2018 was a big year for health technology.
During the past 365 days, IT giants have flourished in healthcare: Cerner signed a $10-billion contract with the Department of Veterans Affairs, and tech companies — Amazon, Apple and Google — have all made headway in the industry.
Businesses that once seemed destined to upend the $3.4-trillion healthcare space faltered: IBM confirmed multiple layoffs in its Watson Health artificial intelligence division and the once-favored blood-testing startup Theranos shuttered for good.
Here is Becker's Hospital Review's roundup of the 10 biggest IT developments in healthcare in 2018. We'll leave it to you to try to predict where the industry heads in 2019.
1. Athenahealth sold for nearly $6 billion in cash.
In November, private equity firm Veritas Capital and Elliott Management-affiliate Evergreen Coast Capital bought athenahealth for an estimated $5.7 billion in cash. The decision followed a monthslong debate over whether the Watertown, Mass.-based healthcare software vendor would remain independent or be acquired, which began in May, when activist investment firm Elliott Management issued an unsolicited takeover bid to acquire the company Soon after, athenahealth co-founder and CEO Jonathan Bush stepped down from his post. Veritas and Evergreen plan to combine athenahealth with Virence Health, a value-based care business Veritas acquired from GE Healthcare in July 2018.
2. The VA finalized its Cerner contract, but can't dodge President Donald Trump's "Mar-a-Lago Crowd."
The VA signed its $10 billion, 10-year deal with Cerner in May, putting the agency on the same health records system as the Defense Department. Cerner convened a team of 24 technology businesses to support its work on the EHR modernization project, which will begin at test sites in 2020. However, a ProPublica investigation published in August found former VA Secretary David Shulkin, MD, was pushed out of the agency in March by an informal council at Mar-a-Lago, President Trump's private club in Palm Beach, Fla. A series of subsequent ProPublica investigations revealed the so-called "Mar-a-Lago Crowd" had reviewed the VA's Cerner contract and encouraged the agency to adopt an app developed by one of the council's insiders.
3. Amazon expanded into healthcare in a big way.
It seemed like Amazon touched on every subsector of healthcare in 2018. The e-commerce giant kicked off the year by fielding applications for a HIPAA compliance lead, hinting at its ongoing interest in developing healthcare tools. Since then, the company has unveiled plans to acquire online pharmacy startup PillPack, sell software that mines patient data from EHRs, and release an exclusive brand of at-home medical devices through a partnership with health brand consultancy Arcadia Group. Amazon is also one-third of the elusive Amazon, Berkshire Hathaway and JPMorgan Chase venture, which formed in January to attempt to reduce healthcare costs for the companies' U.S. employees.
4. Apple Watch added an FDA-cleared electrocardiogram.
During a company event in September, Apple COO Jeff Williams announced the newest Apple Watch would include an app that helps wearers identify signs of atrial fibrillation, the most common type of irregular heartbeat, by taking an electrocardiogram reading from their wrist. Apple said the app, which was cleared by the FDA, is the first over-the-counter EKG. While this claim has been contested, it's undeniable that the app brings cardiac data to more people's fingertips. Only time will tell whether the app successfully helps detect undiagnosed atrial fibrillation, or if routine screening of a mostly healthy population will result in potential misdiagnosis or overtreatment.
5. Apple's health records project onboarded 100-plus hospitals and clinics.
In January, the iPhone maker released plans to integrate patient health records — including data on allergies, immunizations and lab results — into its Health app as part of the iOS 11.3 beta rollout. The project kicked off at 12 pilot hospitals, including leading providers like Danville, Pa.-based Geisinger and Baltimore-based Johns Hopkins Medicine. Since the start of 2018, more than 100 hospitals and clinics have added the feature. Along with healthcare facilities, Apple has also been collaborating with national clinical testing labs — such as LabCorp and Quest Diagnostics — to bring patients' diagnostic results directly into the iPhone Health app as part of the health records feature.
6. Google revealed plans to consolidate its health projects.
In November 2018, David Feinberg, MD, confirmed plans to leave his post as CEO and president of Danville, Pa.-based Geisinger to take on a newly created leadership role at Google in January. At Google, Dr. Feinberg reportedly will focus on organizing various fragmented health projects across the search-engine giant, including programs under Google Cloud, Google Brain, Nest home automation and Google Fit wearables. As part of the move to consolidate the company's healthcare strategy, Google will also take over the marketing of some products from DeepMind, the AI arm of Google's parent company, Alphabet. Google has been bolstering its healthcare leadership throughout 2018, adding former Cleveland Clinic CEO Toby Cosgrove, MD, and former University of Chicago Medicine chief quality officer Michael Howell, MD, to its cloud and AI teams, respectively.
7. IBM Watson Health crumbled.
IBM Watson Health's troubled 2018 began in May when it laid off an undisclosed number of employees, including at least 40 workers from its Cleveland office. Anonymous former employees spoke out, calling IBM's healthcare AI arm a bust. The drama heated up over the summer after a series of STAT investigations revealed internal competition and a disorganized operating structure have plagued IBM Watson Health since its inception in 2015. One STAT report found Watson for Oncology, one of the supercomputer's most promoted applications, recommended "unsafe and incorrect" cancer treatments. In August, the company refuted the negative media coverage, saying it distorted and ignored facts by "suggesting IBM has not made 'enough' progress on bringing the benefits of AI to healthcare."
8. UnitedHealth Group unveiled plans to launch an EHR.
UnitedHealth Group reportedly was one of the second-round bidders to express interest in acquiring athenahealth. Although UnitedHealth Group lost the bid, the healthcare company has continued to pursue its health IT ambitions with plans to debut an EHR for its members and for providers in 2019. The product is designed as an individual health record that connects numerous EHRs to create "a unified and secure source of truth for both consumers and care providers," according to Steve Nelson, CEO of UnitedHealth Group's health insurance arm, UnitedHealthcare. UnitedHealth Group said the health record will be accessible to 1 million providers before 2020 and will serve 50 million health plan members. The health record has already been tested at three ACOs.
9. The SamSam ransomware campaign hit healthcare.
Allscripts was one of the first healthcare organizations to fall victim to the SamSam ransomware campaign in January. There were at least five other healthcare entities affected by the campaign: Wichita-based Kansas Heart; Los Angeles-based Hollywood Presbyterian Medical Center; clinical laboratory network LabCorp; Columbia, Md.-based MedStar Health; and Omaha-based OrthoNebraska Hospital. Several cities — including Atlanta and Newark, N.J. — were also victimized by the hackers. Then, in late November, a grand jury in New Jersey indicted two Iranian hackers in connection with the campaign. According to the indictment, SamSam hackers extorted more than $6 million from their victims, who collectively suffered more than $30 million in losses from lack of access to their data.
10. After a three-year saga, Theranos shut down for good.
Theranos launched in 2003 with a promise to revolutionize blood testing, gaining widespread attention after claiming to invent a device that offered quick diagnostic results using only a single drop of blood. At its height, the company was valued at $9 billion. But a 2015 exposé in The Wall Street Journal — which alleged Theranos' devices were flawed and inaccurate — triggered a series of federal investigations into the startup, and in early 2018 the company and its founder and former CEO Elizabeth Holmes were charged with fraud. Theranos was forced to lay off about 80 percent of the company's workforce in April, and in September the company shut down.