CCHIT Releases Framework for ACO Health ITCCHIT Releases Framework for ACO Health IT

8 Accountable Care Organizations Worth Closer Examination

The Certification Commission for Health IT (CCHIT) has issued a framework for accountable care organizations (ACOs) to use as they assemble the components of the health IT infrastructure they will need to do population health management.

Created by commission members and a blue ribbon advisory panel, the technology roadmap is designed to help ACOs "mitigate some of the risks associated with taking on accountability for costs, quality of care and patient loyalty," says the CCHIT ACO HIT Framework document.

According to its authors, the framework is the first "consensus-developed, publicly available" document to address these issues. The National Committee on Quality Assurance (NCQA) accredits ACOs, but it doesn't explain the requisite IT infrastructure in the detail that CCHIT's framework does.

[ Health IT vendor Lumeris has issued its own ACO guidelines. Read Will Doctors 'C' The Way To Accountable Care?. ]

The framework is described as a guide for planning, purchasing and building a health IT infrastructure capable of meeting an ACO's goals of providing "high-quality, efficient care while developing patient and clinician loyalty under different types of financial arrangements." These arrangements include fee-for-service with upside-only risk sharing, up- and down-side risk sharing for a substantial portion of a patient population, and global-risk contracts covering most patients.

The framework is not only intended for provider organizations. Payers partnering with provider groups in ACOs might also be interested, the document says. Another potential audience, it notes, are health IT developers who plan to create the technology that providers will need in the future.

The framework, which includes all of the government's Meaningful Use criteria, focuses on four primary areas:

-- Information sharing between and among clinicians, patients and other authorized entities.

-- Data collection and integration from multiple clinical, financial, operational and patient-derived sources.

-- Health IT functions that support patient safety.

-- Privacy and security protections.

The framework document strongly urges organizations forming ACOs to establish "a data warehouse that can accept, store, normalize and integrate data from multiple clinical, operational, financial and patient derived systems." As of 2011, only about 30% of U.S. hospitals had such data warehouses, according to HIMSS Analytics.

Some of the specific use cases in the framework required very complex connections among various data sources. For example, to "identify best setting for care," CCHIT suggests the use of "technologies that can assess acuity of care, record and display patient and family needs and circumstances, present benefit and health plan provider network information, and access real-time information on available beds and personnel, for appropriate setting of care."

No healthcare organization has these kinds of capabilities today, acknowledged Grace Terrell, MD, CEO of Cornerstone Health Care, a 360-provider multispecialty group in High Point, N.C., and one of the framework's coauthors, in an interview with information Healthcare.

"The framework as it's constructed is about where we need to go, not where we are now," she said. "It's not doable for anybody right now with the current technology and infrastructure we have today."

Current EHRs, she pointed out, were designed for episodic care, not population health management. Some vendors are "trying to superimpose early versions of some of what we need for population health on top of that," she added, but Cornerstone had to use third-party applications as well in its own ACO efforts.

The framework doesn't assume that the infrastructure of the future will be built around EHRs, she added. Drawing an analogy to the proliferation of apps for mobile devices, she said, "We don't worry about the underlying platform, we pull apps in to help us with various functions. It would seem to me that as EHRs become commodities, the next wave of functionality will be applications."

When Cornerstone -- which has had an EHR since 2005 -- set off down the ACO path a couple of years ago, Terrell said, the CCHIT framework would have come in handy for guidance on where to prioritize their investment and how to evaluate vendors. Many physician groups and smaller hospitals, she noted, are calling themselves ACOs without any idea of the IT infrastructure they'll need.

CCHIT, a nonprofit organization, is known primarily for its certification of EHRs. Asked whether it plans to certify ACO health IT at some point, CCHIT spokeswoman Sue Reber replied, "We're in early days, and there's so much here that some of these organizations haven't contemplated before. The intent of this framework is to educate and inform, drawing on the expertise we have on the commission and the advisory panel. Time will tell whether the market is looking for something more concrete from us, perhaps in the form of a certification program."