On June 28, 2012, the United States Supreme Court upheld the Patient Protection and Affordable Care Act (ACA).  The law includes – among many other things – mandatory federal programs that require increased accountability from hospitals for the cost and quality of care that is delivered.  With payment reform initiatives from States and commercial payers also already well underway, the Court’s ruling only accelerates the need for robust HIE and analytics capabilities. 

A Newfound Imperative

Public and commercial payers are rolling out a variety of voluntary accountable care organization (ACO) programs, bundled payment initiatives, and other strategies to increase provider accountability for quality and costs. The ACA – and the Court’s decision to uphold it – creates a newfound urgency though as the law includes mandatory Medicare programs that, beginning in FY2013, tie an increasing percentage of hospital reimbursement to actual performance on a growing number of measures. 

Given the demand for greater accountability, delivery organizations will need to use information and data from an increasing broad community of care partners to help reduce costs and manage quality and outcomes.  Hospitals and health systems will need to exchange data with non-affiliated organizations – and actually use that data to influence care decisions.  Providers will need to be alerted to gaps in care such as overdue tests and procedures, and it will be just as important to understand what services have already been provided so as to avoid duplication.  Simply aggregating patient data from disparate systems across multiple settings of care will not be sufficient; organizations will also need robust analytics tools that can spot trends across a defined population, identify high risk patients, and gauge performance on required metrics.

Remaining Competitive: Two Critical – and Converging – IT Capabilities

Being successful under any accountable care initiative will require widespread use of two critical – and increasingly overlapping – IT capabilities:

Health Information Exchange (HIE) technologies and services that facilitate the exchange of and access to patient data from multiple settings of care – including discrete and structured data across organizational boundaries.

Health Analytics solutions that analyze performance on key clinical and financial metrics, provide real-time alerts to influence care and business decisions, effectively predict and manage risk, and understand trends across a population of patients.

Core clinical vendors, as well as niche vendors, are continuing to expand their HIE and analytics offerings to meet these emerging demands.  As greater emphasis is placed on population health capabilities and tools that help non-affiliated organizations exchange discrete and structured information, the line between HIE and analytics is rapidly blurring.

There are a number of important questions hospitals and health systems should consider as the market continues to evolve in response to the realities of payment reform.

• What are the capabilities of your core clinical and financial vendors? Many HIT vendors are in the process of rolling out HIE and/or analytics capabilities.  Start by understanding your core vendor’s approach for handling data from other EHRs and financial systems.  How is data received from different systems aggregated and normalized?  What is the process for ensuring accuracy of that data?  Are analytics tools primary limited to the data natively captured by the core vendor’s clinical and financial system? 
• Are there niche solutions that address your organization’s specific needs? Capabilities offered by niche solutions vary considerably in scope and depth, so if considering a third-party solution, focus on those with demonstrated strengths in areas that align with the goals of your organization.  Does the vendor offer tools that will enable success under mandatory Medicare programs and any voluntary pilots being considered?  Has the vendor historically focused more on HIE or analytics?  If both are offered, are the products integrated? 
• Have you considered the impact on workflow?  Regardless of whether using HIE and analytics tools from a core clinical vendor or a third-party, ensure a strategy is in place to integrate those capabilities with provider workflow.  Will physicians need to toggle between two screens to see data from outside organizations?  Are reminders and alerts natively embedded into the system used for documentation at the point of care?  Are tools in place to ensure physicians are aware of – and follow up on – time-sensitive information like abnormal test results? 

The Bottom Line

As accountable care initiatives continue to demonstrate an impact on quality and cost, their scope will undoubtedly increase. Provider organizations that achieve early success under any accountable care program will possess a distinct advantage moving forward – but doing so will require widespread use of robust HIE and analytics capabilities.

As a member of Impact Advisors’ Discovery & Development team, Jason D. Fortin has over 10 years of experience researching emerging healthcare IT trends and analyzing the impact of regulatory requirements on healthcare strategic planning, operations and delivery. Mr. Fortin’s areas of expertise include IS strategic planning, payment reform, health information exchange, and business intelligence / data analytics.