Ashish Atreja, Asst Professor and Chief Innovation Officer, Medicine, Icahn School of Medicine at Mount Sinai; Scientific Founder, Rx.Health
There have been two major technology waves that have influenced healthcare IT in the last two decades. The first wave of technology, Electronic Health Records, have fundamentally changed the role of CIOs, brought in new roles of CMIOs and an ever-growing team of analysts, managers, directors and VPs for EHR implementation and support. The roles and expectations of CIOs rapidly evolved from managing information systems to directly supporting clinical transformation within the health systems. The $28 billion federal investment in health IT has been a key factor in incentivizing adoption of EHRs despite concerns related to lack of interoperability, decreasing provider productivity and suboptimal user experience.
While EHRs and interoperability standards have continued to evolve, they fundamentally remain transactional provider-centric record keeping systems. This limits their capability to provide and engage longitudinal care that is needed for real clinical transformation. Furthermore, soaring healthcare costs, significant variations in management, poor quality outcomes, and an increasing fragmentation of care have become the major drivers of healthcare reforms, including pay-for-performance (P4P), the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs).The inability of EHRs to meet value-based requirements is helping shape the second wave of Health IT: The wave of patient centered digital medicine technologies.
Very much like the early days of EHRs evolution, from lab information systems to billing systems and results reviewing, Digital Medicine, has been loosely structured around apps, telemedicine, wearables, IoT, big data, augmented and virtual reality, AI, precision medicine and blockchain. However, it is the same amorphous nature that makes digital medicine flexible and in a unique position of power to address multiple use cases. Functioning beyond the four walls of health system, these use cases range from digital therapeutics to remote monitoring to population management to patient centered engagement. Recent FDA approvals of digital sensors to track adherence, to CRISPR, to continuous glucose monitoring, stand as proof that these technologies are no longer limited to just early pilots but are ready for mainstream adoption.
An innovation revolution has hit healthcare IT and CIOs are uniquely positioned to lead digital medicine change. Hospital bankruptcies have more than tripled with the advent of value based healthcare and organizations can either disrupt by harnessing the power of digital medicine technologies or they can be the ones disrupted. With this realization, executive teams are now filled with new digital leaders and new digital medicine initiatives across major health systems. Most health systems are seeing expansion of C-suites with the addition of CDOs (chief digital officers), CTOs (chief transformation officers), chief innovation officers and chief population health officers. By acquiring relevant skills and hiring nimble teams, CIOs will stay relevant in the fast pace transformation and begin to lead an even more pivotal role than has ever been previously possible.
The question remains-how do CIOs and other executives acquire these new skillsets? Beyond conferences, literature, and consultants, there is a need to structure the learning and awareness of emerging technologies. Conversely, there is also a need to foster an environment where health systems can learn from each other and openly share both their success stories and failed endeavors. One such effort has been through NODE. Health, a non-profit coalition of health systems is aiming to create a virtual digital medicine university. In summary, it is up to us to take ownership of this second wave and leverage opportunity from these technologies so that Health IT and organizations can not only successfully survive but thrive in an increasingly challenging healthcare delivery ecosystem.