Ever-bigger HIT silos might be the result of ACO buildup

The recent KLAS report on how providers are grappling with accountable care organizations shows that no single IT vendor can provide a complete ACO solution. Nevertheless, the advent of ACOs--and all they portend in terms of future reimbursement changes--is driving many healthcare organizations to depend more on a single vendor for their IT needs, says Colin Buckley, a co-author of the report.

"What we're seeing is that organizations have been trying to get more standardized and are driving toward a single integrated vendor to simplify their lives," Buckley tells FierceHealthIT. "They look to those vendors to continuously develop their platform. But I don't think anybody we talked to is expecting that their single vendor is going to give them everything they need for an ACO."

Provider organizations that have a more integrated solution, he added, are more confident about their ability to build ACOs. In contrast, institutions that have best-of-breed systems are concerned about the future.

One CIO told Buckley, "'That's not a model I want to have with the changes coming down the pike in healthcare delivery.' So it's definitely something they're worried about. There's so much change you've got to do from a relationship and cultural point of view that you want to get all of the unnecessary complexity out of your way."

In this context, it makes sense to have an integrated solution. But that's clearly not sufficient when you look at internal relationships, as well as the need to move healthcare data across care settings.

Take a hospital's relationships with its medical staff. In the KLAS report, Cerner ranked highest in ACO readiness, partly because it has tightly integrated inpatient and outpatient solutions. But, as KLAS points out--and as some physicians have told me--Cerner's ambulatory-care EHR is weak. That means a lot of unhappy physicians, even before you talk to them about an ACO.

Then there's the small matter of health information exchanges, which are essential for communicating across care settings. Of the vendors mentioned in the KLAS survey, only Cerner offers an HIE that can effectively exchange data with other vendors' products. Epic, which also ranked high as an ACO-ready vendor, has an HIE that can move information between Epic customers. But, although Epic has talked about creating a more inclusive HIE capability, it does not yet have one, Buckley notes.

To become successful ACOs, hospitals must exchange data not only with ambulatory-care practices, but also with post-acute care providers such as home care agencies and long-term-care facilities. Another recent KLAS survey showed that only a quarter of home care agencies could exchange any data with hospitals. And while some HIS vendors have home care applications, they're not integrated with the enterprise systems.

Nevertheless, the fastest growing HIEs are private exchanges built by healthcare systems. Regional and statewide HIEs, which could knit together healthcare communities, are growing slowly because they lack a business model. And the growth of private HIEs makes it less likely that that business model will emerge.

Of the major vendors, only Epic, Cerner and McKesson offer their own HIEs, according to KLAS. Providers that use other vendors' systems must rely on third-party HIE vendors, which make HIEs that can't communicate with one another.

This problem reflects the main factor driving integration of systems: Healthcare organizations want to gather all ACO components--including ambulatory care practices--within their own enterprises for competitive reasons. Hence, they're not demanding that their vendors build HIEs that can communicate with disparate products used by other entities and healthcare systems.

When healthcare providers wake up and realize that collaboration, not competition, is what ACOs demand, health IT will follow in their wake. Until then, they'll keep on building ever-bigger silos. - Ken (@FierceHealthIT)