From the May 2011 print issue
On March 31, the Centers for Medicare & Medicaid Services proposed new regulations for accountable care organizations. While they are complex – in excess of 400 pages in length – it is also clear that technology will play a significant role in implementing ACOs. With more providers financially responsible for patient health outcomes, and the push to execute on the objectives of error reduction, standardization and improved coordination, the need for a stronger technology backbone that helps manage a population and individual patients is even greater than ever before.
Strategies to meet ACO requirements: Start small & grow quickly.
The ACO roadmap does need to be well planned. Most institutions interested in creating ACOs have already begun implementing EMRs and ancillary documentation solutions. They are required for Stages 1 and 2 of the meaningful use requirements under the American Recovery & Reinvestment Act (ARRA) of 2009 and The Health Information Technology for Economic and Clinical Health Act (HITECH). However, even for Stage 1, providers and hospitals alike are finding they require additional technology such as real-time, targeted alerts; evidence-based order sets; patient safety surveillance; lab orders and results; patient reminders; and public health reporting to accomplish critical objectives around clinical decision support and ancillary reporting.
To create effective ACOs, organizations need a solid IT infrastructure – and the right kind of infrastructure. The type of continuous quality improvement envisioned in the ACO model also requires comprehensive clinical decision support (CDS) at the point of care; not to mention population-, practice-, provider- and patient-level reporting to determine whether the encounters are successful and compliant. CDS and analytics must support the clinical and administrative needs of an ACO seamlessly, based on one evidence-based platform that satisfies multiple stakeholders, at many touch points in the care process.
Dressing up static order sets and adding a few hard-coded rules cannot be called clinical decision support anymore. To meet the numerous requirements of delivering effective care, engaging patients and continuously improving processes, organizations will need to deploy systems that provide multi-parameter, real-time decision support. Additionally, to meet the continuous improvement requirement, such systems need to provide a large library of evidence-based content that is truly integrated with both population management analytics and analytics showing the financial impact of discrete clinical events. Only when all these technologies are integrated on a Web services-based platform that is also able to process the clinical document architecture, will our health system reap the benefits of accountable care.
Where to start: Focus on what’s important now.
When creating an ACO, the best way to facilitate a positive experience within an organization is to choose a specific area that needs improvement. Some health systems will focus on population management analytics first, while others may pick high-volume disease states around which to innovate. A third system may choose to close known gaps in care using alerts at the point of care. While the ideal starting point is institution- and situation-specific, the key is not to try and do everything at once. Selecting one or two issues to focus on and resolving them will create a platform to grow the ACO.
Make it enjoyable – or at least non-disruptive.
Moving to an ACO is challenging. Changing clinical workflows and IT tools as part of that transformation can be intimidating to the organization. Ideally, introduction of analytics and clinical decision support, patient-driven orders, or automated patient-education, should be as non-disruptive to clinicians as possible. From a technology perspective, this includes using existing IT tools and frameworks as much as possible, and augmenting them with data and transactions deployed using Web-based services. When entirely new solutions are needed, an outstanding user experience, as well as clinical excellence, is paramount in any selection process.
Ensure that whatever goes in can change over time.
As ACOs continue to evolve, the informatics requirements will rightly change as well. Rigid clinical IT solutions may be excellent at accomplishing key tasks specified today in a Request for Proposal (RFP). However, flexibility to grow and adapt to changes in provider needs, clinical priorities, deployment models, and information requests is equally important. Any clinical knowledge embedded in a solution must also be flexible when adjusting functionality. The solution provider, whether a vendor or in-house developer, must furnish provider tools and services to manage the content over time, as medical science in general (evidence), and comparative effectiveness research in particular, evolve.
As the ACO model gains momentum in the market, the innovators must be there to give hospital, payer and EMR clients new methods to ensure each care encounter is as informed as possible, and each health system leader has the information required to design effective health-improvement strategies. Providers will be uniquely positioned to reap the financial windfalls associated with consistently providing evidence-driven, informed care.
Mansoor Khan is chief executive officer at DiagnosisOne, a clinical decision support and analytics company. He has more than 15 years of technical information technology and management experience in multiple industries.
