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The Importance of Information Technology in the ACO Age

As healthcare systems in America move toward the creation of accountable care organizations (ACOs), many questions remain about which ones will be successful and how long that success might take. One thing is certain, however: the need for strategically implemented healthcare information technology has never been greater. In fact, the success of the ACO model depends on it.

“In terms of information technology, absolutely what is at the core is a health system’s ability to share clinical information and clinical support tools across the whole continuum of care,” explained Jordan Battani, principal of CSC’s healthcare sector. “This means that every provider involved in a patient’s care will share the same electronic medical record. The reality is that most of healthcare in the United States isn’t going to be able to work that way.”

The implementation of a universal electronic medical record is at the core of the ACO model, allowing providers in all aspects of a patient’s care —from home health to hospital to lab to nursing home—to access that patient’s information and coordinate care in order to meet the ACO model’s requirements of aligned, collaborative healthcare delivery that offers better care for individuals, better health for populations and reduced costs across the board.

“This means that different physicians and the different hospitals they work with, and nursing home facilities and nursing home labs, and all the other different providers that touch a patient’s information, have to be able to keep track of all their data in a rigorous electronic format,” Battani said.

Of critical importance is the patient—and physician—identification process, with the goal that all providers use the same method of identification in their electronic system in order to protect patient safety and provide optimal care.

“There must be some mechanism for information exchange, especially if you have a system where everyone isn’t using the same electronic health record,” she continued. “There still has to be an approach to master data management and integration—a type of cross-reference library used to identify patients across the continuum.”

One example of an established health information exchange is a public/private non-profit alliance of healthcare providers, payers and the State of Nebraska: NeHII, the Nebraska Health Information Initiative, which serves more than half of the state’s population on an opt-in basis and allows the electronic exchange of real-time clinical information between physicians and other healthcare providers across the state.

Self-service technology empowers patients  

In addition to the adoption of an electronic health record and the development of a health information exchange, another goal of the ACO model is to increase patients’ involvement in their care. Health information technology plays a critical role in empowering patients to become active participants in the maintenance of good health, the management of disease and the financial and operational facets of medical care.

In a white paper by Medicity, Technology Fundamentals for Realizing ACO Success, researchers from one of the nation’s leading health information exchange vendors highlighted the goal of patient engagement utilizing such tools as personal health records and patient portals, asserting that they serve to “enable patients’ access to their health information, discharge instructions, e-mail communication with clinicians, lab results, prescription ordering, monitoring of clinical status and compliance,” and offer key benefits including, “increased patient adherence with treatment protocols, better outcomes and increased patient engagement and satisfaction.”

Battani explained that these types of patient self-service technologies serve as valuable support tools that help in care management decision making.

“These really engage the patient and the patient’s family in managing a highly structured and coordinated care plan, either for an acute episode or a chronic condition,” she said. “One thing that makes the ACO model different than the traditional healthcare model is this highlighted role of the patient in their care— particularly for patients who don’t have disease. You really want to deliver lots of support, tools and reinforcement of the behaviors that are keeping them healthy, and intervene with people who have chronic disease so their condition doesn’t become acute.”

Integration imperative to ACO success  

While healthcare providers across the country rush to implement IT systems to meet ACO and meaningful use requirements, Battani asserts that facilities that already operate as part of an integrated system will likely be the quickest to succeed at creating an ACO model.

“The attributes of organizations that will be successful first are those that have a good solid foundation of primary care, because that’s what drives this whole thing,” she said. “These are organizations that have the ability to link primary care providers with each other and with other organizations across the continuum to pass information and make decisions across that shared information exchange. These will tend to be the handful of integrated group practices with hospital affiliations.”

For others, the key, according to Battani, is to get integral stakeholders—namely primary care physicians—on board from the start.

“You can’t overemphasize the role of the primary care physician in planning and implementation,” she concluded. “The role of the hospital is not a straightforward one because you have to first enable that foundation of primary care delivery.”