HIT Outlook for 2012: A crystal ball.

Now that we are in the last month of 2011 it is time to look forward to 2012. Here are my choices for what I think will be the hot topics in health information technology for the coming year.


1. Meaningful Use Stage 2 NPRM. I know it seems like Stage 1 started just yesterday but the plans for new requirements in Stage 2 are quite mature. The Federal Advisory committees have made their recommendations to the Secretary of Health and Human Services and the NPRM should be published in the first half of 2012. Mostly this should be a modulation of Stage 1 requirements with some items shifting from menu to core and the performance percentages ratcheting upwards toward 100 percent. There will be some new electronic quality measures to report. The good news for everyone is that implementation of Stage 2 has been delayed from 2013 to 2014. Watch for the number of hospitals and eligible providers qualifying Meaningful Use Stage 1 incentives to increase. In my opinion, the number of those who have met all the requirements of Stage 1 to date is disappointing. There have been 8,001 eligible providers and 302 eligible hospitals that have passed the gauntlet successfully through the end of Sept. 2011. Judge the level of participation for yourself. There will be more reports available on best practices and lessons learned to help those aiming to qualify for Stage 1 in 2012. I think the challenge is greatest for smaller practices and organizations that lack the IT resources to achieve meaningful use.


2. Preparation for ICD 10. Preparations for ICD 10 should ramp up significantly in 2012. Those who wait until later will be way behind the curve and could face drastic financial consequences. The costs and work needed to implement ICD 10 by the health care system in the US are astronomical but cannot be avoided. Many providers will need to significantly modify how they document clinical care if their coding (and by association, their income) is to be accurate. Coders will need to train on what amounts to a totally new code structure. The need for coders to learn and understand additional medical and procedural terminology cannot be minimized. Multiple IT systems will have to be upgraded to accommodate the new codes. Finally, cooperation between all elements of the health care community will need to be expedited in order to pull off the monumental changes that are required.


3. Health Information Exchange Initiatives. The vision of improved health care for the US through HIT cannot be realized without robust health information exchange. Stage 1 Meaningful Use requirements primarily were for tests of HIE capabilities. I expect Stage 2 requirements to be more demanding. Efforts to achieve broader adoption of health information exchange have been hindered by a number of factors including: lack of sufficient HIE infrastructure, reluctance of providers to share information, low adoption rates for EHRs, complex governance issues, and a paucity of models that demonstrate financial sustainability independent of government grants. Earlier this year, I expected that there would be an explosion in the use of the Direct Project specifications. This apparently has not occurred. I think that HIE will make significant progress in 2012 as the State HIE projects move from the drawing board to actual implementations. Developments in provider directories, digital certificate management, consumer consent assurance, workflow optimization, and EHR capability toward interoperable exchange of clinical summary documents through CDA should all be watched because these capabilities will speed HIE adoption. Also, watch for progress on the query health initiative. I think there are a lot of challenges for this project, not the least of which are yet to be developed specifications, lack of infrastructure for large scale HIE, and patient identity management issues, especially given the lack of national unique patient identifiers. On the horizon are mobile computing apps that may circumvent issues related to interoperability, lack of HIE infrastructure, and disparate silos of clinical information through use of cloud computing that can transform relatively unwieldy data to easy to manage webpage applications.


4. Mobile computing. It's not too late to jump on the mobile computing bandwagon but the front of the train representing mobile applications has already left the station. There has been an explosion in the use of mobile devices and applications by clinicians and patients alike. The actual potential of the technology has yet to be imagined. I think mobile apps and cloud computing will revolutionize how we collect and use data in the health care field. The FDA is hovering near the forefront to apply some braking action through its regulatory powers and represents a risk that developers must take into consideration. Security and privacy requirements are especially important but already many solutions are available through proper use of technology, policy, and thorough user training and monitoring.


5. The Learning Health Care System. I thought this was a bit of a silly term when I first heard of it. After all, how can a system learn? It is really people who learn. But this is part of the Federal Health IT Strategic Plan 2011-2015 so I think I'll adopt it. As professionals in the health care field, each of us should commit to and invest in life-long learning. We should benefit from a growing volume of information in 2012 as reports are returned from the projects developed under federal grant programs such as the Beacon Community, State Level HIE grants, SHARP grants, and HIT workforce development efforts. Look for useful feedback drawn from the experiences of the Regional Extension Centers. And this just scratches the surface of information sources. Try to attend one of the meetings of national organizations such as HIMSS, AHIMA, AMDIS, and others this coming year.