The healthcare industry’s transformation from a volume-based to a value-based payment model has resulted in new partnerships, collaborations and approaches to clinical care. Accountable care organizations (ACOs) are a critical component of the new healthcare environment as providers seek the best way to optimize patient care with cost-effective strategies.
The success of an ACO rests on a healthcare organization’s ability to easily collect, store and share clinical and financial data. To achieve the level of interoperability needed for effective exchange of healthcare data, the organization must overcome financial, staffing and technological challenges, as well as potential reluctance of individual providers to adopt new technology and to share patient data.
Although the primary focus of an ACO is the aggregation and analysis of metrics to produce the outcomes and financial reports required at the collaborative care level, this approach does not ensure that the right data is collected. All of these challenges are best addressed by approaching the development of ACO data exchange and management with the same strategy children use when playing with building blocks.
Just as a child creates a structure with building blocks by starting with the base or foundation, a successful ACO begins building its health data exchange at the foundation or physician practice level of the healthcare business. The patient-provider relationship starts with individual patients, physicians and a single medical record. Collecting complete clinical information at the point of care – including clinical notes, lab and imaging results, medications, diagnoses and treatment plans – ensures providers throughout the care continuum have a thorough overview of the patient’s medical history.
[See also: 3 interoperability building blocks for ACOs.]
While physicians have implemented electronic health records (EHRs) to meet Meaningful Use (MU) requirements, not all practice management and EHR systems are the same. Even if the same system is implemented by two practices, one may use it differently than another. For example, practices may optimize their use of the EHR to match their prior paper-based workflows, which vary considerably from one practice to another. If different practices order from different labs (or even if one practice orders from multiple labs) the coding and format of the lab result data will be different. Factors such as these lead to considerable variation in data for the same patient across practices.
A collaborative care organization faces these challenges when enhancing practice-level use of EHRs:
• Financial concerns about the cost of technology and staff training that is not offset by MU incentives;
• Perception that collecting more data means more work;
• Lack of technology expertise to oversee implementation of robust systems in the practice;
• Reluctance to give up legacy systems;
• Unwillingness to modify existing workflows to make better use of EHR technology and to facilitate data sharing.
An ACO, or other collaborative care organization such as a patient-centered medical home (PCMH) or population health management program, can improve the practice-level use of EHRs by implementing the following strategies:
• Work with the practice to provide or obtain training to enable full use of existing EHR or practice management systems, and help them understand how data they are capturing at the point of care is critical for patient care within the ACO;
• Offer open, web-based solutions that provide links to labs, imaging services, or other providers that work with existing systems to enhance rather than disrupt practice workflow;
• Provide a platform that provides connectivity physicians need to share data with other ACO members and enables updates or changes while minimizing the impact on individual practice operations.
• Provide immediate or near real-time feedback regarding how well the providers are performing against the ACO or quality metrics so that they have time to make necessary changes rather than a quarter or year later.
Investing time and resources to capture the right data at the first point-of-contact between patients and providers, and storing it in the EHR in a readily usable form, sets the stage for the next step in exchanging health data among disparate providers since most of the care is delivered at the practices. This ultimately leads to the final stage of data exchange which addresses analytics that support business decisions for a sustainable ACO.
Naveen Sarabu is the director of product management for Liaison Technologies, which provides healthcare organizations with solutions to integration and data management needs. Sarabu received his MBA from the University of North Carolina, Chapel Hill. He can be reached at NSarabu@liaison.com.
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