ACOs hamstrung by poor data exchange
Most accountable care organizations have health information technology in place to improve quality and lower costs, but many say difficulties with interoperability are keeping them from reaching their potential.
Of the 62 ACOs polled by Premier healthcare alliance this past summer, 88 percent report "significant obstacles" in integrating data from disparate sources. Also, 83 percent say they have a hard time fitting analytics tools into their workflow. As ACOs grow, gathering data from more and different care settings, these challenges become more acute, according to Premier.
Cost and ROI are also cited as key roadblocks to more effective implementation of health IT, according to 90 percent of respondents.
Even when ACOs have successfully merged health IT systems, "they aren't able to effectively leverage data and analytics to derive value out of their investments given the pervasive issues with data quality, liquidity and access, as well as issues with integrating data from disparate sources," said Keith J. Figlioli, Premier's senior vice president of healthcare informatics, in a press statement announcing the findings.
The numbers reported in the survey suggest interoperability is a "pervasive problem among ACOs, and it could stymie the long-term vision for ACO cost and quality improvements if not addressed," Figlioli added.
The good news is that ACOs are reporting heartening improvements in clinical quality (66 percent), preventive screenings and vaccinations (63 percent), chronic disease management (59 percent) and health outcomes (55 percent). But those percentages could be even higher.
"While accountable care organizations are providing quality care for many patients, even more could be accomplished if interoperability issues were addressed," said Jennifer Covich Bordenick, chief executive officer, eHealth Initiative. "However, the cost of interoperability can be prohibitive for many organizations."
In a Sept. 24 call discussing the report's findings, Bryan Bowles, Premier's vice president for population health solution management, noted that this new era of shifting risk from payers to providers requires a lot of these organizations, necessitating that they manage health at both an individual and population level, and make smart use of clinical, claims, financial and administrative data.
Mercifully, "you have to do it all, but you don't have to do it at the same time," said Bowles.
Indeed, ACOs nationwide exist at very different levels of IT maturity, said Tracy Okubu, senior director of HIT stakeholder outreach at eHealth Initiative.
"The majority of the surveyed ACOs have some sort of health information infrastructure that can support quality measurement, population health management and physician payment and contract adjudication," said Okubo.
Core health IT components for these organizations "include electronic health record, disease registry, data warehouse and clinical decision support systems," she said. "However, only 28 percent of ACOs report use of revenue cycle management or a master patient index, suggesting that many organizations may not be well-equipped to manage populations and lower costs."
Without those components in place, "most ACOs also report that their infrastructure is unable to effectively support patient engagement and risk management," said Okubo.
"Similarly, ACO capabilities for distance-based medicine have yet to fully mature, with few organizations able to use secure messaging, referral management tools (or) phone- or video-based medicine," she said. "Given that many of the newer ACOs are forming in rural and/or underserved areas, it is concerning that ACOs may be unable to leverage health IT to effectively manage populations in some of the more remote geographic areas.
Size matters, said Okubo, but only a little bit.
"Generally speaking, small-to-medium-sized ACOs – fewer than 100 physicians on staff – do not have a health IT infrastructure beyond the four building blocks of a data warehouse, disease registry, electronic health record or health information exchange," she said.
"However, capabilities do not change significantly among large ACOs with more than 100 physicians," she added. "Less than half of large ACOs feature clinical decision support, record locator service, revenue cycle management, telemedicine or referral management system. Larger ACOs have more technical capabilities and are better staffed and equipped."
The good news is that once ACOs reach 18 months of operation, "they report substantially more advanced capabilities, data use for analytics and performance improvement associated with health IT," said Okubo.
The big hurdle, of course, is that "many of these things are all interrelated," said Bowles.
"Disease registries are based on data coming out of electronic health records. You've got your data warehouse where you have your inpatient data from the HER; you've got your ambulatory footprint, you're dealing with adjudicated claims coming from payers; you've got your affiliated physicians that are in your ACO but not necessarily on the same IT platform, the master patient index certainly is central to knowing which patients are which across those systems."
Synergy of that level necessitates a very robust level of technological interoperability – one that's still yet to materialize in most cases.
Premier data shows that right now a majority of ACOs pull data from fewer than 10 different data platforms. However, as ACOs gather information from more and more sources, they're reporting decreased ability to leverage IT infrastructure to support critical tasks such as care coordination, patient engagement, physician payment, population health management and quality measurement.
"There have been significant investments made into health IT infrastructure over the years," said Okubo. "But ACOs continue to report significant challenges in being able to use the technology."