Digital Health Trends of 2014

I tried to hold off on writing this post because of the poor performance of my 2013 predictions. However, I’m a sucker for peer pressure, and reading predictions all over the place about what is going to happen in mobile or digital health in 2014 has motivated me to write a predictions post.

Smartphones -> Smart Devices
How many people have devices that plug in or interface with their smartphones? I have have a Fuelband and a Pebble that connect to my iPhone using Bluetooth. I also use my phone as a remote for my Apple TV. My dad has a Glooko cable to connect his Bayer glucometer to his phone (he had an iBGStar, but switched back to Bayer because of the cost of iBGStar test strips.) My wife has a dermatoscope for her phone. There’s a long list of such smartphone extenders and it will grow exponentially in 2014.

We’ll see more connected diagnostic devices like stethoscopes, thermometers, heart monitors, vision testers, and probably even home lab tests. Every one of these devices adds value to mobile devices and leverages smartphones as a platform for connected hardware. With online funding sites like Kickstarter and IndieGoGo, the barriers to building connected health devices is even lower. It’s going to be an exciting proliferation over the course of 2014.

A Better Understanding of What "Big Data" Means
What does it mean, anyway? It’s one of those terms (like "patient engagement") that is so widely used that it means different things to different people. This year I hope we see less hedging about the meaning of big data and more concrete talk about how it can be used to improve health and wellness.

The promise of big data is having many dimensions that create a complete (or at least full) picture of a person. These dimensions are going to require a lot more patient data than we are collecting and will include data sources that have not traditionally been considered health or wellness data sources. This understanding and aggregation of relevant data dimensions is not going to happen on a large scale in 2014, but I hope we can at least reach agreement this year on what big data in healthcare is.

Lightbulb – The Cloud is Cool. And Secure.
The move of healthcare data and technology services to the cloud is already happening and will continue full force in 2014. "Cloud" is somewhat vague. It includes private and public clouds, dedicated and multi-tenant environment, and hybrid models of these. The industry will get a lot more comfortable with the security and privacy of cloud-base technology in 2014. We’ll start to see a dialogue about which digital health tools and data fit best outside the corporate firewall.

Exciting things are happening in the cloud (or hosted infrastructure industry) these days. Health and wellness are going to get on the bandwagon and start realizing the benefits soon enough. It won’t happen in a major way, but we’ll see more and more of a migration in 2014. We’ll also see more comfort with that migration related to privacy and security of data. Or maybe I’m wrong and everything will go to the new Epic data centers being assembled in Verona (that was a joke, not about the Epic data centers, about everything going to them.)

Open Data
We’ll see more and more API offerings and app stores from EHR vendors. I’m skeptical of how successful this push will be, both for the EHR vendors as well as for the third-party app developers. We’ll likely see a solid crop of EHR extenders like HealthFinch grow up around some of these APIs. Look at athenahealth’s marketplace for a good sense of other types of offerings. But long term, I’m not sure if these EHR app stores are part of the model that succeeds in enterprise HIT.

I’ve written before about my skepticism that EHRs will be the hub of the health IT ecosystem, especially with the shifts to value-base care, patient-centered care, and more risk and accountability placed on providers. Regardless of the long-term outcome, we’ll see more EHRs opening up in 2014 and we’ll see lots of press releases about apps integrations with EHRs.

The biggest growth areas related to EHRs in 2014 will be services that support and optimize EHR installations. Companies like Nordic Consulting that service EHRs — especially Epic — will be happy with their growth in 2014. We’ll also see more of a push for opening up silos of best practices around EHRs, with solutions like Breadcrumbs being interesting to me. The growth of these services will be much bigger in 2014 than the growth of apps that sit on top of EHR APIs.

Thought Leadership is the Key to Distribution
Digital health has a few major challenges to address before getting to scale. One relates to the technology itself and access to data. The other is that health IT is complex and knowledge about it is domain specific. Few people know coding systems, data exchange, compliance, regulation, and general industry operations (payments being the biggest black box for most people) very well, and that includes people both inside and outside of healthcare.

Thought leadership in healthcare technology, as in other industries, will become a major driver of sales and distribution. Customers are looking for more than just tech solutions and products – they are looking for knowledge. Vendors that can help inform customers will win more market share.

Patients Matter a Lot
There’s not a lot to expand on with this one. The trend to patient engagement and patient-centered data and care will only increase in 2014. We’ll see more seamless data flow from clinical systems to patients through initiatives like Blue Button Plus. We’ll begin to see integration of new patient-centered and patient-reported data points into clinical systems, and hopefully provider-patient interactions as well. We’re likely to see many new vendors emerge. Hopefully we’ll see more providers becoming informed and accepting of this shift.

We’re also likely to start getting a better sense of the different meanings and metrics for patient engagement. No “one size fits all” approach to engagement exists and neither do scaled examples or templates. Integrated delivery networks and direct primary care will likely lead the way on engagement out of necessity.

Quantified self apps and services will also inform and become a part of engagement strategies. Ideally an exchange of best practices and tools will emerge, but it’s unlikely that we’ll see too much of this in 2014. Healthcare is a slow-moving industry and this is a major shift.

Managing Risk Means Knowing Your Population
Health systems are taking on more and more of the risk associated with caring for a patient population. That risk makes providers and systems accountable for how they care (and how much they spend to care) for patients. Managing that risk, or to even negotiating payer contracts, requires tools to better assess and understand populations. Non-EHR companies like Forward Health Group will continue their success in 2014 around population health visibility and analytics.

Niches = White Spaces and Innovation
I’ve written about niche offerings in healthcare. Healthcare is a monster of an industry and is becoming increasingly specialized. I was having a discussion with my wife this morning about how boring it seems to be so specialized that you perform the same small set of procedures or see the same small set of conditions over and over again your whole career. I’m betting that contributes to some of the staggering physician burnout numbers. Specialization in healthcare is what mandates better communication and collaboration tools (notice I didn’t say EHRs because they suck at these.)

Specialization is also what makes a “one size fits all approach” — for provider tools like EHRs as well as for patient devices, apps, and networks — a poor fit. We’re increasingly seeing best-of-breed EHRs for specialties. These are growing rapidly using modern cloud and mobile technologies and providers actually like them.

The major question about these specialty-based offerings is how they fit with the rollup trends in healthcare. Owned specialty groups and departments are generally mandated to use the enterprise EHR (Epic, Cerner, etc.) The efficiency of specialty providers, especially high-volume specialties, is vastly different between larger enterprise EHRs and smaller, targeted offerings. It will be interesting to see if some of these niche offerings can disaggregate the monolithic vendors. A couple of my favorite niche EHR offerings are Modernizing Medicine’s dermatology EHR and Atlas.MD’s direct primary care EHR (Atlas is very new, having just launched this past fall.)

On the patient side, we’ll see more organ system-based or disease-based offerings like Telcare and Propellor Health. One of the most exciting trends is the emerging pediatric-targeted apps and platforms. My kids use Sqords and they are just awesome. Kurbo Health recently raised a round of funding to target childhood health problems such as obesity.

Remembering Healthcare is Local
Being in the Midwest, I’ve seen some exciting and interesting companies sprout up to create targeted, locally-driven offerings in fly-over states. Most of them aren’t concerned with coastal density (San Francisco, Los Angeles, New York, Boston) and target 251 smaller markets that aren’t on the coasts (they’ve done the research and I think it’s 251 markets over a certain population size.)

Despite the hype and early success of virtual and telemedicine, healthcare will always involve face-to-face encounters. Face-to-face means there is a local angle, and that’s what poses the greatest threat to companies like ZocDoc. Finding doctors and booking appointments, while good for sound bites and investors, is different from finding restaurants and booking tables. We’ll see more locally-based health startups targeting the connection between consumers and local health resources in 2014.

My Own Resolution
I chose what’s most important and really matters for my 2014 resolution – being more attentive to my family. I’m under a considerable amount of stress and I have a hard time shutting things off when I’m home. From that one resolution, a whole bunch of things fall out: exercising daily, eating better (for me, that’s mostly green juicing every day), getting better sleep, journaling daily, and intentionally unplugging at times. All of these help me to be more patient and attentive to my family. It’s a subtle change since most of those specific activities were on my resolution list last year, but it’s significant for me because I’m only tracking what really matters.

I tend to draw parallels from just about everything to healthcare, so this is no different. I’m not the only one who wonders if we’re mistaken in chasing the low-hanging fruit. Quality indicators such as blood pressure and glucose, while important, may miss the underlying causes of those problems. Simply medicating our way to better indicators isn’t likely to lead to better patient engagement or satisfaction, which in turn makes it unlikely that we’ll succeed in a sustained way at making people healthier and driving down costs.

I’m not sure what the answer is, but I’m betting it’s not as simple as driving full speed at the indicators and not the problems.


Travis Good is an MD/MBA and co-founder of Catalyze. More about me.

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