Although the accountable care organizations (ACOs) defined in the Patient Protection and Affordable Care Act won’t take shape until January 2012, chief information officers and chief medical information officers are already trying to determine ACOs’ information technology requirements.
Under the basic definition of ACOs, Medicare beneficiaries who are enrolled in the traditional fee-for-service program will be assigned to ACOs, which will agree to be accountable for those patients’ quality, cost, and overall care. Although the Centers for Medicare and Medicaid Services still has to write specific rules around ACOs, it is clear they will have to share data across organizational boundaries, report the necessary data to evaluate quality and cost measures, and demonstrate a patient-centered focus.
At the recent World Healthcare Innovation & Technology Congress meeting in Washington, D.C., Mike Cummens, M.D., associate chief medical information officer at 750-physician Marshfield Clinic in Wisconsin, talked about his organization’s thinking on ACOs. As planning begins, Cummens said, organizations need to think about spanning inpatient and outpatient settings, which involves integration between hospital and ambulatory systems. ACOs also will require integration between clinical and financial systems.
Organizations will have to pay attention to ordering lifecycle management, he explained. That is, orders are initiated, scheduled, fulfilled and then followed up on. “There will have to be communication and follow-up as well as real-time monitoring to alert about any unacceptable delays in the order process,” Mullen said. He said Marshfield is looking at how to support enterprise-wide electronic monitoring of that ordering lifecycle and how to provide real-time alerts about delays.
There will be an emphasis on transfer-of-care summaries and how to facilitate information sharing across the full continuum of care, he said. “For instance, you will have to work into care management plans the notification of home health agencies,” Cummens added. “In an ACO model, you will have to have methods in place to communicate all this information to providers who are not part of your own organization. People will have an option to see providers outside an ACO, so you will need to be able to transfer care summaries and discharge summaries outside the ACO.”
Also, because patient involvement is a key part of ACOs, the IT infrastructure will have to support patients signing off on their care plans and document their progress toward reaching goals, he noted. That will involve some type of self-management tools and personal health record access to their own data.
Cummens noted that the patient-centered medical home is geared toward an individual practice, and meaningful use metrics are geared toward providers, but ACOs will require managing data across enterprises. “When we visualize this and realize we are dealing with multiple electronic health records, the infrastructure for ACOs really has to ride on top of that,” he said. He sees the need for a new type of system, probably outside the EHR, that can bridge organizations, allow for risk assessment and analytics and reach down into tools for day-to-day management. That’s a tall order.
Some organizations, such as Geisinger Health System in Pennsylvania, have customized their off-the-shelf clinical software to create team-based tools, he said, but most organizations will probably find it more efficient to buy or create a separate software system outside the EHR for all the new tasks the ACO will require.