HIMSS subject matter experts are looking ahead to the new year, drawing from their vast experience, networks and areas of expertise to provide predictions for the next 12 months and beyond in the healthcare ecosystem.
Read more 2022 Predictions:
"Will our current system incrementally tackle the problems COVID exacerbated? Will it quickly reinvent itself? Or will the rapidly evolving world outside of healthcare sweep away the old paradigms and replace them with something new?"
– Rob Havasy, Senior Director of Connected Health
In “The Sun Also Rises,” Bill Gorton asks Mike Campbell how he went bankrupt. “Two ways,” Mike famously replies: “Gradually and then suddenly.” People looking back at this pandemic period may one day say the same thing about the inflection point COVID-19 caused for the global healthcare system.
The fractures and problems we see emerging today may feel like a sudden shift due to an unprecedented challenge from a global pandemic. However, we arrived at the point where we now find ourselves through gradual evolution until the sudden emergence of COVID exacerbated existing deficiencies in our system.
What the post-COVID healthcare system will look like is anyone’s guess. Nevertheless, to predict how the healthcare system might respond to these problems, we might describe two possible paths based on biologic theories of evolution.
Most people remembering their high school exposure to Charles Darwin think of evolution as a gradual process by which one species slowly morphs into another species over long periods, known as phyletic gradualism in biology texts. A competing theory suggests that species sometimes change rapidly and become entirely new evolutionary branches in response to rapid environmental changes, a theory known as punctuated equilibrium.
For almost 30 years, social scientists and management professors have been using these biologic models to explain organizational development, going back to some foundational work published in management journals in the 1990s. So we might predict that the healthcare enterprise will respond to these newly identified problems either gradually or suddenly. Will our current system incrementally tackle the problems COVID exacerbated? Will it quickly reinvent itself? Or will the rapidly evolving world outside of healthcare sweep away the old paradigms and replace them with something new?
Keeping our focus on how information and technology will help or hinder this reform (we are HIMSS, after all), a few critical pressures can offer some guidance about how organizations may need to approach their response. These include:
Reality precludes healthcare from being swept away and replaced as a whole. Nevertheless, healthcare leaders must be aware that some parts of the current business are ripe for punctuated equilibrium types of evolution rather than the gradualism common to most healthcare endeavors.
The American primary and emergency care businesses come to mind as one of the first areas ripe for disruption by digitalization and whose equilibrium has been punctuated by COVID. Pressures from the growth of urgent care centers will combine with growth in direct-to-consumer and other telehealth services that could virtualize as much as $250 billion in current healthcare revenue to put unprecedented pressure on traditional practices to transform to match these new entrants rapidly. Psychiatry and substance use disorder treatment were already approaching 50 percent and 30 percent virtual delivery in 2021, a trend that is likely to continue.
Other healthcare specialties may have the time to adapt more gradually, but adapt they must. One area where patients will demand better from our system is communication during systemic stress like COVID has created. Two of the three pressures listed above combined to exacerbate this problem. I know at least four close friends hospitalized in different parts of the U.S. with COVID. Whether short-term in a patient room or long-term in an ICU, every one reports unbearable isolation during their hospital stay, and their families echo this complaint.
Our system cracked at the most basic task of informing patients and their loved ones what was happening. It is not that healthcare lacked the technology to communicate with patients sick with contagious pathogens. Indeed, previous disease outbreaks like Ebola taught us valuable lessons in employing technology in these situations. Early lockdowns in Europe spurred clinicians to contemplate better ways of communicating with families. Nevertheless, our system could not implement these practices when they were needed most. Here, overburdened and burned-out clinicians ran headlong into a patient population that expects information to flow freely and constantly through virtual channels as it does in other parts of our lives.
These two examples highlight the challenge that lies ahead for our systems and their leaders. Navigating the next few years may very well prove to be the challenge of professional life as they must balance stresses on their workforces and the rapidly evolving and expectations of our patients. Technology is often the solution to and the cause of many of these problems, as EHR deployments and their impact on clinician satisfaction demonstrate.
Knowing when gradualism is appropriate or when a punctuated equilibrium requires a rapid response will be essential for successful organizations that hope to survive.
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