Wednesday, January 1, 2014

The Year That Was 2013

As the year drew to a close, I was interviewed by many trade publications about the key themes that shaped 2013.   Here's my own version of the notable events of 2013.

1.  Meaningful Use changed the EHR landscape
Regardless of your political affiliation, there is little debate that EHR adoption in the US achieved a tipping point in 2013.   Here are our Massachusetts statistics from the 2013 Massachusetts Medical Society survey

The current overall percentage of EHR use is 79% (N=201, CI=5.6) and 82% of those using EHRs have had access to this technology for more than 2 years. Extrapolated to the estimated 18,000 clinical physicians in the state, that would leave less than 3,500 clinical providers without access to EHR systems (3% of respondents indicating that they are no longer in practice).

Broken down by practice size adoption rates are:
1-9 Physician practices made up 66% of respondents and had an adoption rate of 75%
10-25 Physicians practices made up 13% of respondents and had an adoption rate of 96%
26-75 Physicians practices made up 6% of respondents and had an adoption rate of 100%
>75 Physicians practices made up 12% of respondents and had an adoption rate of 97%

2.  Healthcare Information Exchange developed great momentum
Meaningful Use Stage 2 and more importantly the Affordable Care Act motivated organizations to implement push (via Direct and HISPs), pull (via regional and state HIE activities) and view (among clinical affiliates) interoperability for care coordination and population health.   As a CIO, I'm no longer the lone voice driving interoperability top down, it has become a bottom up demand.

3.  Security and privacy became Board-level issues
Meaningful Use, compliance requirements, and enterprise risk assessments elevated security and privacy issues to top priority for many organizations.  CIOs are hiring new security staff, enhancing capabilities, and expanding budgets to address increases in threat sophistication and volume.

4.  Self built EHRs became increasingly rare
Partners Healthcare and MD Anderson adopted Epic.   Intermountain Healthcare adopted Cerner.  That leaves Beth Israel Deaconess and the Marshfield Clinic among the few healthcare organizations building applications to enhance innovation and reduce cost.    An unintended side effect of Meaningful Use Stage 2 certification criteria was that provider self built systems, niche specialty applications, and small EHR vendors all became rare.

5.  Innovation slowed as the regulatory combination of ACA, ICD-10, MU2, and HIPAA Omnibus rule dominated the agenda for IT organizations.

The work I've done on Natural Language processing, Google Glass, advanced analytics, workflow enhancement, and patient/family engagement was limited to nights/weekends and the strength of will of selfless volunteers who innovated outside the workday.

As Meg Aranow guest posted on my blog in 2011, the content of being a CIO in 2013 continued to be great, but the context became even more anxiety-provoking .   Demand exceeded supply, anxiety/tension escalated, and budgets became even more constrained (except for selected security/compliance projects, which are often seen as burdensome rather than beneficial by customers).  The holidays brought a welcome reduction in post traumatic stress disorder symptoms for many CIOs I know.    However, on the positive side, I've always felt that times of great struggle are opportunities for greatness.   We are living in the most transformative time for healthcare in the US, and the worsening CIO stress is just a side effect of accelerating change for all healthcare stakeholders.   I recently wrote about the mitigations we need to consider to get through each day.

Personally, 2013 was a combination of emotional highs and lows.   My father died in March.   My mother entered a new chapter in her life requiring resilience and new skills.  My wife's cancer is in remission although she still experiences the side effects of chemotherapy, peripheral neuropathies and muscle spasms, that impact her activities of daily living.   My daughter thrived at Tufts University in 2013, maintaining her own apartment, living independently, and viewing the world with increasing sophistication.

Unity Farm continued to grow in 2013 with 11 chickens, 10 ducks, 29 guinea fowl, 11 alpaca, 1 llama, 2 Great Pyrenees Mountain dogs, 3 cats, and 1 rabbit in perfect health.  2013 was the year our orchard was born, the cider house was built, our duck house/pond was created, and we established a regular routine for efficiently managing all 15 acres of woodland, pasture, and wetland.   We obtained various licenses and certifications to begin selling our jams/honey/cider/mushrooms/vegetables and learned a great deal about producing organic, handcrafted products.

The combined responsibilities of leading IT for a growing ACO, assisting several countries with IT strategic planning, working on US national standards, championing state healthcare information exchange adoption, and being a Harvard Professor strained my endurance at times, especially early in the year when I made 5 visits to California around the time of my father's death.   Trips to China, Japan, Taiwan, and London were all important, but required boundless energy to ensure my day jobs were fully supported while I was half a world away.   2014 will have much less travel than 2013.

I turn 52 in a few months and as I reflect on the year that was 2013, I can say it was one of the most difficult on the journey thus far.  However, at the end of the year I feel the trajectory heading into 2014 is right.   The healthcare environment will still undergo tectonic shifts but my family, friends, and colleagues will make it navigable.    I will reaffirm my quest for equanimity in all difficult situations, my veganism, and my balance of work/farm life.    May 2014 be happy and healthy for all of you and enable you to make a difference.


TWM said...

Happy New Year! Although I see you don't post as much, I love hearing about the healthcare IT landscape, your thoughts & opinions and the story of the farm and your family. Happy New Year and thanks for sharing with all of us faceless readers. May you all continue to have wonderful health.

David Rosenthal said...

Thank you for your wonderful insights (both professional and personal), your continued optimism is the face of great uncertainties, and continued dedication to transparency and progress! To a healthy, peaceful, prosperous 2014.

Ravi said...

Happy new year and thank you so much, I generally read every blog post you write. You are such a great inspiration for me and I hope you and your family continue to have great health and a fantastic 2014.

Paul Dexter said...

Happy New Year - I appreciate your ongoing insights! Excellent point on the high hurdle meaningful use certification poses for self built EHRs. Regenstrief's completely rewritten Gopher is still very much committed - recently achieved base meaningful use certification and going strong at Eskenazi Health (formerly Wishard).