IT in ACOs: Hospital execs writing their own instruction manuals

Hospital executives are divided on whether or when accountable care organizations are going to be a major part of their business. But some healthcare systems are starting to put together the pieces needed to implement an ACO strategy, including the requisite health IT infrastructure.

For example, South Jersey Healthcare (SJH), a two-hospital system based in Vineland, N.J., is negotiating an ACO contract with Horizon Blue Cross Blue Shield. At the recent CHIME Fall CIO Forum in San Antonio, Thomas Pacek, SJH's vice president of information systems and CIO, explained how his organization is working with area physicians and other providers to build the ACO.

To start, SJH is providing a subsidy--85 percent of the software cost up to $5,000 per provider--to community physicians who acquire electronic health records and agree to provide clinical data to the ACO.

SJH also has built a data warehouse and implemented a cluster of business intelligence tools. These tools have enabled it to provide a series of "dashboards" that monitor and review performance in various clinical and administrative areas. All ACO participants, including physicians, can access the dashboards on a portal.

With the help of MobileMD, SJH also has created its own health information exchange. Though this exchange is private, it is designed for data interchange among all the community providers that do business with the healthcare system.

The HIE connects SJH's Siemens enterprise system with six different ambulatory-care EHRs, and five more will be linked soon. Thirteen outpatient practices with 41 providers already feed data to the HIE, which is used for referrals and for sharing electronic "face sheets" on patients being treated by multiple clinicians. SJH is now working with Sage and NextGen to import Continuity of Care Documents into the HIE, Pacek said.

SJH also is using the HIE to communicate with post-acute care providers. The hospital system has written an interface between its HIE and the Thornberry home care application, and can send lab data directly to the EHR used by an SJH-owned home health agency.

SJH doesn't own a nursing home, and Pacek noted that many of the area's long-term-care facilities are not automated.  But one facility does have electronic documentation, and SJH soon will be sharing information with it via the HIE, he said.

SJH is not the only healthcare system trying to expand its connectivity with post-acute-care providers: The Baptist Health System, a five-hospital organization in San Antonio, is beginning to work on exchanging information with area nursing homes, Baptist executive Raje Wolf told CHIME attendees. Baptist wants PAC data on order sets, medication reconciliation, and quality measures to support its involvement in Medicare's new bundled payment program, she said.

Pacek confessed that despite progress, SJH's ACO program still has a couple of big holes to fill. Care management and the IT applications to support it still have a long way to go. And SJH must reconfigure its financial systems to account for ACO services and distribute money to participating providers. The organization is in early discussions with Siemens about how to do this.

Nevertheless, this healthcare system is pretty far along toward assembling the IT pieces it will need to raise efficiency and quality and reduce readmissions as it moves into the brave new ACO world. What remains to be seen is whether SJH and its healthcare partners will be financially rewarded for their pioneering efforts. - Ken

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