Information Technology Considerations of ACOs

April 20, 2011

There are huge technology issues around the ACO model, not the least of which is the digital divide that separates those providers and practices who have embraced technology and are on board with EHR systems, and those who are still sitting on the sidelines.

Accountable Care Organizations (ACOs) represent a new healthcare delivery concept - multiple providers in a variety of both primary care and specialty areas that provide a seamless cycle of care across a large and diverse patient population, with compensation based on the overall health of that population rather than on specific procedure codes. The concept of ACOs represents a radical departure from the current fee-for-service model, which many argue focuses more on sick care than healthcare. 

It obviously requires a high degree of integration between and among all the providers in the different episodes of care.

There are huge technology issues around this model, however, not the least of which is the digital divide that separates those providers and practices who have embraced technology and are on board with Electronic Health Record (EHR) systems, and those who are still sitting on the sidelines (and in some cases even turning their backs on the concept entirely, deciding instead to hang on to their manila patient folders and clipboards). It would be hard to imagine an ACO being very functional or effective if there is only one physical patient record, and if that record is paper-based. In fact it would probably be nearly impossible for an ACO to even function with paper-based patient records.

With multiple clinical and business office staff needing rapid access to the same information, the only realistic solution is a robust, feature-rich electronic health record system, along with other automation systems plus well-optimized clinical and business office workflows.

The move towards ACOs therefore favors those medical practices and systems with mature, integrated IT systems, including EHRs. The ability to share patient data seamlessly and securely across different boundaries of care is critical to making the ACO concept effective. Huge efficiencies can be gained if the patient record can be accessed and updated - with the next person in the ACO chain having the benefit of the most recent updates to the patient record - and duplicate steps can be avoided. This is true both on the clinical side (e.g., avoiding duplicate medical tests) as well as the business office side (e.g., avoiding recapturing and re-entering patient demographics and billing information.)

With the ACO being a new concept, however, are today’s EHRs set up to support this functionality or are they going to have to be significantly upgraded or even replaced? Is this another reason for providers to take a “wait and see” approach to EHR adoption, until ACO-specific EHRs are developed? The answer is generally no. Those major EHR systems that are mature, feature-rich and support multiple specialties should handle the ACO concept just fine. In fact the feature set that has been part of most of the major EHR vendors’ playbook for the last several years supports the ACO model very well. Multi-specialty integration and support as represented by ACOs has been on the EHR agenda for some time now. Such functionality as advanced search and reporting, as well as clinical decision support and other knowledge-based features, is consistent with the needs of a successful ACO. In other words, what ACOs require of an EHR is already present in most mature systems available from the major vendors. However, you need to make sure you have kept up with the updates of your EHR system, so you have the latest feature/functionality from the vendor.

On the other hand, narrowly specialized EHR systems, with limited or tightly focused functionality targeting a single sub-specialty, or systems that don’t provide a full feature set and have to be interfaced externally with other modules such as practice management, billing, labs, etc., are going to be at a disadvantage in the ACO world. They may need to be significantly augmented or perhaps replaced.

It is not a necessity for all member practices of an ACO to be on the same EHR system, but it is certainly an advantage if they are. Software interfaces based on standards such as HL7 can certainly be developed, but if an ACO can find (and agree on) a single integrated EHR system that supports all the clinical and business functions of the entire organization, that simplifies both initial implementation as well as ongoing operations.

Because it is not possible to simply flip a switch and instantly convert from paper records to a fully functional EHR, those practices that have already implemented or are far down the road with an EHR implementation should be well positioned to embrace the ACO concept as it unfolds. However, as is the case with qualifying for potential ARRA/HITECH funds, optimizing both the technology and workflow processes for an ACO will require many months of effort. That effort - on both counts - cannot start too soon.

ACOs provide a new and refreshing model for health care delivery. There are important implications from an information technology standpoint, and those practices who have implemented or who are implementing a full-featured, certified EHR system should be well-positioned to adapt to this model. Those who are not will find it very difficult to make the transition, and take advantage of the operational and clinical benefits of this integrated healthcare delivery model.

Learn more about Marion K. Jenkins and our other contributing bloggers here.