This series of commentaries has attempted, early in Accountable Care Organization (ACO) development, to identify health information technology functionality and architecture to support their developing needs.

Part I discussed possibilities for data warehouses, analytics, and reporting systems as well as models for outsourcing analytics to other organizations and “the cloud”. Part II focused on ACO health information exchange to support advanced information access for providers and applications.

Both emphasized population data management and registry capabilities in Medical Home, ACO, and public health contexts. ACOs bring new provider-side responsibilities and in both pieces, I discussed provider-side views on information. In Part I it was the “view” of the health system looking at its data. In Part II it was the individual providers’ view of the clinical data of the organizations in the ACO.

Provider-supported patient view

The organizing principal for this final take is the patient’s IT view on the ACO and the need to bring together coordinated communications, health record, and care support services.

This patient view may include a provider-supported patient portal, patient mobile health tools, home monitoring systems, and communications tools that face the patient as they interact with providers, provider data, and the provision of care.

[NHINWatch Editor Patty Enrado: The importance of coordinated care and the full patient narrative.]

The degree to which ACOs can present an integrated view across services and providers will vary. The organizations closest to having this kind of simplicity and access for patients now are major health systems and plans that provide care. ACOs have been somewhat modeled after these types of organizations, and the degree to which they can match their integrated IT environments will be related to the ACO’s success.

The starting assumption, however, is that ACOs, as sometimes loose associations of community providers and hospitals will not, themselves, support significant IT infrastructure. Some may be dominated by organizations with well-coordinated internal infrastructure that will. But in general, HIT coordination will depend on the types of included organizations, the organizations’ existing infrastructure, and the ACO’s political maturity.

Outsourcing and cloud-based services may be a key strategy for ACOs that are not close to an integrated organizational picture but recognize the need to get there. We have previously discussed how important an integrated ACO enterprise data environment will be for analytics and information access. It will also be a key metric for patient value and outcomes.

A technical triple aim?

From the perspective of the patient, a lot of HIT falls flat because it tries to connect to care that is loosely organized and provider oriented. Patients want services that provide value to them regardless of whom they need to connect to and where they need to find the relevant data. Patients want easy access, easy communication with those involved in supporting their care, and the ability to trust that their interests are being looked after in data sharing. The evidence is that rather than managing their own records patients want the healthcare system to manage them in a trusted way.

It is not surprising that the portion of the PHR industry that is getting the most traction is provider-tethered PHRs as elements of provider-supported portals.

[Q&A: On ACOs and the 'cartelization' of healthcare.]

Tethered PHRs generally have the best and easiest access to patient data and services. They can provide additional high value services like secure patient-provider email, scheduling, and lab result access. These seem to be as least as strong drivers for patient engagement as traditional record retrieval.
If you add portal functions of prescription renewal, remote patient monitoring, prevention programs, disease management, and care plan interactions, there is a compelling accumulation of patient value. If that value is then associated with a single portal where they only need to understand and remember one access methodology, where they can access all of their different providers and data, and where they can schedule multiple providers as part of a plan of care, patient centricity comes into focus.