Guest Post: Healthcare 2025 Embracing Risk & Change

Editor’s note: this is a guest post by John McDaniel, VP of Innovation & Technology Solutions at The HCI Group and former executive at McKesson, Siemens, and Cerner. John is also a member of Goliath’s Healthcare IT Advisory Council, and is regularly a featured speaker at healthcare conferences like HIMSS and CHIME.

Cultures and Infrastructures

Innovations in healthcare information technology are enabling the creation of delivery models capable of improving care while reducing costs.

Organizations must start changing their cultures and infrastructures now if they are to benefit from these changes, and if they are to remain relevant and competitive in a not-too-distant future, in which the best care will be delivered at the least cost at the most appropriate site.

Healthcare is moving beyond the hospital and into the home as individuals assume control of their information and become more active in the process. Providers and payers are simultaneously seeking to leverage data to better predict potential medical problems and to improve preventive medicine and disease management for whole populations.

In Healthcare 2025, care will be provided largely in homes and ambulatory sites, often directed by health coaches and administered by individuals themselves. Best practices and treatments will emanate from comprehensive, real-time information that is assembled by aggregating data collected by providers, individuals and a myriad of other external sources ,including genetics, environment, employer, etc.

New levels of health and wellness are attainable if organizations embrace the inevitable risk that comes with change and invest in the technologies required. Though Healthcare 2025 is still theoretical, technology, organizational structures and delivery models must evolve if we are to fulfill the promise that a future centered upon eHealth, healthcare analytics, patient engagement and care coaching processes offers.


In Healthcare 2025, having more comprehensive and timely information that health IT improvements will provide will allow us to spot and address potential problems before they become debilitating—and costly—crises.

For example, overlaying the medical histories of an individual and their family with current trends and conditions based on knowledge formed by collecting and analyzing data will allow us to better prevent illnesses or to alleviate their severity. The electronic health record (EHR) of today will be less than 1 percent of the important data that we will want to collect and analyze real time by thousands of web apps working in tandem Information sources from socio-economic, environmental, and behavioral health determinants along with genomic and individual Microbiota data will play bigger roles in predictive outcomes than retrospective clinical data.

But today’s technology cannot support tomorrow’s needs. We must increase our capacity to capture and store data, as well as improve our abilities to secure it and to process it quickly. Affordable, efficient care requires high-quality information, which can only be derived by accurately aggregating data from disparate sources in real-time into expansive warehouses and analyzing it with appropriate tools like complex algorithms that can identify trends and potential disease states. Stronger encryption is also required, as evidenced by recent security breaches.

Even the most robust EHR systems do not yet aggregate all of the data that is relevant to an individual’s health and the potential to improve it through care. EHRs do not necessarily integrate with all of the applications within a single hospital, much less with the systems used by external providers or applications used by individuals, like wearables and personal health records. Interoperability is imperative if we are to realize the potential of using healthcare analytics to manage individuals’ health.

Organizational structures

In the future, medical centers will be reserved for the most complex of care. Care will be provided mostly in clinics and homes instead. A hospital will be the epicenter of a network of as many as 200 ambulatory care centers instead of a sprawling campus.

Pressured to reduce costs, organizations are already shifting care to less expensive facilities, such as ambulatory sites and urgent care clinics. Some prescient organizations have curtailed investments in hospitals altogether.

Shifting to such a distribution-of-care model will also bring an emphasis on telemedicine and digital health. An off-site physician or health coach could provide as much, if not more, personalized care to an individual in their home via a 15-minute conversation over a video system or teleprompter as they would in a hospital or clinic.

Organizations could fail if they do not adopt distribution-of-care models that provide care at the least expensive site because payers are increasingly shifting to value-based reimbursement. The proliferation of affordable care organizations (ACOs) is indicative of the extent to which organizations will go to control costs by keeping individuals out of hospitals without compromising care.

Decentralizing care will require organizations to accept the risk that is inherent in building distribution networks and investing in emerging technologies for home-based care. They must also adopt entrepreneurial cultures in which leaders emphasize innovation and risk-taking.


The primary physician’s role will change dramatically in Healthcare 2025. Primary care physicians (PCPs) will be in scarce supply but still in demand. They will interact with patients more through the supercomputer in their pocket than in ambulatory settings; and the home will be a virtual care center, with extensive, non-invasive monitoring and collaboration. The operational processes for PCPs will flip upside down and they will coordinate care for populations with many new care resources (like health coaches) available to the individual patient. Information on symptoms will be so abundant and data-based diagnoses so accurate that individuals will take accountability for their health and care for themselves or seek the support of health coaches.

Seniors are already demanding more access to home-based care, according to a mid-2014 survey of 10,730 adults across 10 countries by Accenture, an international consulting firm.

“Just as seniors are turning to digital tools for banking, shopping, entertainment and communications, they also expect to handle certain aspects of their healthcare services online,” said Kaveh Safavi M.D., global managing director of Accenture’s health business, in announcing the results. “What this means for healthcare systems is that they need to consider the role that digital technology can play in making healthcare more convenient for patients of all ages at every touch point.”

Seniors were most interested in self-care, wearables, online communities, navigating healthcare and health record management. Researchers also found that most seniors want access to healthcare technology, such as virtual physician consultations (20 percent), but less than a third of healthcare providers offer such capabilities.

Medical students must be trained with the expectations that they may never touch a patient. Rather, they will view a bruise or mole, for example, on a high-resolution screen and deliver care based on research data and treatment protocols.

Though they tend to resist change, physicians must adopt home-based care technologies, knowing that they will likely be caring mostly for patients who are critically ill, as health coaches and individuals focus on preventive and routine care. If general wellness improves, the sick will require the most advanced care possible.

Healthcare 2025 offers the potential to provide the best care for the least cost at the most appropriate site. But fulfilling that promise will require organizations to find the means to invest in tomorrow’s technologies while addressing today’s challenges of changes in reimbursements. They must also cultivate a culture of change as they move to a home-based delivery network and accept the accompanying risk.

These changes are crucial if we are going to again become the world’s healthcare leader in both cost and quality. This may take more than 10 years, but if we don’t get started, it’s never going to happen.