The coronavirus pandemic has usurped normal operations of American healthcare, spurring an unprecedented shift to digitally delivered care and leaving many providers scrambling to retain patient volume and revenue.
The public health and financial devastation of COVID-19 can't be overlooked, but the pandemic has also created opportunities to leverage tech for EHR vendors, Big Tech and health IT leaders, experts said at last week's CHIME21 Spring Forum, hosted by the College of Healthcare Information Management Executives.
"In terms of durable change, I think we're in that window now where we need to think about what is that new normal and where do we go from here," Cerner President Don Trigg said at the conference.
Some of the biggest names in EHRs shared lessons from COVID-19 and reiterated the importance of bolstering the U.S. data reporting infrastructure, while Amazon, Microsoft and Google executives teased what healthcare arenas they might disrupt next. Similarly, some noted venture capitalists shared where forward-thinking hospital CIOs should prioritize investments at this unique moment.
Here are the three biggest takeaways from the event.
EHR vendors eye the road ahead
COVID-19 has shined a harsh light on the IT failures of the U.S. healthcare infrastructure, where data input and sharing can still be a manual process. Top leaders at major EHR vendors said it was imperative to modernize the country's public health reporting, including record-keeping for COVID-19 vaccinations.
When Howard Messing, CEO of Meditech, an EHR company with a web-based record used by a quarter of all hospitals in the U.S., got vaccinated recently at Boston's Fenway Park, there was "not a computer in sight," Messing said. "Clearly, we've got to figure out how to do this better. We can't rely on paper records anymore."
Digital health professionals and hospital CIOs are increasingly bullish about the potential of tech like quantum computing and artificial intelligence in healthcare. But the industry should first focus on low-hanging fruit, like smoother data-sharing and the patient-provider relationship, according to the CEO.
"There's a lot we can do to make things better and I think we need to position the market to focus on those things," Messing said.
As adoption of virtual tools snowballed during the pandemic, provider organizations should start thinking more deeply about patient relationships, copying industries like banking and travel that rely more heavily on digital-first services — and have seen rising consumer engagement and satisfaction as a result, according to Trigg.
"Understanding communication preferences is a critical dimension as far as engagement," Trigg said, noting provider clients want their EHR to help them drive service-line growth and make money at Medicare and Medicaid rates, along with driving care outside the hospital's four walls.
The software executives also addressed rising interest among Big Tech in healthcare, noting IT vendors — even entrenched, powerful players like Epic, Cerner and Meditech — shouldn't discount the influence being amassed by companies like Amazon, Google and Apple.
"They are plugged into the consumer, and our industry needs to be coordinated with that," Messing said.
Vendors should also be keeping a wary eye on Washington, as shifting payment models nudge the industry toward things like value-based care.
In the future, "we'll see a new value equation around the person, focused on cost and convenience and experience," Trigg said. "We also have to think a great deal about the governmental role and policy now with Washington as the largest regulator and payer."
Twin data-sharing rules that kicked into gear earlier this month should help patients access their data. The vendors reiterated their support for the sweeping regulations and how they would lower barriers to medical data sharing between systems.
However, Epic CEO Judy Faulkner took a more cautious tone on the rules' repercussions, pointing out not all consumers want to single-handedly manage their information.
"The patient — the person — wants access to his or her data whenever they desire it, but they also want the health system to take care of it for them. They don't want to take care of everything themselves," Faulkner said.
Epic, the country's largest EHR vendor, campaigned for much of the past few years to nix or at least loosen the rules, arguing making it easier to share patient data between healthcare organizations and third-party apps could threaten the privacy and security of the sensitive medical information.
And revamping the nation's EHR-reliant software infrastructure isn't an easy task, the executives pointed out. Healthcare has the most complicated database of any industry, Messing said, and it needs to exist indefinitely: As standards change, companies can't just throw their data and systems out and start over from scratch, because that could compromise patient care.
"We have to make sure the data stays good," Messing said. "If the bank gets your balance wrong, it's not good, but you're not going to die."
Big Tech commits to open standards, cloud computing
Healthcare leaders at Amazon, Google and Microsoft committed to helping build an interoperable infrastructure, noting medical software should be open to numerous researchers and facilities, while interfacing with existing systems.
Interoperability is "a belief we all share," said David Rhew, chief medical officer at Microsoft.
"We believe in open standards," agreed Aashima Gupta, director of global healthcare strategy and solutions at Google, arguing the best new tech in healthcare will power health democratization by getting data moving. "A rising tide lifts all boats."
The executives agreed the coronavirus has driven unprecedented innovation in healthcare, pushing companies to make their products more convenient and affordable for consumers while highlighting the need for accurate, timely information.
However, despite rising tech adoption from the normally leery industry, it's unclear how much of that interest will remain after the pandemic.
"What's permanent is we know technology can help us advance," said Phoebe Yang, general manager of Amazon Web Services.
The executives said a main area of application for their companies is in cloud computing and getting big medical datasets onto the cloud for new use cases, whether it be new scientific discoveries or insights into streamlining healthcare administration.
Cloud computing in healthcare is a multibillion dollar global market. Microsoft Azure, Amazon Web Services and Google Cloud Platform have all inked lucrative deals with major health systems in recent years to transfer and manage their data on the cloud.
In 2019 alone, Walgreens, Providence and Humana reached data-storage agreements with Microsoft; EHR vendor Cerner named Amazon Web Services its preferred cloud host; and nonprofit academic medical center Mayo Clinic inked a 10-year deal with Google. This year, Google opened a new office by Mayo's main campus to galvanize the partnership.
And Microsoft, which introduced a vertical cloud offering in healthcare last year, plans to acquire clinical documentation and artificial intelligence company Nuance Communications for $19.7 billion.
"Ultimately, our goal is to move toward more of a cloud services type of opportunity," Rhew said. "We do envision that this will go beyond the current capabilities."
Another nascent opportunity for Big Tech in healthcare is in virtual care. Though the tech behemoths all touted the potential of telehealth to transform care delivery, telehealth alone isn't the answer, they said.
"There will be a marriage of virtual and in person care," Gupta said, noting Google is working with health systems on what steps could go virtual through tools like chatbots, virtual agents and integrating AI into the clinical space.
For its part, Amazon is expanding its on-demand virtual care program nationwide to employees and third-party employers. Amazon Care offers preventative, urgent and wellness telehealth visits, along with the option for an in-home checkup in select metro areas.
Despite a fair amount of hype, though, analysts say the program is unlikely to challenge telehealth incumbents like Teladoc and Amwell — yet. And Yang noted Amazon Care doesn't directly infringe on hospital systems' care delivery pathways, either.
"The important thing to remember is, that most health systems that I know are not getting their bread and butter from that component of primary and urgent care," Yang said. "That creates an opportunity for us to look for ways to partner."
Hospitals should invest in new revenue streams, VCs say
The coronavirus has driven unprecedented demand for digital health products, sparking record-setting funding rounds and M&A. A panel of venture capital investors explored new ideas, as increasingly digital-first care trends nudge hospitals to look for revenue streams outside their four walls.
In 2020, equity funding in digital health globally hit an all-time high of $26.5 billion in 2020, according to CB Insights. Previously niche areas like women's health and teletherapy recorded notable deal boosts.
"I don't know how much of this is new, but much of this is accelerated," said Keith Figlioli, general partner at LRVHealth.
Hospital-at-home is especially hot, according to Figlioli, citing Optum's reported acquisition of in-home medical group Landmark Health, value-based homecare provider Signify Health's $564 million IPO in February and the creation of the Moving Health Home coalition, which includes Amazon and hospital giants Ascension and Intermountain, in March.
"We're in the first inning of that, but it's a huge trend," Figlioli said.
Another intriguing idea, according to Julie Yoo, general partner at Andreessen Horowitz, is figuring out how to create products to manage back-end hospital administration, freeing up providers to focus on their core competencies like quality of care and consumer experience.
In this consumerist era where virtual care is increasingly en vogue, it's important for health systems to rethink their role and leverage what they do best around things like scale and brick-and-mortar locations to grow revenue streams moving forward, Yoo said.
And as third-party medical apps and trackers become more commonplace, the vast majority of important data will no longer be siloed in the EHR.
"Entire care models are being built on the fact that data isn't just going to be the premise of core EHR systems in the future," Yoo said.
As a result, hospital investments helmed by savvy CIOs will shift beyond the EHR, into previously backburner priorities like virtual check-ins, chatbots, voice-to-text, AI and even cybersecurity — services that prioritize the consumer, according to Matt Hermann, senior managing director at Ascension Ventures.
At this unique moment, where companies are finally seeing venture-level returns in the digital health market, hospitals that want to get ahead need to be wired into the country's entrepreneurial infrastructure, and work with startups instead of sticking to the tech-bare status quo, the investors said.
"The balance of power has shifted," Hermann said.