ACOs have become quite a hot topic among health care leaders today, with some of the main concerns being governance, payment structure, infrastructure and architecture challenges. Some feel strongly that ACOs will require a more complex and advanced technology infrastructure than the ones currently being employed in HIEs, and many are left wondering just what that will mean to providers in terms of moving forward.
The goal of an ACO, or a set of health care organizations that work together and collaborate on and coordinate care for a set of patients, is to not only reduce costs and increase efficiencies in the system, but also improve patient outcomes and the overall coordination of care. But while ACOs are still evolving and taking shape, it is important to dive into some of the core infrastructure components that will be required to ensure success and long-term sustainability.
In order for an ACO to succeed, it must operate a provider network that will enable the electronic exchange of information, provide a platform for care management and offer a payment distribution system. Underlying all of these attributes, of course, are the technology implications, some of which are the following:
Health Information Exchange (HIE): This is a standards based exchange for electronic health records. The current standard being used is the HL7 CDA or CCR (Continuity Care record), which is the format in which health information is stored and exchanged across systems. The HIE is the facilitator that will enable systems to identify patients as well as locate their chart and route it to the requestor. This does not necessarily mean that an ACO will need to operate its own HIE, however. In fact, most ACO will likely connect, or have the option to connect, to one or more HIEs, especially when working across state lines.
Certified Electronic Health Records (EHRs): For participating caregivers, having EHRs to view and document care during a visit is a must. An ACO might offer a hosted EHR or patient tracking system to help boost participation, though it is not required to have one common EHR system for all the members simply due to the fact that most certified products do have the capability to exchange medical information in a standardized format.
Patient portals: In order to improve patient engagement, an ACO will need to provide a patient portal to facilitate secure electronic communication. This will provide the patients with web based and interactive personal healthcare records. The ACO should also offer integration with all major PHR providers.
Data warehousing and business intelligence (BI): There are over 65 measures in the proposed ruling for ACOs. All these quality measures must be reported on in order to be eligible for shared savings. The measures cover everything from care coordination and preventative health to patient experience. Much of the information will be submitted via GPRO tools. In addition, each measure has a minimum attainment threshold and performance benchmark, which requires the ACO to continuously monitor its performance over time.
IT support: In order to ensure system uptime and reduce disruptions to data flow, an ACO will need to provide IT support not only to support the connectivity amongst the members, but will also need a team of HIT specialists to maintain the internal ACO platform.
Unified communications: In a recent article, I discussed the need for sites or platforms that will facility coordination of care similar to Facebook , except more business oriented (similar to Chatter). These solutions will not only allow caregivers to communicate with each other regardless of distance, but it can provide them cost effective ways to have video conferencing, including telehealth services, and a platform for discussing patient cases.
ACO management technology: Since an ACO is the result of the collaboration of cross-disciplinary services and multi organizations collectivity accountable for the total patient care, it is critical to have a system that will support governance and management of the ACO care-delivery model.
Document management: While this may not be obvious at first, the reality is that there are still patients that bring their medical information in paper format. This may require the ACO to provide tools to digitize that information and make it available to everyone. The ACO may be forced to identify alternatives such as cloud-based document management system to be able to provide easy to use and widely accessible system to retrieve and review paper based documents.
Preventative health: In order for an ACO to have a proactive role in the population’s health, the organization must ensure that it is continuously working with patient through reminders and alerts for preventative care. This is especially important for patients with chronic disease.
Clearly an ACO will require a lot of technology as part of its foundation. This means significant capital upfront as well as resources and a strong strategic plan to ensure sustainability. Some hospital led ACOs may have some of the infrastructure components already available to them, while other ACOs may integrate with a payer system which has most of the components. Either way, the ACO and medical home models are not going away, and health IT leaders will continue to be faced with a unique set of challenges as the industry leaders continue to pave the way toward true coordination of care through health IT collaboration.
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