I usually reserve posts about the state of the industry for the new year, but since there have been a lot of changes this year, I see the need to share my thoughts on the state of healthcare information technology right now. While COVID-19 hasn’t gone away completely, at least for now the worst is probably behind us. I’ve observed some fairly significant developments in healthcare organizations and vendors who are trying to find their bearings in this turbulent phase.
Work From Home – Be Careful What You Wish For
As the economy began to recover in 2021 and then overheat in 2022, the labor market has continued to favor those who perform the day-to-day functions. Management in many places have prodded workers to get back into the office whenever possible, but for the most part, workers are having none of it. Productivity remains high for work-at-home technology workers, who continue to prioritize work-life balance over corporate demands.
However, the pushback from management is coming in some unexpected ways, and I sense that a reversal of fortunes is in the making. After almost two years of senior managers and executives coming to work at mostly empty offices, many are starting to realize that they could just as easily shed real estate, and while they’re at it maybe some of those pesky, complaining workers. The prime example of this happened July when Ohio Health outsourced almost all of its information technology and revenue cycle operations to Accenture. Oddly enough, the stated reason for the changes wasn’t financial, but “better patient care”. The backlash from the staff at Ohio Health was predictably brutal, and it didn’t take long for workers to allege on Reddit that the wife of the CIO apparently works for Accenture. It seems that the phrase “out of sight, out of mind” might be working against some technology workers. I believe that the tension in labor economics is enough that if the economy continues its slide toward recession, a more severe downward trend in IT staff could materialize.
My advice for non-management healthcare IT workers at this stage is to not make yourself invisible. Make sure that you are keeping your skills sharp, looking for creative projects to work on, and be sensitive to changes in culture that might be happening in your organization.
Time To Pay The Piper
During the pandemic, health systems were forced to care for very sick patients at all costs. The Federal government did its part with PPP loans and other COVID-related assistance. The biggest hit to healthcare systems was increased nursing costs. Travelling consulting nurses could pick and choose when and where they worked, and frequently made double what they were paid at regular staff positions. Some nurses could even resign from their regular positions and and then rehire as a consultant at the same hospital at a much higher hourly rate. It was very easy to justify paying nurses as much as doctors when they were working long hours, risking their lives to treat COVID patients, and then got accosted outside the workplace by anti-vaccine extremists who thought it all was a hoax.
Eventually, health systems ran low on cash reserves or had to borrow to pay for the labor costs. And of course, inflation has hit every part of every business, which continues to today.
According to the America Hospital Association, expenses in 2022 are projected to increase by nearly $135 billion over 2021 levels. $86 billion of that expense is expected to be from labor costs.
Additionally, deferred care during the pandemic has resulted in higher acuity levels in many hospitals.
A Push Toward Outpatient Care
Just about everyone in healthcare knows that it’s better to prevent as many hospital visits as possible by providing comprehensive outpatient care. This effort has taken on renewed focus post-COVID to help address the care needs that were deferred for almost two years. On example is the for-profit Tenant Health group, who in 2021 acquired the outpatient surgery center group SurgCenter for $1.1 billion. This gives Tenant control over 86 surgery centers in the US, with room to grow. Many healthcare organizations are also opening more clinics that provide urgent care and primary care under the same roof. An example of this is Raleigh-based WakeMed, who over the past year has opened a number of primary/urgent locations dubbed “MyCare 365”.
Technology Projects Are Not Slowing Down
In spite of the challenges facing health systems and workers, the demand for technology services and data is as strong as ever. Operational leaders continue to look for ways to optimize workflows in clinics and hospitals, and are looking for ways to keep patients engaged with their providers. One example that I’ve noticed is the increased focus on catching patients who fall through the cracks when they don’t keep up with regular health maintenance tasks. EHR systems like Epic are very good at identifying for example, diabetic patients who have not had recent foot and eye exams. Using these types of clinical tools has been shown to head off serious health issues in patients with chronic conditions.
Another area of high demand in healthcare IT continues to be reporting needs. Most of my peers in hospital systems tell me that reporting analysts continue to be in high demand.
An Uneven Road For DoD Genesis Cerner Project
In 2015, the Department of Defense awarded a multi-year multi-Billion dollar EHR contract to Cerner and its partner Leidos. The project has pushed forward with the exception of a pause in 2021, and now has the system live in over 1,300 military facilities. In spite of the rollout, many providers complain that the system is causing actual harm to patients. There have also been a number of high-profile system outages. Adding to the scrutiny has been the acquisition of Cerner by Oracle, which closed in June 2022.
Another Big Win For Epic
In November, it was announced that New South Wales Health in Australia has chosen Epic to implement a single patient record system in its more than 220 hospitals. This will include replacing nine EHR platforms, five pathology systems, and a variety of other clinical systems.
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