20 Years of Health IT Wisdom: 2023 Trends & Charting the Course for 2024

By Tony Schueth, CEO & Managing Partner

As we come to the end of 2023, which marks Point-of-Care Partners’ (POCP) 20th anniversary, we find ourselves looking back at all we’ve achieved as a company and as an industry over the past two decades. As we revel in the team we’ve built and all we’ve accomplished together, it's equally important to acknowledge the broader landscape of health information technology (health IT) over those 20 years.

In that time, the industry has witnessed transformative milestones that have reshaped the way healthcare is delivered and received. From the widespread adoption of electronic health records (EHRs) and electronic prescribing to the telemedicine revolution that brought care to our screens, these advancements have paved the way for a more connected and patient-centric healthcare system.

More recently, over the past 10 years, interoperability took a leap forward with the introduction and then maturing of Fast Healthcare Interoperability Resources (FHIR), which offers a more modern standards-based approach to healthcare interoperability than legacy Consolidated Clinical Document Architecture, X12 or other standards. Alongside this came the push to transition from fee-for-service to value-based care models, which not only marked a fundamental shift in healthcare delivery but further spurred rapid innovation and progress toward interoperability. Empowering patients with information and decision-making capabilities has been another driving force behind the shift to interoperable, value-based care. The industry has seen cycles of expansion and increasing consolidation among providers, vendors and payers.

These milestones have set the stage for the healthcare technology trends of 2023 and beyond. Let’s discuss the progress and milestones of this past year, detail what may be in need of further testing and help determine what stakeholders should contemplate as they shape their strategies for the coming year.

Interoperability and APIs in Healthcare

Application programming interfaces (APIs), which enable one application to communicate with another, define how systems can integrate, like a language translation. They facilitate the exchange of data between applications, streamlining information flow and reducing the need for duplicate data entry. The API-enabled integration of various devices and applications enhances efficiency, reduces costs and improves the quality of patient care. Information governance is crucial to ensuring the safe and effective integration of APIs throughout the healthcare system.

While APIs are widely used in other industries like banking and retail, healthcare, as with many other innovations, has been slow to fully embrace them. To the betterment of patient care, thankfully, API adoption ramped up in 2023. For example, HL7’s FHIR API, as an open standard, has grown organically and through the passing of regulatory requirements. In addition, 2023 was a banner year for Notices of Proposed Rule Making (NPRM). Several proposed rules reference FHIR and name specific FHIR implementation guides (IGs).

Key Takeaways to Keep in Mind for 2024

Policy Requirements – it’s Time to Move Beyond Just Checking the Regulatory Box

FHIR requirements are real, and so it’s somewhat surprising to hear some stakeholders refer to FHIR as though it’s a new standards philosophy or a passing fad and doing the minimum necessary to be compliant or prepare for compliance. As requirements mount, it will be tougher for laggard organizations to catch up if they haven’t made meaningful investments in the move to increased real-time data sharing with APIs and FHIR and in their own strategic interoperability roadmaps. Federal policymakers have made their intentions quite clear through the federal Health IT Strategic Plan, as well as by requiring various APIs in the spate of rulemaking that starting in 2022 and continued throughout 2023. For example, the Centers for Medicare and Medicaid Services’ (CMS) Advancing Interoperability and Improving Prior Authorization Processes Rule includes:

• Patient Access APIs: CMS refers to the patient access API as a single API, emphasizing the importance of providing individuals with electronic copies of their personal health information using industry standard FHIR APIs. The prevalence of health apps is a catalyst for this emphasis.
• Provider Access APIs: To enhance coordination across the care continuum and support the shift toward value-based care, CMS proposes that impacted payers implement and maintain a provider access API, consistent with technical standards set in previous CMS rules. This API facilitates the exchange of current patient data from payers to providers, including claims and encounter data.
• Payer-to-Payer APIs: Recognizing challenges arising from the lack of technical specifications for payer-to-payer data exchange, CMS introduced new requirements for payer-to-payer APIs. This is aimed at promoting interoperable data exchange between payers, ensuring patient health information remains consistent across transitions.
• Improving Prior Authorization: The NPRM introduced the concept of a prior authorization requirements, documentation and decision (PARDD) API. The benefits of this API are contingent upon providers using health IT solutions that can interact with payer APIs. Additionally, CMS is proposing new measures to incentivize the use of the PARDD API, further promoting interoperability and electronic prior authorizations.

We’ve been beating the “do more than check the regulatory box” drum for years. We’re hoping the writing is finally on the wall as we head into 2024.

Governance

As API use becomes more prevalent, governance will be essential. Stakeholders should quickly become familiar with its many facets:

• Legacy Systems Governance: Legacy systems present challenges in the modern healthcare landscape. APIs help bridge the gap between legacy/archived data and current/real-time data in a way that ensures the integrity of legacy systems and allows secure access to the data. This enables organizations with older systems to adapt to new technologies.
• Strategic Asset Management/Configuration Management: Healthcare organizations should use common language and open standards like FHIR and OAuth2 in their contracts to ensure the inclusion of a uniform healthcare API.
• Privacy and Security: Governance should ensure organizational controls to leverage modern standards as well as for consumer access and existing business process clearance and permission around data privacy and security, ensuring that apps request only the necessary data and have clear privacy policies, audit and oversight. Health Insurance Portability and Accountability Act (HIPAA) business associate agreements may be required, along with compliance oversight as the information blocking rule makes the HIPAA wall slightly more porous with the correct permissions and consent in place e.g., use of digital data services under Treatment, Payment and Operations.
• Quality Assurance: Data quality and documentation guidelines ensure APIs enable accurate and complete information exchange. Stakeholders should have already evaluated or be well into an assessment of the minimal data needed, best sources and the systems in place to collate and cleanse where necessary.
• Legal and Compliance Considerations: Legal aspects of API usage must be addressed, including data ownership, usage rights, terms of use, data retention policies and liabilities.

Real-World ROI

If regulatory mandates and the need for requirements don’t convince you, examples of real-world return on investment (ROI) most likely will. Take, for example, the results of a recent collaboration between HL7 Da Vinci members MultiCare and Regence involving implementation of Da Vinci IGs related to prior authorization (PA) (those named in the CMS NPRM) and quality reporting. Notable as a successful collaboration between a provider and payer organization, this collaboration required technical teams from each organization to work together toward a common goal. Additionally, both organizations have been incredibly transparent by sharing the results and ROI in several presentations and by appearing on the POCP podcast, “The Dish on Health IT.” By sharing their success, they inspire other stakeholders to pick up these IGs and get to work. (It doesn’t have to be a huge initial investment.)  The results include:

Improved Quality Reporting

• Saved $50 per chart thanks to reduced chart chasing.
• Closed 48% of care gaps.
• Recouped initial investments with increased reimbursement within six months.

Improved Provider User Experience

• Providers now refer to the new automation as “the magic button.”

APIs Aren’t Just for Acute Care Settings

Patients are no longer confined to the traditional walls of their general practitioner's office or local hospital. Today, the healthcare journey takes them to various places, often depending on their unique needs. Seniors or those with special requirements may find themselves shuttling between long-term post-acute care facilities, their trusted general practitioner or the hospital. For others, the neighborhood pharmacy or specialized care centers may become their go-to destinations. Wherever patients seek care, one crucial element remains constant: their health data must accompany them. This is where the magic of APIs come into play if stakeholders see the value and choose to implement them to seamlessly weave data throughout the entire healthcare system, ensuring that patients receive the best, most informed care no matter where they go.

Prior Authorization: A Dynamic Landscape

PA in healthcare has for quite some time been the subject of passionate discussions. It’s another area that saw a lot of action in 2023. Providers often express a strong desire for PA to disappear altogether, while patients find themselves exasperated by its complexities. Historically, patients would only realize the need for a PA when they couldn't fill a prescription or encountered unexpectedly high costs due to noncoverage. Even payers, the gatekeepers of PA, are reevaluating their policies and procedures, with the more forward-thinking redefining their PA approach. They're selectively withdrawing the requirement for PA on treatments that have consistently demonstrated a high approval rate without the need for resubmission or additional data. This pragmatic shift reflects a growing understanding that some treatments simply don't warrant the often time-consuming PA process.

In the era of artificial intelligence (AI), certain payers have embraced AI-powered adjudication for simpler claims. By automating these processes, they free their staff to focus on more complex PA submissions.

Another interesting approach gaining traction among both payers and policymakers is "gold carding." This approach exempts providers from submitting PAs altogether if they have a proven track record of high PA approval rates. For more information about gold carding, read our recent blog.

A hot-button aspect of PA, especially in 2023, is the administrative burden it imposes on both payers and providers. Reducing this burden – be it through automation, gold carding or the reevaluation of policies and procedures – benefits everyone involved in healthcare. Numerous efforts are underway to automate PAs using FHIR IGs developed by the HL7 Da Vinci Project. In addition, oncology-specific work is emerging from HL7 CodeX, contributing to the advancement of PA automation.

Key Takeaways for 2024

• Standards Are Inclusive IGs and standards guidance emerging from collaborative efforts are accessible to everyone regardless of whether you or your organization directly contributed to standards development work. These standards are instrumental in streamlining healthcare processes and improving interoperability.
• PA Automation Delivers Real-World ROI. The benefits of PA automation are tangible and far reaching. A prime example of this is the collaborative project between MultiCare and Regence mentioned in the previous section, which illustrates how providers and payers can work together for mutual benefit. In the Pacific Northwest, this collaboration resulted in remarkable outcomes:

• 89% of providers received immediate responses indicating that no PA was required, enabling prioritization of requests requiring human review.
• PA processing speed surged from three to five PA requests per hour to an impressive 10 to 12 requests per hour.

These results highlight the fact that automation isn't just a buzzword; it's a transformational force that enhances efficiency and ultimately benefits everyone. As we journey into 2024, the continued evolution of health IT and PA automation promises to bring more streamlined and patient-focused healthcare processes.

It should be noted that the Advancing Interoperability and Improving Prior Authorization Processes rule anticipated to drop later this year did not include requirements for PA for specialty medications, so there may be an opportunity for stakeholders to take on that work in 2024 to fill a potential gap with standardized workflows.

• Data Quality Will Matter More than Ever. As the industry looks to automate transactions like PA via standards or by leveraging AI, data quality will be a growing concern and likely another area ripe for collaboration between payers and providers.

Pharmacogenomics (PGx) and Its Role in Precision Medicine

While PGx and precision medicine have been buzzwords over the past few years, there was real traction in 2023. The concept of precision medicine started to be seen as the cornerstone of a more patient-centered approach to care. PGx, the study of how an individual's genetic makeup impacts their response to medications, serves as a crucial component in achieving the goals of precision medicine. It plays a pivotal role in personalizing treatment plans, making them as unique as the patients they serve.

Integrating PGx into Healthcare Workflow and the Need for Standards

To fully realize the potential of PGx, it must seamlessly integrate into healthcare workflows. Achieving this integration necessitates the development of and adherence to standards to ensure uniformity and reliability in PGx testing and interpretation. Standardization is key to streamlining reimbursement processes and facilitating the incorporation of PGx results into routine healthcare practices.

Pharmacists: The Pillars of PGx Implementation

Within the realm of PGx, pharmacists have emerged as instrumental players. Their expertise in analyzing genetic data and advising on the most suitable treatment options is invaluable. Pharmacists bridge the gap between PGx results and patient care, ensuring that the insights gained from genetic testing translate to optimized treatment plans and medication adherence.

Key Takeaways for 2024

As we look forward to 2024, there are several things to keep an eye out for:

• An expected increase in payer coverage for genomics testing in areas with high treatment costs, including cancer, mental health and cardiovascular care.
• Ongoing progress in codifying and standardizing PGx data, essential for efficient reimbursement and seamless integration into healthcare workflows.
• Continued progress from the National Council for Prescription Drug Programs PGx Task Group, which aims to identify processes and standards to communicate PGx information within EHR and pharmacy system workflows. The task group will consider the need for education, patient selection criteria, testing and criteria intervention.

The convergence of precision medicine and PGx offers a future where healthcare is not only individualized but also highly effective. In this dynamic landscape, the roles of pharmacists and the importance of standards cannot be overstated.

The Evolution of Informed Consent in Healthcare in 2023

Informed patient consent, a fundamental element of healthcare, has been part of the medical landscape for years. As data become more fluid, however, a modernized approach is needed. Traditional, paper-based consent forms have long been a staple for patients, providers and payers alike. The realm of informed consent, however, is undergoing transformation as digital consent forms and processes bring newfound efficiency and possibilities. While digital consent mechanisms are not entirely novel, their integration into modern-day payer and provider workflows is rapidly advancing.

Digital Transformation and eConsent

Similar to the early days of EHRs and meaningful use, electronic consent (eConsent) is following a digital trajectory of its own. Currently, eConsent solutions predominantly function within individual healthcare organizations, creating digital enclaves of consent within these entities. Nevertheless, progress is on the horizon as innovative healthcare technology vendors and organizations work to interconnect these digital islands to introduce true interoperability to patient care.

Researching and Exploring What’s Possible

Nonprofit organizations such as the Stewards of Change Institute are exploring industry needs and the potential of innovative solutions to modernize the consent process. Its Consent Learning Lab at HIMSS23 brought together subject-matter experts from various disciplines to provide valuable insights and formulate actionable recommendations to advance consent-to-share practices. These insights have contributed to the growing body of knowledge on consent issues and will likely play a significant role in shaping policy and practice in the coming years. You can download the full summary of the Consent Learning Lab here.

Identity and Consent Standards and Infrastructure

The HL7 FHIR at Scale Taskforce (FAST) has taken significant steps to address the complexities of identity management within the healthcare domain, demonstrating progress in this essential area. The prospect of further advancements is on the horizon, particularly in the field of consent. FAST's recognition of consent as a crucial component of healthcare data infrastructure indicates that this coming year may see significant progress in consent-related standards. These developments reflect the industry's commitment to refining identity and consent practices, with a keen eye on improving patient data privacy and security.

Key Takeaways for 2024:

• Stay attuned to the initiatives of FAST and consider becoming involved in its work related to identity and consent. Diverse perspectives can enhance the development of standards.
• Keep a vigilant eye on potential developments from the Health Information Technology Advisory Committee  task force on consent. Its focus on consent is a strong indication that the Office of the National Coordinator for Health IT recognizes consent as a significant challenge.
• The notion of a universal patient identifier is under consideration and may hold the potential to address several industry challenges. Active participation in public meetings, responses to requests for information and collaboration with industry stakeholders can help shape the future of healthcare consent and patient identification.

Artificial Intelligence: Buzz vs Reality

AI has emerged as a transformative force in healthcare, driving significant progress and innovation in various facets of the industry. As a matter of fact, when attending conferences in 2023, sessions on AI were impossible to avoid, as were marketing messages at exhibitor booths claiming AI will solve one problem or another. It’s true that AI's application in the medical field extends beyond mere automation; it delves into the realms of diagnosis, treatment, drug discovery and even medical education. Some may tout it as a panacea of sorts, but it still has limitations and risks. Here are some of the key areas where AI is making a profound impact:

1. Diagnostic Assistance: AI, armed with advanced language capabilities, can analyze unstructured data like clinical notes and medical literature. This ability proves invaluable in aiding healthcare professionals with diagnosis and uncovering associations between symptoms and diseases.
2. Medical Question Response: Google's Med-PaLM 2 and PaLM 2 have set new standards for answering medical queries and handling complex reasoning, coding and mathematical calculations. Med-PaLM 2, in particular, has achieved remarkable results, scoring 85.4% on the US Medical Licensing Exam.
3. Healthcare Data Analysis: Epic Systems and Microsoft have joined forces with OpenAI's GPT-4 AI language model to draft patient message responses and extract insights from medical records, identifying crucial trends.
4. Drug Discovery: AI's involvement in drug design, chemical synthesis, drug screening and repurposing has significantly expedited the drug discovery process. AI can unveil new biology and chemistry, potentially reducing drug discovery costs by up to 70%.
5. Protein Structure Prediction: Google's AlphaFold, a deep learning system, can predict the three-dimensional (3D) structure of proteins from their amino acid sequences. This breakthrough aids in understanding protein functionality and potential drug targeting.
6. Medical Imaging: AI models excel at detecting and classifying abnormalities in radiographs, computed tomography and magnetic resonance imaging scans, electrocardiograms, pathology slides and ophthalmic images. They enhance diagnostic accuracy and speed up the evaluation process.
7. Surgical Advancements: AI, coupled with artificial and virtual reality, facilitates precise navigation during surgical procedures, offering real-time 3D visualizations for improved precision and fewer complications. AI can also assist with preoperative planning, outcome prediction and risk identification.
8. Genomic Insights: AI plays a crucial role in analyzing genetic and genomic data, identifying mutations associated with diseases, and contributing to early disease detection and personalized treatment plans.
9. Medical Education: AI personalizes and enhances medical education by offering adaptive, interactive and scalable learning experiences. It can simulate realistic patient scenarios for hands-on practice and improve teaching strategies based on data analysis.

Key Takeaways for 2024:

• AI-driven conversational agents will become increasingly proficient, providing enhanced customer and patient interactions that include appointment scheduling and prescription refills.
• Large language models will give rise to specialized bots for various healthcare purposes, offering support in multiple languages and significantly expanding the scope of AI interactions.
• The healthcare industry will grapple with the implications of AI and clinical decision support algorithms, as reflected in the proposed rule by the US Department of Health and Human Services.
• The evolving landscape of AI in healthcare will necessitate robust regulatory frameworks focusing on data privacy, security and adherence to ethical standards.
• Initiatives at federal, state and industry levels are addressing AI's potential misuse and impact on society, with growing recognition of the need for comprehensive standards and safeguards.
• The public's perception of AI in healthcare will continue to evolve, with tech leaders and policymakers actively engaging in the conversation and advocating for responsible AI development and regulation.

2023 was a busy year – one of positive progress, particularly on the policy front. Collaboration seems to have been the key to the meaningful and positive change that has occurred over the past 12 months. If your organization needs support in developing its strategic efforts or understanding policy, know that POCP is here to help. We have an entire team of regulatory experts in our Regulatory Resource Center that can help you understand how new rules whether proposed or final will impact your organization. We also have experts that can help with objective assessments and adjustments to your strategic plan and interoperability roadmap, research into new-to-you markets for new product strategy and developing objective criteria if you’re in the market for new technology partners. Reach out to me directly if you’d like to set up some time to talk about where/how your organization wants to impact healthcare in 2024. Given all the innovative progress made over the last year, we expect 2023 to go out with a bang instead of a whimper. Get your eggnog ready for the final rules we expect to come out by year’s end and be sure to reach out to me or Brian Dwyer (brian.dwyer@pocp.com) if you need help.