Agenda Overview for Healthcare, 2013

Transcription

1 Industry Research G Agenda Overview for Healthcare, 2013 Published: 2 January 2013 Analyst(s): Thomas J. Handler, M.D. Healthcare organizations face intense pressure to control costs, while improving care quality and adapting to new business models. Gartner's 2013 research will provide CIOs of healthcare providers and payers the strategic insight and tactical guidance to survive in a fast-changing environment. Analysis Figure 1. Healthcare Agenda Overview Source: Gartner (January 2013) In the coming year, healthcare leaders in both the provider and the payer segments will face demands to control costs, while simultaneously demonstrating improvements in the quality of care and making care more patient-centric. These pressures will bring significant changes, and a blurring of the lines between the traditionally separate and often adversarial positioning of those providing care and those paying for it. To ensure their continued success, healthcare organizations will need to focus on mastering the most important business processes and on fostering enterprise agility to respond to new payment and care management processes.

2 Healthcare is moving toward an era of dispassionate economics. Many governments and businesses do not have the means to provide everything to everyone, and must make difficult choices. In this new reality, maintaining the autonomy of the primary care, specialty care and acute care segments, and of healthcare delivery organizations and payers (both private and government), is not feasible and can no longer be tolerated. Providers are necessarily taking on more care management functions, and payers are taking on more-active roles in care delivery. Crossorganizational collaboration and better care coordination will be the new standard. Just as importantly, healthcare consumers are no longer passive recipients of their care, but are taking a more active role in managing their health conditions. For these changes to occur, all healthcare stakeholders will need new applications and processes that enable them to participate in decisions and better understand the potential opportunities and consequences of their choices. Risk will increasingly be shared by providers, consumers and payers. This will cause traditional roles to converge, broadening the scope of IT services to enable closer collaboration within and between provider and payer organizations (see Figure 1). Healthcare organizations' need to manage, evaluate and transform healthcare delivery under these radically evolving market conditions will make IT more crucial than ever. The overarching goal for healthcare CIOs should be to have all stakeholders work to better coordinate care for individuals, making it easier to deliver high-quality care, while spending healthcare funds more wisely. However, the benefits of these efforts will accrue only to those healthcare organizations that ensure: Conformance Universal adherence to recommendations or evidence-based medical processes Agility Rapid enterprisewide intelligence; the ability to sense the need to change; and timely adoption of new care management processes, regulatory requirements and business initiatives Key Issues How can IT best support accountable care or chronic disease care management and valuebased purchasing models? How can organizations best procure, deploy, manage, measure and optimize the benefits from electronic health record (EHR) systems? How should healthcare payers and providers meet critical infrastructure, mobility, and security or privacy needs? What applications, analytics, vendors and processes will most impact healthcare payers and providers? What emerging technologies create opportunities for new healthcare models? What IT strategic planning, governance and operations management areas should CIOs focus on improving this year? Page 2 of 11 Gartner, Inc. G

3 How can IT best support accountable care or chronic disease care management and value-based purchasing models? If consistent high-quality care is to become the norm in a fast-changing environment with stakeholders sharing risk and an increased emphasis on reducing variations in care or disease management both healthcare payers and providers will need to substantially increase the effective use of IT. Healthcare payers will need systems that can support a variety of contracting models, and providers, too, will need support as they move away from the fee-for-service model and toward a shared-risk model. Healthcare organizations are focusing on cross-organizational care management software, and are looking to implement new software from new vendors. This market remains immature and is rife with new entrants, so CIOs require assistance on identifying credible vendors, creating requirements documents and determining selection criteria. In 2013, we will focus on IT applications and processes that support the new accountable care/ chronic disease management environment. Our research will consider the convergence of payer and provider as it relates to promoting consistent and high-quality practice. We will examine the emerging care management market and report on selection criteria and implementation and governance issues that are likely to arise as healthcare organizations attempt to create an ecosystem that crosses organizational boundaries. Our research will also cover the applications and processes required for new risk-sharing models as healthcare changes from primarily fee-forservice to value-based incentives and reimbursement. How can organizations best procure, deploy, manage, measure and optimize the benefits from EHR systems? Healthcare delivery organizations (HDOs) worldwide have made, or are planning to make, substantial investments in EHR systems. HDOs planning to purchase EHR systems are looking for best practices to implement, pitfalls to avoid, and ways to successfully plan for and staff EHR projects. HDOs that are farther along on their EHR journeys are interested in how to manage EHRs and related clinical content, and how to best leverage EHRs to achieve the highest possible impact on quality, cost and satisfaction outcomes. We will once again publish in-depth research on the key global enterprise EHR vendors, including an updated Magic Quadrant. We will re-examine EHR functional requirements, so that HDOs can understand which capabilities of an EHR system are essential and which are optional. The primary aim of our research in this area will be to allow HDOs to better define a vision for the future and assess the completeness of vendor offerings in order to enable better purchasing decisions. We will address difficult questions relating to clinician engagement, especially clinical governance, and begin to address the important question of the relationship of patients to EHR systems. Gartner, Inc. G Page 3 of 11

4 How should healthcare payers and providers meet critical infrastructure, mobility, and security or privacy needs? The IT infrastructure required to support real-time health system processes raises multiple interconnected challenges related to complexity, capacity, performance, availability, privacy and security. In healthcare, as in other industries, infrastructure is often underappreciated, and organizations need help in identifying the right investments. However, as a healthcare organization implements new systems and processes and especially as more mission-critical systems come online it must ensure that its underlying infrastructure is sufficient to meet its needs. With increased demand for mobile device connectivity and remote access, securing the privacy of personal health information is a critical focus. For both healthcare payers and providers, this Key Issue is vast, increasingly important and fraught with risk, and will be critical to the CIO's credibility. We will continue to produce strategic overviews, including Hype Cycles, Predicts and Cool Vendors. We will also tackle hot topics that are critically important for real-time infrastructure, such as medical image archiving, mobility and bring-your-own-device policy, security risk management, remote hosting, legacy system decommissioning, cloud computing, and business process management. Our research in this area will combine vendor analysis, best practices and tutorials to provide healthcare-specific interpretations of Gartner's cross-industry expertise. What applications, analytics, vendors and processes will most impact healthcare payers and providers? With the profound changes likely to occur in the upcoming years, the potential impact of IT for healthcare payers and providers has never been greater. The once-clear distinction between payer and provider organizations is blurring, and patients are being asked to and want to take on increasing responsibility for managing their own care and wellness. Transparency and accountability are now requirements for healthcare success. The net result is that healthcare payers and providers must broaden the traditional scopes of their processes and use new applications to be best able to address new realities. EHR systems remain critically important, but more as a prerequisite for the very difficult task of consistent care management. Healthcare organizations recognize the increasing need for quality information and for systems to improve adherence to evidence-based medicine best practices. There is increased demand for analytic tools, as well as population and care management tools, that cross organizational boundaries. Changes in accountability and reimbursement schemes are requiring healthcare payers and providers to review and revamp their core financial and administrative applications. Along with inward-focused IT, and the rise of healthcare consumerism, comes a need for patient- or consumerfocused IT. Healthcare CIOs need to keep abreast of the latest trends, applications and vendors to help their organizations succeed in the turbulent times ahead. In the coming year, we will publish research covering applications, vendors and processes. In addition to assistance with vendor selection, this research will include objective advice on Page 4 of 11 Gartner, Inc. G

5 evaluating a vendor's road map for enhancements and new capabilities. We will provide research on the trends and vendors of new core applications for healthcare insurers and revenue cycle products for healthcare providers, as well as broader coverage of business intelligence and analytics for both constituencies. We will continue our coverage of the ICD-10 system and fraud and abuse detection, and the global focus on collaborative care and incentives to promote higher-quality and more efficient care (these efforts are being driven by entities known as "accountable care organizations" [ACOs] in the U.S., and there are similar efforts in other countries). Our research will include coverage of interoperability and health information exchanges. This year, we will increase our coverage of tools to improve patient engagement, and will publish research on patient-focused IT. We will continue to provide insight on a broad range of applications and systems important for healthcare provider and payer organizations by publishing Hype Cycle and Cool Vendors documents. What emerging technologies create opportunities for new healthcare models? New healthcare models are the likely outcome of the current economic climate, which is driving healthcare payer and provider organizations to control costs, while improving quality. New technologies will provide the framework for new models, and new models will drive the need for new and innovative technology. Healthcare is moving toward high-velocity precision medicine, in which the individual, rather than a generic group of patients, is key. The speed and magnitude of new discoveries are accelerating, as is the imperative to incorporate these discoveries into clinical practice rapidly and pervasively, and to determine how best to reimburse for appropriate care. In response, HDOs are becoming "real-time health systems" that depend on infrastructures that are highly available, aware and responsive. Similarly, healthcare payers must prepare for a host of new healthcare models, each of which will require different structures. Healthcare organizations need to become agile and adept at sensing the prevailing winds to meet these challenges. In 2013, we will examine the potential new models and explore how IT will support and drive changes. We will also look at the top technical and business trends impacting healthcare, which provide the necessary backdrop for identifying critical emerging technologies that will help organizations remain viable and competitive. We will highlight new payment methodologies for payers and providers, and explore new approaches to collaboration with consumers, including the use of social media and mobile applications. We will also investigate health information exchanges and the need for new information architectures to support big data. Our annual Hype Cycles will provide a detailed look at technology maturity across the healthcare payer and provider landscape. Research on business opportunities, convergence and merger-and-acquisition activity will offer the market insight necessary to make informed business and IT decisions. What IT strategic planning, governance and operations management areas should CIOs focus on improving this year? Healthcare organizations are seeking a more cohesive approach to strategic planning, governance and change management that will enable them to achieve economies of scale and improved patient Gartner, Inc. G Page 5 of 11

6 outcomes. Project and portfolio management and IT governance are critical to the successful deployment of EHRs, the replacement of existing core applications and other large implementation projects. The healthcare CIO must be prepared to drive strategies that create agility, innovation and impact, while staying ahead of changes in roles and responsibilities. In addition to our annual research on key business and IT issues facing healthcare, we will again publish the top actions for healthcare CIOs. We will continue to conduct surveys of healthcare IT budgets, staffing and technology usage. These surveys help healthcare organizations benchmark themselves against their peers, and guide their investments in hardware, infrastructure and technology. We will also continue our survey of the changing role of the chief medical informatics officer, publish our annual Predicts document and given the changes facing healthcare payers publish research to help CIOs with their strategic planning. Related Priorities Key Initiatives address significant business opportunities and threats, and typically have defined objectives, substantial financial implications and high organizational visibility. They are normally implemented by a designated team with clear roles and responsibilities, as well as defined performance objectives. Page 6 of 11 Gartner, Inc. G

7 Table 1. Related Priorities for Healthcare Analytics Key Initiative Business Intelligence and Performance Management Customer Strategy and Experience Management Information Security Program Management Privacy Risk Management Focus This Key Initiative focuses on three styles: predictive, real-time and content analytics. Investments in these areas will yield insights to optimize various business domains. Business intelligence (BI) and performance management (PM) initiatives help enterprises align their organizations with consistent and insightful measurement and decision support systems. This involves designing and reacting to customer interactions to best meet or exceed expectations, and to increase customer satisfaction, loyalty and advocacy. This is the discipline of designing, implementing and maturing security practices to protect critical business processes and IT assets enterprisewide. Privacy protection is critical to consumer and employee trust. A good privacy program facilitates global IT operations and ensures compliance with multiple privacy laws, regulations and customs. This is the strategic discipline of assessing, prioritizing, monitoring and controlling the impact of uncertainty on objectives. Source: Gartner (January 2013) Suggested Next Steps Healthcare CIOs: If you are revising or are about to refresh your IT strategic plans, reach out to Gartner healthcare analysts for a critical review of drafts and to learn more about current trends and directions. Attend Gartner's Symposium/ITxpo and some of the Summit conferences, which will offer healthcare-specific content, analyst access and networking opportunities. Related Agendas Application Strategy and Governance Cloud Computing Customer Relationship Management Information Security Technology and Services Program and Portfolio Management Gartner, Inc. G Page 7 of 11

8 Security and Risk Management Leaders Supply Chain Strategy and Enablers Vendor Management Recommended Reading Some documents may not be available as part of your current Gartner subscription. How can IT best support accountable care or chronic disease care management and valuebased purchasing models? "Healthcare Payer Care Management Key Initiative Overview" "Care Management Defined: Clarifying the Terms Used in the Analysis of Care Management" "Five Industry Trends Create Opportunity for a Revolution in Care Management Engagement" "The Patient-Centered Medical Home: High Potential, but Difficult to Achieve" How can organizations best procure, deploy, manage, measure and optimize the benefits from EHR systems? "Magic Quadrant for Global Enterprise EHR Systems" "Electronic Health Records (EHR) Key Initiative Overview" How should healthcare payers and providers meet critical infrastructure, mobility, and security or privacy needs? "As the Mobility Movement Gains Momentum, Healthcare Delivery Organizations Must Prepare to Adapt" "As HIPAA Regulations Get Teeth, Healthcare Firms Feel the Bite" "Addressing HIPAA Security, Part 1: The Standards, 2012" "Addressing HIPAA Security, Part 2: 'Rightsizing' Compliance, 2012" "HIPAA and HITECH Do Not Require Encryption" "Healthcare Organizations Must Address the Risks of Social Media Privacy Breaches" "Good Authentication Choices for Healthcare Delivery Organizations" Page 8 of 11 Gartner, Inc. G

9 What applications, analytics, vendors and processes will most impact healthcare payers and providers? "Hype Cycle for Healthcare Payers, 2012" "Hype Cycle for Healthcare Provider Applications and Systems, 2012" "Hype Cycle for Healthcare Provider Technologies and Standards, 2012" "Best Practices in Usability for Payer BI: Delivering Value to the Analytics End User" "Move From Document Management to Enterprise Content Management" "U.S. Healthcare Payers Should Assess ICD-10 Vendor Capabilities Against Three Issues" "Predicts 2013: U.S. Healthcare Payers Face Challenges From Regulatory Reform and Market Disruption" "CIOs Should Use These Guidelines to Ensure Healthcare IT Megasuite Vendors Don't Handcuff Their Futures" What emerging technologies create opportunities for new healthcare models? "Healthcare's Future Is Partly Cloudy: External Service Provider Options for Healthcare Delivery Organizations" "Hype Cycle for Telemedicine, 2012" "Implement the Right Text-Messaging Platform to Support the Provider and Engage the Patient" "Five Steps Healthcare Providers Can Take Toward Social Media" What IT strategic planning, governance and operations management areas should CIOs focus on improving this year? "Healthcare Payers Must Use Technology to Reimagine Practice on the 'Flat of the Curve'" "Healthcare Payers Must Embrace a New Business Model to Manage Disruptive Change" "Predicts 2013: For Healthcare Delivery Organization IT Leaders, Great Potential Will Produce Greater Responsibility" "Top Actions for Healthcare Delivery Organization CIOs: Use IT to Better Engage and Influence Patients" "Top Actions for Healthcare Delivery Organization CIOs: Practice Information Life Cycle Management" "Cost-Cutting Measures Healthcare Delivery Organizations Can Take in a Difficult Economy" Gartner, Inc. G Page 9 of 11

10 Agenda Manager Profile Thomas J. Handler, M.D., is a research director in the Healthcare Provider analyst group. Dr. Handler primarily focuses on clinical applications, including EHR systems and personal health record (PHR) systems, and issues with their supporting functionality, governance and implementation. His research includes patient engagement and the use of social media by healthcare providers. Dr. Handler manages the Healthcare agenda within Gartner (for both payers and providers) and has more than 25 years of healthcare and IT experience. This is part of a set of related research. See the following for an overview: Roundup of Healthcare Provider Research, 1Q13 Page 10 of 11 Gartner, Inc. G

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