By JEFF GOLDSMITH (2)
After a decade dominated by ObamaCare- its enactment in 2010, the fraught implementation, its near repeal in 2017, and the welter of inconclusive experiments with Medicare payment reform – healthcare in the 2020s is likely to be reshaped by technological and scientific advances, as well as continued political struggles over societal and family cost. We can expect major change in seven areas:
1. Rising Patient Safety Risks.
Two emerging patient safety risks will spike in seriousness during the 20s. One risk, that of drug resistant bacterial infections, boiled under the surface for more than two decades, with the rise of MRSA, Candida aureas, Clostridiodes difficele and more than a dozen other agents.
Nearly three million people were infected with these agents in 2017, and more than 48 thousand died. While hospital infection control has improved, and deaths from hospital infections fell during the 2010’s, antibiotic drug development has lagged, and the potential for one or more breakout infection risks is highly likely in the 2020s. The Economist published a chilling and entirely possible scenario in July, 2019.
The second major risk has resulted from the confluence of two information technology (IT) trends- the migration of health system clinical and financial operations to the Cloud and the 5G-enabled connectedness of medical devices and hospital infrastructure to the Internet, the so-called Internet of Things (IOT). These two linked migrations opened a gaping digital “back door” in hospitals and systems to “black hat” hackers.
The fall of 2019 saw two major health systems-Tuscaloosa-based DCH Health System (AL) and Hackensack Meridian (NJ) – succumb to ransomware attacks that paralyzed clinical operations for days before the system paid cyber-extortionists to stand down. However, there is a more threatening risk of mass patient casualty episodes in hospitals if hackers gain control over critical life support functions like respirators, infusion pumps, oxygen systems, HVAC and electrical systems.
The virtually unmanaged spread of connected devices and systems in hospitals is a significant threat to patient safety. Health systems and regulators will be playing catch up in both these patient safety domains during the 20s as the degree of patient risk becomes more clearly understood.