, blood sugar, weight fluctuation, heart rate, pulse rate, oxygen levels and peak flow.
Physicians will use their smartphones and tablets chiefly for a number of apps that help them keep current on prescribing, safety information, and best practices. Among the most used are:
Epocrates: which enables physicians to review drug prescribing and safety information, select health insurance formularies for drug coverage information, perform calculations.
Medscape: which offers prescribing and safety information for drugs, procedure, videos a medical calculator and access to continuing medical education materials
MedCalc: which features an exhaustive list of formulas scales, scores calculations is a decision support tool that features drug information, a medical calculator, evidence-based clinical information and summaries of journal articles.
Doximity: a professional network for physicians which offers the opportunity to connect with other doctors and comes with HIPAA compliant faxing, emailing and text messaging.
Up To Date: a reference that comes with evidence-based recommendations, mobile optimized calculators and a CME tracker.
Chronic care monitoring tools for patients will include a variety of wearable devices that clip onto their wrists or are sensors that are embedded into clothing or woven into fabrics. This bio-sensing apparel is able to track daily health and wellness as well as monitor heart rate, breathing and activity. There are also tracker devices that record the intensity and duration of work-outs and can automatically track the calories that people are consuming.
Social networking will continue to play a major role in 2014 as patients connect with others so they can compare symptoms and treatments, and offer empathy and encouragement. These online health communities give patients a way to understand their illness, both individually and in the context of everyone else. For people facing a new diagnosis, undergoing treatment, or living with chronic illness, social networks enable them to tap into larger groups of individuals where they can share information and opinions.
Social media in 2014 is going to transform how doctors and patients interact with each other. For example, doctors will increasingly use options such as Google Hangouts, as an innovative economical way for them to deploy technology to connect with patients and set standards for a transparent, patient-centric model of healthcare that helps them capture and resolve patient issues and increase loyalty and satisfaction. These social media strategies open the communication channels with patients and enable feedback and better service.
Population health: The ongoing systematic collection, analysis, and interpretation of data, closely integrated with the timely dissemination of this data to those responsible for preventing and controlling various disease will be another hot button in the health care world of 2014. Enabling tools are available that allow researchers to aggregate information from multiple sources to track disease clusters in real time. More disease surveillance programs that identify and take actions on outbreaks for strep, whooping cough and bacterial meningitis, hepatitis and many other diseases will emerge this year. Additionally doctors will be doing a lot more with data analytics that come from genetic and genomic testing as the costs go down and the ability to identify specific genome markers becomes more widespread.
In the hospital, Accountable Care (ACO) will continue to be the watchword. ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to foster payment and care delivery models that seek to tie provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients.
In 2014 hospitals will also increase their use of wireless sensing, radio frequency identification (RFID) and near-field communication (NFC), barcodes that help these institutions move toward safer, more efficient and intelligent hospitals. Near field communication (NFC) is a set of standards for smartphones and similar devices to establish radio communication with each other by touching them together or bringing them into proximity, usually no more than a few inches.
Retail Clinics and Health Kiosks will get a boost in 2014. Retail clinics, typically are located in pharmacies or in shopping malls, offer quick easy access to patients for treatment of colds, flu, sore throats, minor cuts and bruises, monitoring of blood pressure and blood sugar, injections and other medical conditions that can be treated on the spot and generally cost no more than a co-pay. Retail Clinics are generally open during evening and weekend hours when patients have very little choice about where to go for treatment if they do not want to go through the hassle and high cost of the emergency department. Many payers will now cover treatment delivered by a Retail Clinic.
Kiosks that are in pharmacies and shopping malls, airports etc. enable people to get basic vital signs read and allow them to connect with an online doctor for quick advice about a medical condition at a low price point.
In spite of the many problems that continue to plague U.S. healthcare, in 2014 we will move toward a more connected system where technology will enable patients and providers to communicate more effectively to achieve better results. The hope is that we do not lose sight, this year, of the urgent need to use these same technology advances to educate and support our consumer populations so they better understand their care delivery options and costs.
Nancy, nice post. Your predictions are compelling but perhaps overly optimistic. For example, full implementation of Stage 2 and 3 MU, perhaps the most patient-centered changed to health care we’ve seen in our lifetimes (other than perhaps the HIPAA guarantees of patient access to their medical records) has been delayed and providers continue to gripe that even the watered down expectations for patient access to records and e-communication are too stringent. Also, to maintain coordinated care with the patient at the center requires health information exchange, which sadly remains elusive in most areas.
But it’s important to aim high…
I do not mean to imply that these predictions are a “fait accompli” but that we are moving in the right direction with these trends. Legally MU Stage 2 does kick in this year although I agree it may be watered down by industry objectors.
Also totally agree with your contention that health information exchange is so critical to attaining complete coordinated care and for many reasons including politics, financial restraints and lack of incentive, health systems nationwide are dragging their feet on this important technology.