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2014 was quite a year. Thinking back to December 2013, I cannot believe that so much has happened. Let’s take a look at the major HIT events that shaped 2014 and what they portend for 2015

Affordable Care Act – despite challenges with healthcare.gov and state health insurance exchanges, the notion of moving forward with an open insurance marketplace and accountable care got traction. The IT needed to meet the needs of the patient centered medical home, the ACO, and Care Management spawned a new type of software – the care management medical record. Not many products exist and none are mature, but HIMSS was filled with promises of workflow engines, population health, and protocol driven care management tools. 2014 made it clear that the EHR is just a starting point and over time there will be a new generation of tools used by clinicians and non-clinician extenders to keep people healthy, not just record their encounters when they’re sick. Hopefully we’ll see maturing products in 2015.

Meaningful Use/Standards – 2014 was really the first year we could take a look back at the Meaningful Use program. I think we can conclude that Meaningful Use Stage 1 was generally perceived as a positive step, laying the foundation for EHR adoption by hospitals and professionals. Stage 2 was aspirational and a few of the provisions – Direct-based summary exchange and patient view/download/transmit required an ecosystem that does not yet exist. The goals were good but the standards were not yet mature based on the framework created by the Standards Committee. At this point the only way out of the readiness/adoption challenge is to allow more time for the ecosystems to develop by changing the attestation period in 2015 to 90 days. Although Direct/CCDA was a reasonable starting point for 2014, the future belongs to FHIR/REST/OAuth, which are going to be much easier to implement. We need to be careful not to incorporate FHIR into any regulatory program until it has achieved an objective level of maturity/adoption

HIPAA Omnibus Rule – 2014 saw increased federal and state enforcement of the HIPAA Omnibus Rule with record fines for security breaches at a time when the nature of security attacks became increasingly sophisticated – witness the Home Depot, JP Morgan, and Target breaches as well as denial of service attacks on numerous healthcare and non-healthcare organizations. Healthcare as an industry directed substantial resources toward improving the security protections of their networks in 2014. It will be interesting to look back at this era in several years and ask the question if million dollar fines for stolen laptops/smartphones was a helpful policy or if other enablers such as the evolution of security technologies and culture change were more effective.

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