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The Accountable Care Organization (ACO) draft rule is out, and the political, clinical and technical trek is on to establish these lynchpins of the Affordable Care Act and health reform. Community physicians and hospitals are jockeying for potential shares of the incentives that will be distributed via the ACO program. Health information technology has been so frequently cited as being a critical part of making ACOs successful that it is now de rigueur.
But if ACO information technology is assumed, it's still not completely defined, and certainly not completely available or implemented.
ACOs will need new analytic, clinical workflow, administrative and communication functions if they are to actually reduce costs and improve care. They'll have to aggressively pursue prevention, decision support, error reduction, revenue cycle optimization and disease management to be successful. But not all of these functions or activities are currently performed by existing electronic health records, health information exchange or traditional hospital IT systems. Where the functions do exist, they aren't carried out at the required scale in an integrated fashion across multiple care organizations.
With this article we will begin an exploration of the HIT needs of ACOs. While provider organizations are hashing out the financial distribution, we will start with the second most important influencer – the data. Data for an ACO can be considered as being used for at least three purposes: 1) to analyze and report on trends in clinical and claims data, 2) to support traditional clinical care and administrative recording processes, and, in a new category; 3) to manage shared information across multiple providers such as in ACO-wide managed problem lists, medication lists, care plans or directories of identity and privacy settings.
Here we focus on use the first: data analysis and reporting.
Identifying the Analytic Data
As HIT goes through its awkward teenage years and heads toward young adulthood, it's clear that a mix of well and poorly structured and maintained clinical data will persist. The first stage of meaningful use didn't specify health data transactions, but it began to specify a few important terminologies for recording problem, drug and lab data. These and other standards will be important when they slowly find their way into clinical systems as, at least, mappings for local codes and terms. Comparable high-quality, coded clinical data is important because, in conjunction with coded but clinically flawed claims data, it will be the basis for forming comparable lists, charts and statistical analyses of costs and care.
The ACO draft regulation describes how ACOs can get identifiable Medicare claims data from the Centers for Medicare and Medicaid Services. It's assumed that this will lead to the availability of Medicaid and even all-claims data at the ACO level as well. With both coded clinical and claims data in hand, ACOs will be better able to report on and, more importantly, advance IT and non-IT programs to manage costs and quality internally. ACOs need to work on where high healthcare costs align with actionable programs for prevention, clinical efficiencies and comparable, but more economical, treatments.
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