2013 saw an accelerated crumbling of borders and boundaries in health care, fueled by technological and scientific advances. Boundaries between high-tech Western medicine and global health practices have begun blurring in interesting ways, as are those between home and hospital, patient and doctor and even a patient’s own body and the treatment used for her disease.
Last year also saw a fierce political fight over the Affordable Care Act (ACA)—aka Obamacare—ending in some six million people crossing the boundary from uninsured to insured, according to HMS, if you count Medicaid and Children’s Health Insurance Program eligibles.
What does all this portend for 2014? This year, Vector asked leaders from all walks of life at Boston Children’s Hospital to weigh in with their predictions.
POLICY PUSHBACK
1. ACA’s aftermath
2013 will be remembered for the never-ending arguments about ACA, including the substantial problems associated with the initial rollout of online health care exchanges around the U.S. My expectation for 2014 is that ACA supporters will be able to declare partial success by the end of the year. There will be a substantially greater number of people covered through new health care options, with the initial wave coming through existing and expanded Medicaid programs. As online products begin to sort themselves out, I believe a new wave of challenges and concerns (some of which we are already reading about) will emerge. In particular, new insurance products with restrictive provider networks will proliferate nationally and may be especially problematic for pediatric patients requiring highly specialized care.
2. Clinician revolt against federal health IT deadlines
Although implementation of technology has helped streamline some tasks in health care, it has equally added new ones. The pressures of regulatory mandates, including Meaningful Use Stage 2 requirements for electronic health records (EHRs) and transition to the ICD-10 diagnostic coding system, will continue to push clinicians toward the brink. As detailed thoroughly in this recent blog post, there is just too much “peripheral” work for clinicians to do, in addition to actually examining and treating their patients.
INNOVATION INFRASTRUCTURE
3. New health care innovation centers and Lean business models
4. Fueling life sciences: the rise of corporate venture capital
5. The first digital health IPO
Today, the digital health industry is ripe with investment and entrepreneurs. A growing number of new products are entering accelerators like Rock Health, HealthBox, Blueprint Health and many more. Over the past five years, the industry has grown with new companies and increasing investments from venture capital, but most investor exits (or divesting of investments for a return on capital) have been through acquisition, such as Aetna’s purchase of iTriage, a nonprofit offering resources to help patients manage their health.
One promising company, HealthTap, just received a new financing round of $24 million and has great potential to change consumer participation in health care. Another company, Scanadu, is probably further from an IPO—having just completed early production of its devices and still needing to complete the FDA approval process—but is a company to watch in the digital health space. As the health care industry transforms under ACA, the investor community already sees potential in digital health, but an IPO will be an important milestone to unlock the full potential. —Alex Pelletier, MBA, Digital Health Program Manager, Innovation Acceleration Program and manager of the FastTrack Innovation in Technology Award
SCIENCE-DRIVEN CARE
“Stem cell and gene therapy will explode with new opportunities for treating rare diseases in children.” —Sandra Fenwick, CEO, Boston Children’s Hospital
6. Genome sequencing at birth
7. Gene therapy comes of age
8. Cell-based therapies
Can patients’ own cells be turned into cancer drugs? Together with scientists at the Memorial Sloan-Kettering Cancer Center, we are opening a trial in which we take immune cells from children with high-risk leukemia, bioengineer them genetically to attack the cancer and return them to the patients as “designer drugs.” This approach has shown promise in other types of leukemias and lymphomas and could be extended into some types of pediatric solid tumors in the future. —David Williams, MD, Chief, Division of Hematology/Oncology; Director of Translational Research, Boston Children’s Hospital
DIGITAL HEALTH
9. EHRs will become more intelligently designed and mobile
Doctors and other clinicians currently spend, on average, 40 percent of their time in stuffy workrooms documenting patient encounters. In 2014, these activities will be taking place more often at the point of care. Cerner Corporation and many other IT companies have realized the value of mobile health and the importance of getting doctors out of the workroom and into face-to-face contact with their patients—where they truly want to be and belong.
We have seen exponential growth of mobile devices and their nearly ubiquitous adoption by clinicians. iPhones, iPads and other mobile operating systems offer everything from search tools to the ability to take photographs and, ultimately, to access patient records at the point of care via the EHR. In the coming months, I will be fortunate to help pilot PowerChart touch, an iPad-specific version of our EHR system.
Technology, such as voice recognition from companies like Nuance, will allow capture of further elements recently dubbed the para-EHR—elements like phone calls, emails and texts that currently don’t make their way into the EHR. Through an iPad app, clinicians will be able to dictate directly into the EHR and readily capture snippets of communication—from phone conversations to chance meetings in the hospital lobby. —Michael Docktor, MD, director of clinical mobile solutions at Boston Children’s Hospital and a co-founder of Hacking Pediatrics
10. Wearable technology reaches the tipping point
In 2014, wearable consumer health-tracking devices—from the Jawbone UP to Fitbit, Nike FuelBand and the Misfit Shine—will become commonplace, along with an increasing groundswell of software apps that will democratize and mobilize medicine and empower patients. We will see a tremendous and rapid rise in the number of individuals tracking their health metrics.
Many start-ups, employers, insurance companies and even EHR companies are vying to be part of these software and hardware ecosystems. With the launch of the Apple iWatch, expected in 2014, the barrier to entry for wearable devices will be lowered dramatically. While none of the tracking technologies are particularly novel, they will be increasingly common in many forms, from Google Glass to clothing with integrated sensors. Patients will hopefully use their data to communicate better with their physicians and take part in their own care. —Michael Docktor, MD, director of clinical mobile solutions at Boston Children’s Hospital and a co-founder of Hacking Pediatrics
THINKING GLOBALLY, ACTING LOCALLY
“The use of technology to educate, train and support clinicians will grow in application and spread worldwide. Capturing massive amounts of data as clinicians use these tools will allow for quality improvement and will serve to develop the predictive analytical capability to better diagnose and treat patients.” —Sandra Fenwick, CEO, Boston Children’s Hospital
11. Evolution in global health
We also are seeing increasing interest globally in non-communicable diseases like diabetes, sickle cell, seizures and congenital anomalies. This is due in part to the progress being made with communicable diseases and in part to a new ability to obtain remote consults regarding chronic diseases. Expect to see two other very unfortunate trends related to “lifestyle” illnesses: Obesity is increasing ferociously around the world (including in countries like China and India) and childhood tobacco use is on the rise. —Judith Palfrey, MD, Children’s Hospital Primary Care Center; Director, International Pediatric Center; Past President, American Academy of Pediatrics
12. Global partnerships: it’s a small world after all
We are fortunate in Boston to have the largest biotech/pharma industry cluster alongside world leading academic institutions. This cluster grows every year as new companies form and as established international companies open new satellite locations. In 2014, there will be increasing momentum for members of our health care ecosystem to reach out to partners on a global scale. OPENPediatrics, an interactive, cloud-based clinician education platform created by Boston Children’s and IBM, is one example that is promoting exchange of knowledge between health care providers around the world who care for critically ill children. International scientific consortia also are moving forward across geographic borders to address some of the world’s toughest medical challenges. —Maude Tessier, PhD, Assistant Director, Business Development and Strategic Initiatives, Technology and Innovation Development Office, Boston Children’s Hospital
13. The ramp-up in “reverse innovation”
CARE DELIVERY
14. Family-friendly care models will mature
The concept of patient-centered medicine almost seems redundant: shouldn’t all of medicine center on the patient? Yet typically, we elicit a story, perform an exam, run tests, get x-rays, talk amongst ourselves, come up with a diagnosis, write a prescription and send the patient on his way. And we are shocked to discover that prescriptions go unfilled, pills are not taken, referrals don’t occur, exercise and nutrition regimens aren’t followed, health disparities grow and our patients, all too often, do not get better.
Patient-centered care initiatives also are being enabled through technology: examples at our hospital include HelpSteps.com, a web-based system that helps families connect to social services, and ICISS Health, a web platform for evaluating patients’ response to therapy and quality of life over time that connects patients, parents, teachers and others and integrates their reports for clinicians. —Eric Fleegler, MD, MPH, Department of Emergency Medicine, Boston Children’s Hospital
Family engagement in care coordination will be a critical component of high-value care delivery, and national efforts to measure patient-reported outcomes are proceeding robustly, as evidenced by PCORI’s efforts. —Richard Antonelli, MD, Medical Director, Integrated Care and Strategic Partnerships, Boston Children’s Hospital
Companies like American Well, Teladoc, MDLive and RingMD finally found traction in 2013, and are poised for massive growth in 2014. These companies leverage web technologies that enable patients and clinicians to communicate securely using the most appropriate modality (text, email, chat, phone or video) at the most convenient time and place. Large EHR companies like Epic are beginning to incorporate these features into their own products. Insurance health companies like Aetna, Wellpoint, Cigna and Highmark are jumping on the bandwagon.
The pace of development of virtual visit technologies will also accelerate, as evidenced by the American Telemedicine Association’s partnership with X-Prize, a contest to develop a “tricorder-like” handheld device for consumers that can diagnose 15 different conditions and capture five vital biometric assessments. —Shawn Farrell, MBA, Telemedicine and Telehealth Program Manager, Boston Children’s Hospital
Have predictions of your own? Feel free to share them in Comments, or tweet us @BCH_Innovation.