The upcoming presidential election has everyone spooked: What if Donald Trump is actually elected? What will the transition of administrations, regardless of who is elected mean to healthcare and existing healthcare IT regulations?  Will our strategic plans and priorities need to change?

I've spoken to many people in government, industry and academia over the past month about the rapid pace of change stakeholders are feeling right now. Here are a few of their observations:

1. In the next year or two there will continue to be consolidation in the healthcare IT industry. Many smaller EHR companies will fold due to declining marketshare and some established incumbents with older technologies are likely to sell their healthcare IT businesses or reduce their scope.

2. Mergers and acquisitions will continue to accelerate, reducing the number of stand alone community hospitals and practices. The end result is that the market for software supporting midsize hospitals and small group practices is likely to shrink since ACOs/networks/healthcare systems will probably mandate a single centralized EHR solution for the enterprise.

3. Although the election may change the regulatory burden, many incumbent vendors will be spending the next year or two complying with certification demands, reducing their ability to innovate.  It's quite a conundrum. The market is demanding innovative solutions in the short term, but vendors cannot produce them because their development resources have been co-opted by regulatory demands. Thus, vendors may see a reduction in new sales, which will diminish their ability to hire new staff to meet the regulatory demands, putting them even further behind.  It reminds of a classic unstable system - beer pong. The more you miss, the more you drink, the more you miss. The more regulation, the fewer new sales, the less ability to deal with regulation.

4. The capacity of hospitals to pay large sums for EHR implementation and operation will be reduced as margins shrink during the fee for service transition to value-based payment. Vendors will be pressured to offer cloud hosted subscription models with standard configurations that are less resource intensive. Customization will be less attractive than a good enough platform that is affordable and highly usable.

5. As I wrote about last week, innovation is likely to come from one of two areas: smaller/agile companies that are not yet overwhelmed with regulatory burden or companies on the edges of the healthcare IT industry such as Apple, Google, and Amazon. It's hard to predict the winners. There was a flurry of small startups in 2014-2015, but in 2016 we're seeing them close/sell/merge. The pace of new startups has slowed.

What kind of innovation do we need? I have a "top challenges" list that includes

• A master patient identifier for the country
• A provider directory for the country
• A consent registry/record locator service for the country
• A customer relationship management platform that supports care management
• A groupware communication tool for healthcare
• A set of security solutions that makes two factor authentication/endpoint encryption easier
• A mobile platform for patient/family engagement that provides usability and high value transactions to the consumer
• A telehealth/telemedicine platform that supports documentation/billing in the cloud
• An interoperability platform that leverages cloud technologies to seamlessly provide clinicians with the information they need when their need it
• An analytics platform that notifies/alerts clinicians when something needs to be done - providing wisdom, not just a flood of data

I'm increasingly on the lookout for organizations which will address these challenges during the uncertain 24 months ahead. The advantage of being at Beth Israel Deaconess is that I can draw on all sectors - payers, providers, patients, established industry and startups to acquire potential solutions. Situational awareness and agility are a must for the months ahead. I'm keeping my running shoes on!