The intrepid hospital and physician office pioneers leading the charge toward accountable care organizations have learned some key lessons about IT--its role, its limitations and its challenges.
A recent article published in Health Data Management delves into the topic with gusto. It covers a lot of ground, but for CIOs, there are some specific, important tips worth following to help as you evaluate the ACO path for your own institutions, including:
Data exchange: You can't do without it: The Northern Adirondack Region Medical Home Project, based in Plattsburgh, N.Y., has connected electronic health records for its 26 group practices, five hospitals and nine payers to a statewide regional data exchange, according to the HDM article. The EHRs do some of the heavy lifting--allowing doctors to order lab tests, view results and prescribe meds. But the data exchange helps docs keep track of their patients outside their own practice, giving them access to hospital discharge summaries, ER visit records, and medication lists from other providers, the story explains.
It's a daunting task, though, and one that took more than 18 months to get all the interfaces built, testing completed, and bugs worked out.
Data exchanges can have unexpected benefits, too. For example, health information exchange group Michigan Health Connect has turned its data exchange into a central communications/referral hub, HDM reports. More than 200 physician offices are tied into the system, and using referral forms the HIE added to the platform, they now can search for referring physicians, and even complete and forward the referral paperwork online.
Technology needs to automatically update MDs on patient admissions: Any worthwhile ACO will have to give physicians tools to know where their patients are receiving care. In particular doctors need to be notified immediately when a patient presents at the emergency room, so they can help manage the incident. Cox Health Plans, which has applied to participate in an ACO-like bundled-payment program under Medicare, is testing out a "virtual hub" technology for just this purpose, alerting physicians to ongoing exacerbations, HDM reports
Vendors, payers may not be on board: The biggest IT obstacle to an ACO's technology progress isn't always the hospital's budget. In some cases, proprietary vendors aren't willing to put in the time or money to interface or integrate their systems with other multi-system exchanges. Heidi Moore, a member of the Northern Adirondack project's executive board, admits her practice's primary EHR vendor wouldn't create an interface to the state HIE. The result: "Our former vendor had no national vision," she tells HDM. "We had to make a horribly difficult choice to drop them."
Payers, too, may be late to the ACO party, technologically speaking. Our sibling publication, FierceHealthPayer revealed a few weeks ago that insurers are years behind in upgrading their core IT systems. A new study showed that while half of payers want to participate with new business models like ACOs, more than three-quarters say they can't do it from a technology standpoint.
Home monitoring tops IT wish lists: One big technology gap that could sink ACOs is at-home monitoring of chronically ill patients, Jim Adams, managing director of The Advisory Board, tells HDM. In particular, it will make patients more accountable for following their treatment protocols, and adhering to diet, medication or other regimens--all of which are important to keep outcomes high. "Accountability will be pushed out to the patients," he says.
For just this purpose, Richard Lopez, CMIO for Massachusetts ACO Atria Health, recommends ACOs include a patient portal where patients can request prescriptions and appointments and view lab results--all as ways to keep them engaged in their care.
To learn more:
- read the Health Data Management article