ACO Systemness and Integration

As Accountable Care Organizations take on risk contracts which align incentives to create continuous wellness rather than treat episodic sickness, there is a drive to create “systemness” by moving from acquisitions of practices and hospitals to integration.   There are many ways to accomplish this such as moving to a single EHR with a single database for all sites, by enhancing interoperability of existing software, and by building care management databases that incorporate data from every care location.  

Developing a strategy requires a multi-factorial analysis - requirements, cost, competing priorities, regulatory imperatives, and cultural barriers to change.      From March to July, Beth Israel Deaconess will be working on an integration plan for its acquired and affiliated clinical sites.   From an IT perspective, I’ll create a task force that will design an analytic framework for decision making and then develop a prioritized list of projects.

Here’s the early thinking.

A analytic framework might include:
*Impact factor (number of providers, staff, patients)
*Workflow implications
*Degree of implementation difficulty
*Cost/return on investment
*Benefit (safety/quality, security/compliance, efficiency)
*Cultural/Behavioral factors (i.e. politics that can be an enabler or barrier)

Projects could include
*Hospital Information System consolidation (fewer silos than we have today)
*Ambulatory EHR consolidation (less heterogeneity than we have today)
*EHR replacement (new software that works better for evolving requirements)
*New Care Management capabilities (social, mobile, analytics, cloud)
*New enterprise-wide decision support capabilities (clinical and financial)
*Physical network consolidation
*eMail consolidation
*Telephone consolidation
*Domain consolidation (identity management via a single platform)
*Administrative system consolidation (supply chain, human resources, learning management)
*Desktop image standardization
*Storage consolidation
*Data Center consolidation
*Single PACS/Enterprise archive
*Integration engine consolidation
*Outsourcing selected functions
*Centrally managed security tools and staffing

Of course, priorities have to be driven by requirements, given that time and resources are limited.   Our hope that is a July strategy deliverable can be turned into FY15 budgets that enable us to tackle the highest priorities, knowing that the journey to systemness will take years.