Forecasts of future trends go along with a new year as reliably as champagne and the ball drop. Medical Economics spoke with three leading health information technology (HIT) experts to see what HIT trends they expect will matter the most in 2018. Here are the trends they foresee.
 More care taking place outside of traditional times and places:
Doctors used to provide patients with care when patients were in front of them.
“Now the whole issue of place and time is shifting and so is the whole concept of patient-to-doctor communication,” says Jonathan Weiner, DrPH, referring to the various ways that patients and doctors can exchange information now that include electronic means such as online portal or the use of apps that offer visual as well as auditory data. Weiner is a professor at the Johns Hopkins Bloomberg School of Public Health and director of its Center for Population Health IT.
Pat Wise, RN, the vice president of healthcare information systems for the Healthcare Information and Management Systems Society (HIMSS), says that electronic means of connecting can substantively improve patient care as well as convenience. She described a patient who, during the Ebola crisis, returned from an overseas with a fever and a strange rash on his thorax.
“Seeing the rash, his doctor jumped back five feet and said ‘Where have you been?’” Then, observing that the patient had reasonable energy and seemed to be all right, the doctor told him to communicate daily about how he felt and any changes for the next seven days, via the practice’s patient portal. “That would not have happened a few years ago,” says Pat. She foresees such more-frequent, odd-hours communication happening more and more, improving patient care.
 EHRs supporting today’s greater focus on population health measures.
Current policy measures including the Affordable Care Act are restructuring financial incentives in medicine to promote a focus on population health, the health of large groups of people, and prevention. Accordingly, health data systems are going to be designed to support such efforts on the part of healthcare systems to proactively help people stay well, Weiner says. “If data can allow an organization to take action to help people stay healthy and the systems are not taking those kinds of actions, they are potentially causing harm through nonaction,” he says.
 Mobile health gaining in importance.
More and more primary care practices will be collaborating with their patients who are wearing Fitbits, glucose monitors and the like, and relaying information to their physicians.
“This trend is a big one, though it’s implications for patient care are less clear,” says Weiner. Weiner says that good data on the actual impact of this kind of information exchange is lacking.
 An emphasis on outcomes.
Increasingly compensation models throughout medicine will hold clinicians accountable for outcomes, rather than paying for process as was the old approach.
“This trend will increase and it’s in everyone’s best interests,” says Charles Jaffee, MD, PhD, the chief executive officer of Health Level Seven International (HL7). HL7, a nonprofit organization, works on standards for the integration, sharing, and retrieval of electronic health data.
Wise discusses the strong motivation that hospital systems, which increasingly own primary care practices, have to avoid 30-day penalties for readmissions. She cites the example of an elderly patient being discharged from the hospital with a prescription to fill, which he does not fill because he considers its price too high.
“The discharging physician at the hospital assumes the man is going to take the drug but he’s not,” says Wise. “Close association with that patient’s primary care provider could change that outcome.”
 Increasing reliance on clinical decision support tools.
Jaffee often begins his talks by citing the statistic that about 1,000 patients die each day in the US due to medical errors, errors which are the nation’s number three cause of death. “Having information where you need it when you need it will go a long way to addressing that,” he says. “Clinical decision support will become more and more critical in assessing that information.” Weiner also foresees clinical decision support tools becoming increasingly important although he acknowledges that they often annoy doctors due to what he calls the nag factor. “Doctors do not like the computer telling them what to do, yet the computer is often helping the doctors,” says Weiner “The computer has more information at hand than the doctor does so finding ways to work with clinical decision support systems will be increasingly important.”
 Progress in improving patient identification:
“We are the only country in the western world that doesn’t have a medical identification number. This is a really critical issue in Health IT,” says Jaffee, adding that clearly there are both technical and political aspects to this issue. The lack of such unique identifiers for patients leads to medical errors when data for, say, one Maria Gonzalez is confused with data for one of many other Maria Gonzalezes in the same medical system. More and more healthcare systems, including their primary care practices, are now using optical scanners and fingerprints as identifiers, and that trend is likely to grow, says Wise.
 Improved data aggregation.
Progress on this front will allow physicians to see all the important data about a patient quickly and easily, without special effort. Jaffee compares what’s coming in medicine to the application program interface (API) used by most airlines. In the travel realm, the API makes it possible for a consumer who wants to fly from Topeka to Toronto to log onto a site such as Expedia and quickly see all the flights offered by nearly all carriers.
With improvements in data aggregation, a physician will be able to search for a patient’s blood tests, done in one location, their X-rays done in another, and the notes from an office visit conducted in yet a third location. “When a physician wants to see all the information on a certain patient,” says Jaffee, “she looks that person up and – lo and behold—there is all their data.”