What are the basic ingredients of a health IT framework for accountable care organizations? The answer is not clear, in part because the federal rule defining ACOs is still a work in progress. But industry leaders at the hybrid ACO Summit and Health Information Technology and Delivery Transformation Summit in Washington, D.C., said the needs of ACOs would likely stretch beyond the traditional definition of electronic health records and spur the development of new systems designed specifically to enhance care coordination across a still-fragmented delivery system.

Speaking on June 28, Richard Gilfillan, M.D., acting director of the Center for Medicare and Medicaid Innovation (CMMI) at the Centers for Medicare and Medicaid Services, said that there is no shortage of innovation in healthcare, but that previously it has been directed at providing more care at a higher cost. His organization, with $10 billion in funding over a 10-year period, is looking to promote innovation that is conscious about the goal of moving from the current fragmented state of healthcare to a future state that is people-centered and provides coordinated, efficient care.

CMMI, Gilfillan said, has a great interest in better managing care for the population of patients who are eligible for both Medicare and Medicaid and who use up to 40 percent of CMS resources. He said the foundation laid in the HITECH Act is “necessary but not sufficient.” EHRs will likely require ancillary tools or perhaps separate systems for care coordination and patient engagement, as well as for data collection and analysis.

“Tracking people in this dual-eligible group is going to be complex,” Gilfillan said, “and it will require interoperability across Medicare, Medicaid, and the state systems.”

In a panel discussion, William Bria, M.D., chief medical information officer for the Shriners Hospital for Children and chairman of the Association of Medical Directors of Information Systems (AMDIS), agreed that ACOs are likely going to require integration capabilities beyond the current generation of EHRs. “The Idea of achieving coordination with the tools we have now is a great challenge,” he said. Also, unless health systems develop strong registries and data repositories, they will have to readjust the expectations of their patients, clinicians, and informaticists about what can be achieved, he said.


William Bria, M.D.

Keith Figlioli, senior vice president for healthcare informatics at Charlotte, N.C.-based Premier Health Alliance, said his organization’s Accountable Care Collaborative has put together a five-stage stepladder to help CIOs plan for what comes first in terms of IT support for ACOs. Collaborative members have developed a phased approach that they say should lead to seamless accountable care coordination and clinical integration through levels of maturity similar to the HIMSS Analytics EMR Adoption Model.


Keith Figlioli

The Premier alliance is working with IBM on a technology platform to support the new model, Figlioli said. One concern he expressed is that providers are being overwhelmed with measures. Between earlier CMS programs, meaningful use, and insurers’ pay-for-performance measures, organizations are spending too much of their time focused on how to get reports out of their clinical systems and not getting down to the real work of clinical transformation. “With the shared savings plan, the biggest adverse reaction is to the 65 measures organizations have to report on,” he said.

As important as getting the IT pieces in place is creating a culture where people understand how to work with data, said Jim Walker, chief health information officer at Geisinger Health System in central Pennsylvania. “You have to get them to regard data as authoritative stuff they need to act on,” he said.

See the July cover story, for more information on accountable care organizations.