An afternoon session on June 3 at the Health Datapalooza in Washington, D.C., got right down to the nuts and bolts our readers like to hear about. It featured several chief medical officers and chief medical information officers of accountable care organizations talking about their technology needs. Even the moderator was a heavy hitter: Rick Gilfilan, director of the Center for Medicare & Medicaid Innovation. He had asked the speakers to prepare to talk about what types of tools they are finding the ACO efforts need and how they make the decision to buy or build them themselves.
To my surprise, most of the speakers said they had no interest in being software developers but felt they had no choice but to develop their own systems when they found nothing on the market that matched their needs.
William Chin, M.D., executive medical officer of Healthcare Partners, a managed-care provider based in Torrance, Calif., with operations in five states, said his organization is participating in the Pioneer ACO program. “Technology is critical for us, and everything we have is homegrown. We looked at proprietary systems but nothing met our needs,” he said. “The tools have to be seamless to the doctors and woven into the work flow.” He described three tools Healthcare Partners has built: a web-based point of care reminder that identifies gaps in care for the care team. “That has proven the single most important care tool to improve quality,” he said. Another tool guides care managers in creating and following care plans. The third is a clinical decision support tool.
Joe Kimura, M.D., chief medical information officer at physician-based Atrius Health in eastern Massachusetts, said his organization is on a single EHR and has invested in an enterprise data warehouse. “We think about two words when we look at new analytics tools: actionability and learning. We need those tools to actually drive change.” He said Atrius has piloted some commercial analytics offerings, but “they weren't serving end users the way we would like them to, so in the past we have built a lot in house. We are being forced to, because we are not seeing tools that meet the needs of our organization.”
Andy Patstone, vice president for strategic initiatives at MaineHealth, an integrated Health system based in Portland, said that as her team started wrapping their minds around ACOs, “we scanned the market and didn’t see analytics solutions that we wanted.” So they joined the Northern New England Accountable Care Collaborative, along with Dartmouth-Hitchcock Health and Eastern Maine Healthcare Systems. NNEACC provides an ACO technology suite that integrates and augments select clinical data, claims data, public health data and patient-reported data.
“We have invested for the last three years in an Epic EHR system and have very little left for the population health tools we know we need,” she added. For the average healthcare system, extracting data from EHRs “feels like we are making sausage with our bare hands everyday. The data we need is squirreled away in EHRs and we need to get it out.”
Patstone also is looking for practical tools to make providers’ lives easier. “We need to push work back from the physician to a team and optimize the team’s approach.”
Mark Wagar, president of California-based Heritage Medical Systems, an affiliate of the Heritage Provider Network, said his organization doesn’t particularly care whether it buys or builds a solution. “What we care about is whether it is actionable from a clinical or care coordination standpoint,” he said. “We want to know how you can make it easy for clinicians to use and do something different with patients. We have tended to build more than buy. We prefer not have to spend capital developing systems, but sometimes we have no other alternative. We want clinicians to be drivers of change.”
Jessica Dudley, M.D., chief medical officer for Partners Healthcare in Massachusetts, noted that one challenge is finding tools that are workflow-integrated so they actually lead to efficiency gains. “In the care coordination space we are doing a lot of cutting and pasting because we haven’t found a solution that meets our needs,” she said. “Providers want handheld solutions that are as easy to use as an iPhone.”
As Atrius Health’s Kimura put it, there is an influx of data from new technologies such as personalized medicine and remote monitoring tools. “The challenge is how to synthesize it in ways that help clinicians make sense of it. That is an area that needs more work.”