How My 20 Predictions for 2016 Turned Out

Here’s what I predicted on December 28, 2015 and how right or wrong I turned out to be.

Cooled-off funding markets will leave unprofitable startups struggling, IPOs will be postponed, but Health Catalyst will go public.

It’s hard to say whether my first two predictions were correct, but I was wrong about Health Catalyst – they weren’t as anxious or as prepared to go public as I expected. I was right in predicting a poor 2016 IPO market as successful companies in all sectors seemed to prefer increasing their private valuations instead of going public. SEC filings suggest that the trend will continue into 2017. I’m guessing many startups are indeed struggling, mostly because of their own shortcomings. Without the Health Catalyst miss I would have given myself a solid checkmark.

Healthcare costs will be a contentious point in the presidential election, provider mergers will continue, and at least one presidential candidate will timidly suggest cost controls.

Seems right to me. Hillary Clinton touched lightly on cost controls and certainly the cost and premium aspects of the Affordable Care Act became a campaign issue.

Consumers will lose interest in fitness trackers.

I’ll give myself a check even though “lose interest” may or may not be broadly accurate (perhaps, to quote Spinal Tap manager Ian Faith, their appeal is just becoming more selective.) The Apple Watch flopped and some fitness tracker companies sold out or shut down.

The CEOs of Epic, Cerner, and Meditech will start to pull back from day-to-day company involvement as they approach retirement.

This is a toss-up. Epic’s Judy Faulkner is actively involved but talking more about a succession plan because people keep bugging her about it, Cerner’s Neal Patterson was sidelined temporarily by cancer but plans to come back in a few weeks, and I don’t really know about Meditech’s Howard Messing but he seems to be active. I’ll compromise by giving myself an X despite being “directionally correct.” It’s not like they’re just going to disappear while still holding the title, so only Epic and Meditech insiders would know how actively involved their executives are, unlike the publicly traded Cerner who has to be more transparent about what’s going on and Neal has made it clear he’s phasing himself out. In any case, all three companies are likely be replacing their longstanding top executive (and founder in two of those cases) within a few years, introducing the possibility of change.

ONC and Meaningful Use will become increasingly less relevant and more contested as ONC replaces Karen DeSalvo with a new National Coordinator who lacks her experience and bipartisan support.

Meaningful Use was replaced with MACRA while ONC’s influence is debatable – 21st Century Cures gives it more scope. I could score this one either way. Certainly the “more contested” part is true as healthcare member organizations constantly issued press releases and letters complaining about everything MU-related.

Several mid-tier consulting firms will be downsized or acquired as their implementation and advisory business dries up.

I should know better than to make predictions that are hard to quantify. Some companies certainly did cut back or sell out although obviously their reasons for doing so weren’t publicly announced. Like a vendor’s crafty RFP respondent, since I can’t definitively say “no” I’ll go with “yes” since that’s to my advantage.

At least three big health systems will be breached in exposing the information of 100,000 or more patients. The government and organizations like HIMSS will try to help providers share information.

The 100,000-patient number seemed huge a year ago, but breaches of that size are unfortunately not uncommon these days.

The VA will announce plans to eventually replace VistA with a commercial product.

The VA hasn’t specifically said, “We’re dumping VistA,” but their RFIs and conceptual descriptions – not to mention Congressional pressure — clearly suggest such a direction.

At least one customer each from Epic and Cerner will switch to the other’s product to get a better deal on maintenance fees. Epic will expand its hosting service to better compete with Cerner.

I’ve given myself a check on some debatable predictions, so I’ll assign myself an X here even though hospitals have certainly switched both ways between Epic and Cerner and Epic is indeed expanding its hosting services. Most of the swaps were probably related to acquisitions and Soarian customers who were pushed into RFPs that sometimes went Epic’s way, so I don’t have proof that anyone replaced a product just because its ongoing cost was too high.

The terms “telemedicine” and “mobile health” will become antiquated as they simply become another accepted aspect of care delivery. “Information blocking” will also fade away as a hot term when everybody realizes the concept involves speculation without proof.

The terms “mobile health” and “mHealth” are getting long in the tooth and irrelevant since everything is mobile to some degree, but “telemedicine” lives on and “information blocking” is still being thrown around indiscriminately to describe unproven shady behavior by EHR vendors and providers. I was quite wrong in thinking the accusations about information blocking would fizzle due to lack of evidence proving intention. I still haven’t seen the evidence, but the accusations are still flying but with no change in the status quo for patients.

IBM Watson will continue to produce mostly hype. No convincing studies will demonstrate its value, but newly announced, high-profile partnerships will keep IBM shareholders hopeful.

I grade it as all hype so far.

The dark horse publicly traded company best positioned to succeed in health IT and related areas without a lot of fanfare will be Premier.

I didn’t see much of a health IT splash from Premier and its shares are down on the year.

Athenahealth won’t get much inpatient traction with the former RazorInsights and BIDMC’s WebOMR.

It seems logical in hindsight that Athena would need more than a year to become a significant inpatient player if indeed it ever does, but a lot of post-acquisition hype was flying a year ago and this prediction was bolder than it seems now. ATHN share price has dropped 33 percent in 2016.

McKesson will consider packaging and divesting its many health IT offerings as non-core business.

That’s exactly what is happening as the company prepares to create a new, publicly traded company with Change Healthcare and is shopping its Enterprise (Paragon) business around without any takers so far.

Epic will not join CommonWell, but will leapfrog its competitors in offering APIs and slowly building a carefully controlled third-party ecosystem.

I’ll give myself a check since Epic didn’t join CommonWell, but I’m not so sure that Epic has leapfrogged Cerner in offering APIs.

Software for population health management and analytics will enter Gartner’s Trough of Disillusionment as providers implement it poorly and without a commitment to truly change their profitable business models.

I wasn’t speaking literally about Gartner’s hype cycle and I can’t say if population health management software is on it since I don’t subscribe to Gartner, but I think it’s generally true that providers are struggling to wean themselves off fee-for-service business and haven’t done a whole lot with the many software and analytics products that are being sold. You could make a convincing case that I’m wrong, however.

Cerner and Epic will continue to poach the business of Meditech, CPSI, and best-of-breed vendors whose small-hospital customer bases are being acquired by larger health systems.

This is true, although it wasn’t really a bold prediction since the trend was obvious even a year ago.

“Big data” will support a few meaningful clinical studies performed using only aggregated electronic information, but “little data” will provide more impressive but less-publicized results as doctors design the treatments of individual patients by reviewing the outcomes of similar patients.

I’ve given myself some checks for predictions that were partially correct, so I’ll balance it with an X here even though I still believe in the “little data” concept. Certainly some big data-driven studies have turned up some interesting and useful clinical information, so in that regard it probably contributed more than I expected. I could have given myself credit for foreseeing the precision medicine movement that was announced a few weeks after my prediction, but I’m undeserving — that’s really based more on genetic information instead of the “patients like this one” small-scale aggregate data analysis by an individual provider.

Consumer healthcare apps will continue to be plagued by inconsistent use, questionable design, and an unremarkable impact on health or outcomes.

This is another accurate but not especially bold prediction. FDA crackdowns were obviously coming and app vendors rarely bothered to prove that their products influenced patient outcomes.

CHIME and AMIA will follow the HIMSS model of increasing conference attendance and revenue by catering to high-paying vendors willing to buy access to prospects.

I’ll give myself an X since I’m not involved with either organization and thus can’t say how much influence vendors are able to buy. I haven’t heard of any egregious behavior by either organization.