5 Healthcare IT Trends to Watch in 2017

The buzz surrounding blockchain hit a fever
pitch in 2016, but it wasn’t supported by much
in the way of real world examples. That will
change in 2017, as academic and theoretical
discussions give way to production-ready
applications. In our regular interactions with
innovators from healthcare systems,
healthcare device and wearable companies, to
finance and professional services firms, we’re
seeing that the groundwork for healthcare on
the blockchain has already begun.
As context, blockchain is a highly secure
network coupled with a distributed database,
also known as a distributed ledger. This ledger
is used to record the network's transactions
with reliable time stamps and standardized
rules for all participants on the network to
verify and access information. Why will the
shift from talk to action take place this year?
1. Healthcare on the Blockchain Moves from Theory to Practice
“There's one more lesson to draw from
the early days of the internet. If you
had understood in 1995 the
opportunities and threats it would
ultimately present to your company or
industry, what would you have done
differently—to become the disrupter
rather than the disrupted? That is
where we are with blockchain today.”
- Ginni Rometty, President and CIO of IBM
The shift to value-based care isn't just a shift
in economics; it is also a shift in the kinds of
technologies required to deliver those
economics. Costs are increasingly the
responsibility of the consumer, as well as the
providers with whom they share financial
risk. This shift in financial responsibility
requires new patient access models with
real-time, up-front accumulator (deductible)
adjudication and payment calculations that
the current infrastructure isn't designed to
support.
In addition, the move to value-based care
includes a move to reimbursement based on
"episodes of care" which necessitate
changes to billing, data collection, and
reimbursement rules, along with the
technologies that support those models.
Further, a typical episode of care, for
example, a Type 2 diabetic's exam, will likely
have many services that occur outside the
hospital setting requiring technologies that
can record all relevant transactions, from
device data to nutritionists, and attach them
to the correct episode and patient, regardless
of whether or not the transaction is recorded
in a centralized EHR.
Changes to Value-Based Economics
Necessitate Changes in Technologies
In addition, to efficiently deliver patient care,
this diverse network must now exchange data
in real time, around the clock. Add to that the
explosion in device and user-generated data
that can be analyzed for relevant information
and we have completely surpassed what
legacy manual processes and 1990s era
health IT architecture was designed to handle.
Insert blockchain.
Many of the technologies that make up
blockchain have existed for some time and
part of blockchain's value is in organizing
those technologies into a single system to
address the fundamental business problems
and processes in healthcare and other
industries. Blockchain offers a distributed,
secure system that enables a diverse network
of healthcare providers, including payers,
providers, device makers, and acute care
facilities to work together, seamlessly, with
the patient at the center of the healthcare
experience for the first time.
“We believe that blockchain technology
is a powerful tool for creating global
prosperity.”
- Alex Tapscott, author of Blockchain Revolution
2

Realizing the immense value from a real-time,
distributed network like blockchain requires a
new class of artificially intelligent (AI) agents,
called “smart contracts.” These agents can
orchestrate automated business, analytical,
and contractual processes on the blockchain
at a scale only recently made possible through
advances in processing power and efficiency.
Participants in a blockchain network can
encode and host their most common business
processes and contracts as smart contracts.
Whether for a business associate agreement
(BAA) or a patient on-boarding process, the
blockchain acts as a safe, auditable, always-
on coordination mechanism for executing
smart contracts.
To date, interoperability has been addressed
as an afterthought between legacy EMRs,
since they were never designed to be truly
interoperable. This approach won't scale in an
always-on world. And it certainly won't
connect to the machine learning and artificial
intelligence technologies PokitDok and others
are applying to deliver value-based care.
Blockchain offers interoperability, support for
current and emerging data standards, and
strong encryption, all baked into a
transactional architecture. It is accessible to
ALL healthcare stakeholders; from physicians
and their EMRs, to sensors and devices,
putting the patient at the center of care.
“....Soon billions of smart things in the
physical world will be sensing,
responding, communicating, buying
their own electricity, and sharing
important data, doing everything from
protecting our environment to
managing our health. This Internet of
Everything needs a Ledger of
Everything.”
- Alex Tapscott, author of Blockchain Revolution
As an example, PokitDok now runs real-time
eligibility checks through our APIs on
DokChain, for a fully transparent, private, and
encrypted transaction that compliant
healthcare businesses require today. While
this is an undeniable first for the business of
health, in order to have a fully operational
blockchain solution, many more parties need
to be involved. This is only the beginning.
3
Blockchain Delivers Interoperability
and Automation to the Business
of Health

4
- Ted Tanner, Co-Founder, CTO of PokitDok
“Blockchain will be the new
CPU, and it will be everywhere,
running all the time.”

Powerful influencers, like cardiologist and
author, Eric Topol; blockchain expert and
author, Alex Tapscott; President and CEO of
Humana, Bruce Broussard; President and CEO
of IBM, Ginni Rometty; and PokitDok CTO, Ted
Tanner, predict that blockchain will become
the latest healthcare technology innovation;
the new CPU, running everywhere, all the time.
For example, when a patient has a simple
procedure, like an MRI, the blockchain can
review, verify, and authorize information and
process the claim in real-time for immediate
reimbursement to the provider or payment by
the patient, if they haven't met their
deductible.
“It’s unreasonable to consider an
overnight technological transition.
Blockchain supports an evolution.”
Big Players are Involved and Invested
Things move slowly in healthcare for a
reason. It's important to get technology, and
the data and processes it affects, right and
it's unreasonable to consider an overnight
technological transition. Blockchain, however,
supports a phased business model evolution
— one that works fluidly with legacy and new
systems alike.
Blockchain Supports a Phased
Approach to Healthcare’s Evolving
Business Model
“Back-and-forth haggling with the health plan
about what was paid, why it was paid or
whether it should have been paid [will be a
thing of the past]. With transparency and
automation, greater efficiencies will lead to
lower administration costs, faster claims and
less money wasted," noted Humana’s
Broussard. Topol notes that “the trust
machine —blockchain —[will finally] enable
each individual to own their medical
information,” which he considers to be a ‘civil
right.’
Other parties actively exploring blockchain
implementations include Dartmouth-
Hitchcock, Microsoft, and Cigna, all of which
are current members of the Blockchain
Alliance PokitDok is spearheading on
DokChain, it's implementation of blockchain
for healthcare.
By taking advantage of Blockchain’s
advanced security and encryption, healthcare
can lay the technological groundwork to
support a future, fully consumer-centered
experience without having to immediately
overhaul costly IT investments and
operations. This flexibility is invaluable.
To realize the full potential of healthcare on
the blockchain in 2017, major players need to
get involved and actively lay their future IT
framework while enacting live pilot programs.
IBM’s healthcare blockchain endeavor,
“Bluemix Garage,” and Philips’ Blockchain Lab
are excellent examples of just that. Further,
PokitDok’s laser focus on automating
business processes through smart contracts
with our partners in the DokChain Alliance will
lead us toward realizing a blockchain
powered system, one that allows healthcare
consumers to experience their healthcare the
way they want.
5

Healthcare is complicated and heavily
regulated, that much we know. We also know
it's possible for technology to flip the
healthcare business model to which we've
grown accustomed in favor of a transparent,
patient driven, e-commerce experience.
In 2017, after years of testing and prediction,
e-commerce for healthcare will finally take
root and make its way to the mainstream.
2. Demand Drives Adoption of Healthcare E-commerce
• 71% of millennials would be interested in
using a mobile app to actively manage
their well-being, review health records,
and schedule appointments.
• 63% of millennials would be interested in
providing their health data from Wi-Fi /
wearable devices to their doctor so they
can personally monitor their well-being.
• 60% are interested in using telehealth
options (e.g. video chat with doctor) as
an alternative to in-person office visits.
Consumers are Clamoring for It
“Healthcare Consumerism is about
transforming an employer’s health
benefit plan into one that puts economic
purchasing power—and decision-
making—in the hands of participants.”
- The Institute of Healthcare Consumerism (IHC)
Frustration is nothing new for the business of
health, but we’ve reached the tipping point.
Millennial changemakers demand a
fundamental and radical shift for healthcare
to match their consumer-driven expectations,
and there’s no going back. In a world governed
by data, the following statistics, as reported
by TripleTree, represent millennial sentiment
about their healthcare experiences and health
data:
Millennials want to engage in their healthcare
as well-educated consumers — and not
merely as passive patients. As millennials
reach milestones in their lives (e.g. financial
independence, marriage, children, aging
parents), they will interact with the U.S.
healthcare system in more meaningful ways.
The quicker healthcare companies respond to
these preferences and the power this group
holds to shape future delivery and business
models, the more successful they will be. The
impact of this change will be profound -
driving the innovation agenda for years to
come.
Walled gardens, long the standard in
healthcare IT, are beginning to crumble in the
face of demand for transparent and seamless
consumer experiences. Application
programming interfaces (APIs) are fast
becoming the new standard in healthcare
technology to connect legacy infrastructure
and disparate data. Payers and providers are
finally communicating electronically,
exchanging data via APIs, and using that
information to power transparency and
consumer health. Leaders in this mission like
CommonWell, PokitDok, the IHC, and more are
banding together to move from talking about
the possibilities of consumer-driven health to
delivering realities.
The Technology Exists
6

Lisa Maki, CEO of PokitDok, envisions a day, in
the not so distant future, where people will
shop for their healthcare services much like
they shop on Amazon. “In fact, that was our
vision when we founded PokitDok five years
ago,” she said.
“Imagine the cost saving potential, the impact
on the financial health of the nation, the day to
day lives of healthcare professionals, and of
course the relationship consumers have with
their health, if we had access to simple things
like eligibility, pricing, online scheduling,
personal health records, etc. The potential is
limitless.”
Health systems and payers alike are making
price transparency and convenient, online
patient access a top priority. Aside from
telehealth companies like Doctor on Demand
and Teladoc owned HealthiestYou, where an
e-commerce exchange is native to their
business model, big players like TransUnion,
Dignity Health, and UCSF are speaking
publicly about their initiatives to power digital
patient access experiences.
PokitDok CEO, Lisa Maki, directly discussed
this topic on the 2016 Health 2.0 stage with
Michael Seagraves, Sr. Director, Digital
Transformation, Dignity Health; Pamela
Hudson, COO of Digital Health, UCSF; and
Jonathan Wiik, Principal, Revenue Cycle
Management, TransUnion. Their message to
the standing room only crowd was
unanimous: e-commerce is happening in
healthcare.
Who Is Actually Doing It?
“Consumers increasingly demand easier
and more affordable access to care and
greater flexibility in payment options.”
- Advisory Board
Ascension (the largest not-for-profit hospital
system in the US), Cigna, and others,
including St. Clair Hospital who is using
PokitDok's out of pocket price calculator,
have transparent patient access sites
underway and live. Ascension's VP of New
Virtual Markets and Incubation demoed their
PokitDok-powered patient access site on
stage at the recent AWS re:Invent conference
telling attendees that real-time e-commerce
is now available for healthcare. Now is the
time to lay the framework, test, and plan
larger rollouts to prepare large and small
systems to support patient driven
experiences - where the system focuses less
on high cost administration and more on
delivering the best care possible.
7

The adoption of telehealth services has
continued at a rapid pace over the past few
years, but 2017 should be the year that
telehealth “crosses the chasm,” moving from a
passionate base of early adopters and
expanding to an early majority of users.
As wait times at emergency rooms increase —
the CDC’s National Center for Health Statistics
reports that most ER wait times last nearly an
hour — and the cost of an expensive ER visit
more often falls on a consumer who hasn't
met their deductible, the appeal for the
convenience and affordability of telehealth
will grow stronger. With more states requiring
private insurers to cover telehealth
consultations, look to employers and payers
to strengthen outreach programs that
promote telehealth use. Other factors driving
increased telehealth use will include:
3. Telehealth Finally Goes Mainstream
Intensified Focus on Value-Based,
Patient-Centered Care
“The number of Americans receiving
virtual medical care is forecast to
double, from 15 million in 2016 to 30
million in 2017.”
- American Telemedicine Association
Financial risk for healthcare continues to shift
from payers and employers to providers and
patients, driven by untenable cost increases,
an aging population beset with chronic
conditions, and legislative changes. This has
driven the move from fee-for-service business
to value-based business models.
To make those value-based models pay out,
providers in particular will need to
increasingly leverage technologies like
telehealth that decrease the number of
unnecessary ER visits and the cost of chronic
care management. With telehealth, providers
can directly diagnose, monitor, and treat
patients remotely through real-time
communications delivered over digital
devices; reducing per capita costs and
improving patient satisfaction in the process.
and physicians eclipsed in-person visits for
the first time, with over 110 million
consultations conducted using technology like
smart phones, tablets, kiosks, and video
conferencing.
This on-demand, always-on healthcare saves
patients the hassle of unnecessary or
inconvenient trips to a hospital and enables
Kaiser to reduce costly trips to the ER and
provide better care. As a bellwether
healthcare organization, Kaiser will no doubt
influence other hospitals and health systems
to seriously consider launching or expanding
telehealth initiatives in the coming year.
In addition to reducing initial in-person
hospital visits, telehealth can also vastly
improve communications after a patient is
discharged. For instance, telehealth services
can save them a return trip to the ER by
securely connecting them to their provider
through a video call. Telehealth also holds
promise in encouraging preventative care that
can avert the onset of ill health.
“Almost 75% of large companies offered
telehealth doctor visits as part of their
health packages in 2016, a jump of 48%
over 2016.”
- American Telemedicine Association
Some innovative healthcare organizations are
already reaping the benefits of telehealth.
Kaiser CEO, Bernard Tyson recently reported
that virtual interactions between its patients
8

Earlier incarnations of telehealth systems
stumbled out of the gates because they were
often based on expensive, rigid, proprietary
hardware that didn’t integrate well with
electronic health records (EHRs). That’s
changing rapidly, as the telehealth industry
enacts more standards and offers its
customers less costly, off-the-shelf hardware
options.
Telehealth vendors are also making great
strides in integrating across a range of
different electronic health record providers.
This is increasingly important since EHRs
operate as the hub for a whole slew of
clinical and transactional functions related
to patient care and reimbursement.
Integrating with existing physician workflows
and enabling data to flow freely between
different EHRs will speed the path to further
adoption in 2017.
There is also change afoot on the software
side, as vendors increasingly embrace open
architectures that enable creation of more
customized solutions that can be adapted to
new business models. This, in addition to
improved interoperability, will go a long way
to removing barriers that have impeded
telehealth’s momentum in the past.
Improved Integration and Flexibility
Technology is putting consumers in charge
of virtually every aspect of their lives.
Healthcare will be no different, and
telehealth will be in the vanguard of putting
patients in control.
But while convenience has been a hallmark
of telemedicine — as any parent with a sick
child in the middle of the night can attest —
it hasn’t offered consumers much in the way
of control. To date, initiating a telemedicine
consultation has connected a consumer to a
random caregiver, which doesn’t instill a lot
of trust and confidence in patients.
That began to change this past May,
however, when American Well announced the
launch of an online marketplace that allows
telehealth customers to select from a menu
of doctors rather than be subject to the luck
of the draw.
Other telehealth providers are sure to follow
suit in 2017, especially as healthcare
systems strive to burnish their brand, keep
more patients in-network, and improve
patient satisfaction and HCAHPS scores.
To fully realize their promise in 2017,
telehealth vendors will still need to improve
their integration with EHRs and clinical
workflows, improve what can still be an
onerous reimbursement process, and
demonstrate an ROI for providers. PokitDok
can help with all three, which is why major
telehealth platform providers like American
Well, Doctor on Demand, MDLive, Teladoc
and Zipnosis all rely on us.
Consumerism, Choice, and Control
9

In the wake of the 2016 U.S. presidential
election, Americans anxiously await
President-elect Trump’s cabinet appointments
and what they portend for the future of
healthcare. While it is impossible to know with
clarity the magnitude of the changes to come,
it is evident that change is on its way. And
while that change will rock the healthcare
boat, we don't believe that it will tip the boat
over.
4. The Trump Presidency Will Rock the Healthcare Boat
The ACA Will See Modifications
Rather than Total Repeal
“Dismantling the entire structure of the
ACA, ‘root and branch,’ would be difficult.”
- Beth Halpern, Partner at Hogan Lovel, as
interviewed by Fierce Healthcare
While immediate repeal of the Affordable Care
Act (ACA) was Donald Trump's campaign
promise, that is not likely to happen.
For one, a total repeal of the ACA would
undoubtedly face a Senate filibuster, where
Democrats currently have enough votes to
stop it. In addition, there are aspects of the
ACA that have appeal across both political
parties. The provision that prevents insurance
companies from denying coverage because of
preexisting conditions has bipartisan support,
as does the provision that allows parents to
insure their children until age 26.
Moreover, there are practical reasons that
repeal will not happen overnight. It took
many years for providers, payers, and others
throughout the healthcare ecosystem to
implement ACA and Meaningful Use
requirements; enacting any material changes
and unwinding what has already been
implemented will require significant time as
well.
While some features of the ACA will remain
unscathed in the near term, others are more
likely to be axed, especially now that
Representative Tom Price — an outspoken
critic of the ACA — has been selected to lead
the Department of Health and Human
Services. Politically ‘safe’ items, like the
Cadillac tax or a reduction in subsidies, will
be likely first targets for elimination. Other,
more complex issues, like universal
coverage, will need to be debated, revised,
and evolved, especially regarding the 20
million lives affected.
Funding for expansion of Medicaid may also
be ripe for repeal. This will likely reduce the
number of covered individuals and result in
still higher levels of bad debt that providers
must write off. Expect to see more hospitals
and clinics that seek to capture the cost of
care upfront at the time of service, possibly
in return for a discounted rate to the patient
for paying in full.
“... Some believe Republicans and a
Trump administration will selectively
choose parts of the ACA to repeal ...
despite campaign promises to
completely ‘repeal and replace’ it.”
- Modern Healthcare
10

Healthcare has been undergoing a
fundamental shift from the traditional fee-for-
service model to more of a value-based
model, brought about by unsustainable costs
that have not resulted in better health
outcomes. This shift is likely to continue in
one form or another under the Trump
administration.
After all, the underlying challenges that have
fueled the move to value-based care still
remain. The U.S. population continues to age,
and struggles with an obesity epidemic and an
increase in the number of people with co-
occurring chronic conditions. These factors
have resulted in increased costs for payers
and employers who have, in turn, shifted the
risk to providers and patients in the form of
high deductible plans. All of which is pushing
everybody to accept more openness,
accountability, and transparency. None of
these macro trends is likely to change in the
near term.
The Shift to Value-based Care is
Here to Stay
Even providers seem to prefer risk-based or
performance-based payment models rather
than deal with continuing reductions in fee-
for-service reimbursements. At least with
these new payment models there is a sense
among providers that they can control their
own destiny.
Beyond the economic and medical
motivations, there are also political reasons
to believe that the move to value-based
pricing will continue. To date, there has been
bipartisan support for initiatives that strive
to reduce the cost of care and link costs to
improved health outcomes — MACRA was
passed in Congress with 91% support — and
there is no reason to believe that this will
change substantially.
“The concept of value in healthcare has
been around a long time…. [Some things
like the importance of transparency and
data to patients, providers and
competition] are more Republican than
Democrat, frankly.”
- Helen Darling, CEO National Quality Forum
11
High Deductible Health Plans
Should Flourish
High deductible health plans (HDHPs) have
continued to gain favor with employers as a
way to mitigate the spiraling cost of
healthcare premiums. Consumers have also
begun to select them in growing numbers,
albeit often as a cash flow tactic rather than
an enthusiastic endorsement. These plans
should become even more popular under the
next administration, especially those that are
tied to health savings accounts (HSAs).

The Trump healthcare platform has even
floated the notion of allowing those who
contribute to an HSA to pass on the
accumulated value to their successors.
Currently, HSA funds can only be passed on
to a spouse without incurring tax
implications. In language pulled directly
from the Trump website, it states
“Contributions into HSAs should be tax-free
and should be allowed to accumulate. These
accounts would become part of the estate of
the individual and could be passed on to
heirs without fear of any death penalty.” Stay
tuned.
“25% more Americans signed up for
health savings accounts in the first half
of 2016 than in the same period in the
previous year.”
- Devenir
While proposed alternatives to the ACA, put
forward by the GOP, have met with mixed
reactions among congressional Republicans
over the years, HSAs have received almost
universal endorsement within the party. HSAs
are particularly appealing to Republican
legislators because they enable patients to
understand the true cost of care — at least in
theory — and give consumers a say in how
much they spend and where they decide to
seek treatment.
12
While the Trump administration will usher in
some changes, we believe that many of the
fundamental healthcare challenges will
remain: the need to drive down costs and
improve health outcomes, the quest for more
transparency, and the desire for more
interoperability in support of more efficient
care delivery models. These will require the
continued development of new business
models.

The drumbeat to drive down healthcare costs
will only grow louder in 2017, as payers and
providers continue to search for ways to
drive out inefficiency, eliminate errors, and
introduce more automated solutions. We
believe that this focus will finally lead them
to more fully embrace auto-adjudication in a
meaningful way, especially for non-acute
procedures, which tend to be consistent,
repeatable, and the same amount from
patient to patient.
Auto-adjudication uses software to encode
business rules and processes that can be
applied to review claims and render
decisions on whether to reimburse or deny
claims, without the need for manual review.
The ultimate goal being a clean claim that
gets processed automatically after the first
submission without the need to contact the
provider to request more information.
When done well, auto-adjudication reduces
claims processing costs, decreases clearing
times, and allows integration of real-time
fraud detection and recovering services.
While the benefits seem compelling, payers
have been slow to adopt as they have
traditionally been financially incentivized to
hold on to insurance premium dollars as long
as possible.
5. Adoption of Auto-Adjudication will Accelerate
New healthcare economics and
improvements in technology are changing
that view, however, as the cost of processing
claims, particularly non-acute and simpler
claims, exceeds the benefit of a slower,
manual process. New technologies that
automate complex business rules and fraud
detection at scale mean more payers will
find margin improvement by delivering
shorter and more consistent clearing times.
“A claim requiring human intervention
costs approximately $4 to process,
while an auto-adjudicated claim costs
approximately $1.”
- Alsbridge, Inc.
And it’s not just payers that will push auto-
adjudication forward in 2017. With the move
to high deductible plans, providers are
shouldering more of the financial risk and are
seeking ways to get paid faster and more
consistently. Providers are motivated to work
with their EHRs, RCM, and insurance
companies to process claims more quickly,
with auto-adjudication being the holy grail for
revenue cycle stability.
Practice management software vendors are
interested in partnering to deliver adjudication
and business rules as a market differentiator.
Most practice management systems and
electronic health records (EHRs) are currently
designed to process claims after medical
procedures are complete.
New technologies are on the horizon that will
make it even easier to encode and apply
business rules for a growing a host of
business and supply chain processes. With
the emergence of healthcare on the
blockchain, practice management and EHR
companies will be able to offload business
rules for business processes like adjudication
to software programs, known as “smart
contracts”. This will automate complex
business processes, operate more efficiently,
and greatly reduce cost to payers, providers,
and ultimately consumers.
13

About PokitDok
14
The healthcare delivery system has traditionally been opaque, with critical data isolated at different points along
the continuum of patient care. This siloing of data poses a significant obstacle to creating new business models
necessary to address fundamental shifts within healthcare.
PokitDok Helps Solve This Problem
For more, visit pokitdok.com
We provide a software development platform that frees, secures, and unifies business data across the entire
continuum of care, so that healthcare transactions can be quickly and easily integrated into any app, website or
service. Without requiring that providers or payers rip and replace equipment or change their existing workflow.
Hospital systems, digital health companies, business process outsourcing providers and systems integrators rely on
PokitDok to improve workflows, cut costs, and speed time to market.

5 Healthcare IT Trends to Watch in 2017

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