Experts express different views of EHRs' future in accountable care

Not all health IT experts see eye-to-eye on the role of technology in accountable care. Case in point, while a HIT consultant argued in a recent commentary that technology creation hasn't matured past the fee-for-service stage, a hospital system CIO said in a recent interview that she believes today's tools will be crucial to the future of ACOs.

Health IT executive and former Accenture consultant Dave Chase, in a commentary published in iHealthBeat, maintained that electronic health record vendors are still creating systems for the threatened world of fee-for-service reimbursement and acute-care-focused medicine. As a result, he said, healthcare providers vying for Meaningful Use incentives are investing billions of dollars in systems that soon will be obsolete.

In an interview with Executive Insight, meanwhile, Linda Reed, vice president and CIO of Summit, N.J.-based Atlantic Health System, painted a very different picture of the future. She foresees that health IT will play a critical role in accountable care organizations, but that health IT departments will perform the same functions and use many of the same tools that they use today.

"As in Meaningful Use, much of the HIT needed for an ACO is probably already on a CIO's roadmap--data warehouse/analytics, and care management, including care planning, clinical decision support functionality, ambulatory EMRs and data exchange functionality," Reed said.

There are also ACO competencies that are not on many CIOs' radar screens yet, she said. Those include the IT tools needed to perform population health management and risk stratification, to enroll ACO beneficiaries, and to collect quality and outcomes data from physicians in an automated way.

In Reed's view, some of these tools are adjuncts to EHRs, rather than core functions of those systems. In contrast, Chase sees current EHRs as an impediment to changes in healthcare financing and delivery.

The two big problems with today's EHRs, Chase said, is that 1) they were designed for a "do more, bill more" payment system that's on its way out; and 2) they are not nimble enough to cope with a rapidly transforming healthcare environment. In addition, he noted, systems like those of Epic and Cerner "have their strength in automating internal workflows of hospitals and other clinical settings." That works fine in acute care, where providers make the decisions, but they are not well-suited to chronic care, which requires a lot of patient engagement, he said.

Chase's article forms an ironic counterpoint to the just-released comments of the EHR Association on the Centers for Medicare & Medicaid Services' proposal on EHR certification. EHRA wants CMS to allow providers still in Meaningful Use Stage 1 in 2014 to keep using their current EHRs, rather than having to get new systems that have been certified under 2014 rules.

To learn more:
- read Dave Chase's article
- read the interview with Linda Reed
- check out the EHRA comments on the CMS proposal (.pdf)


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