Interoperable IT Crucial For Accountable Health OrganizationsInteroperable IT Crucial For Accountable Health Organizations

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Properly implemented, interoperable health IT is essential to the functions of accountable care organizations (ACOs), according to a recent report from a health IT advocacy group.

"With secure and shared access to complete, appropriate, and accurate clinical information between healthcare providers and patients within the organization, a strong health information technology infrastructure will be available to support the clinical and financial success of the [ACO model]," says a new report from the eHealth Initiative, a Washington-based membership organization pushing for greater use of health IT.

The ACO concept is intended to realign incentives to help healthcare providers achieve the "triple aim" of improving patient care, boosting population health, and containing costs. "Health IT facilitates coordinated, patient-centered, and accountable care that connects healthcare providers across the continuum of care in support of these goals," the report reads.

"It may be difficult for ACOs to accomplish all of their objectives without a strong technology base that facilitates care coordination and gives doctors the tools they need to provide quality and affordable care," said eHealth Initiative CEO Jennifer Covich-Bordenick in a statement.

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Information technology needs to deliver the right information to the right people at the right time, even between competing organizations, and well-implemented IT can lead to better patient safety and more cost-effective care, regardless of financial model and organizational size and structure, according to the report.

The eHealth Initiative's Accountable Care Organization Council, co-chaired by Dr. Michael S. Barr, vice president of practice advocacy and improvement at the American College of Physicians; and Marcia Guida James, director of provider engagement at health insurer Humana, focuses on three aspects for measuring the success of ACOs: safety, the health of populations at high risk of serious ailments, and financial accountability/quality management. ACOs cover a wider landscape than that, but the council said that trying to be comprehensive might be "an insurmountable challenge."

Elements of IT infrastructure should include interoperable electronic health records (EHRs); clinical decision support systems; secure electronic messaging to help coordinate care; various patient-centric technologies such as personal health records (PHRs), telemonitoring, and electronic reminders; and a system to report adverse events, according to the report. This last point has become an important issue in the wake of a November 2011 report from the Institute of Medicine that recommended establishment of an independent government entity to monitor and investigate reports of potentially harmful events associated with health IT.

From a list of key attributes for success with the ACO model, health IT infrastructure should:

--Enable coordination of care and collaboration among providers.

--Support revenue cycle management because ACOs will require changes to how healthcare is paid for. This includes financial analysis and electronic payment capability.

--Include adequate security and access controls to meet Health Insurance Portability and Accountability Act (HIPAA) requirements while still allowing for data interoperability.

--Support telehealth, remote patient monitoring, shared care plans, and other "patient-centered" features.

--Allow for ongoing measurement of quality of care, cost, and patient experiences at both the individual and population levels.

--Provide access to pertinent health information for patients and authorized healthcare providers alike.

--Integrate evidence-based clinical decision support services into provider workflow.

--Support patient education and health literacy to allow for self-management when appropriate.

--Facilitate patient self-care and wellness management, such as health coaching by providers and ongoing monitoring of progress to promote a dialogue between patients and healthcare providers.

--Support clinical, administrative, and financial analytics to help improve care and organizational performance.

"Sophisticated, user-centric health IT systems can not only facilitate and enable care coordination, but also allow the secure transfer of data between all parties involved across the continuum of care," the report says. "The flexibility of the [ACO] health IT infrastructure will be a key factor for ensuring a viable, sustainable business model that can adapt to changing revenue cycles and financial accountability processes."

The recommendations are partially based on a survey of ACOs--in varying developmental stages--that the eHealth Initiative conducted last fall. Seventeen of the respondents described their missions as being consistent with the triple aim, according to the eHealth Initiative.

Healthcare providers must collect all sorts of performance data to meet emerging standards. The new Pay For Performance issue of information Healthcare delves into the huge task ahead. Also in this issue: Why personal health records have flopped. (Free registration required.)