Wednesday, April 25, 2012

Five IT Tactics of an Accountable Care Organization

I recently presented a webinar outlining the the IT work ahead to support Accountable Care Organizations.

Here are the slides that I used.

I recommended five priorities to create a foundation for care management and population health:

1. Universal adoption of EHRs - every clinician in an ACO needs to record data electronically, ideally using the same EHR vendor.   If not the same EHR, then using common pick lists/vocabularies enables data to be comparable across practices.   At BIDMC we created a model office workflow to ensure data is recorded by individuals with the same role at the same time in the same processes using the same value sets.

2. Healthcare Information Exchange - data should be shared among caregivers for care coordination and panel management.   Approaches can include viewing data in remote locations, pushing summaries between providers, or pulling summaries from multiple sites of care.   BIDMC has created novel approaches to secure data sharing as well as participated in many federal and state HIE pilots.

3. Business Intelligence/Analytics - once data is collected and shared, it needs to be analyzed retrospectively to identify gaps in care and prospectively to ensure patients receive the right care at the right time during their encounters with clinicians.   BIDMC has worked with the Massachusetts eHealth Collaborative to create a community-wide quality data center as well as piloted popHealth to support our analytic needs.

4.  Universal availability of PHRs - engaging patients and families in their care, ensuring communication of care plans and achieving seamless handoffs, is essential to keeping patients well.   BIDMC has offered comprehensive PHRs to all of its patients since 1999.

5.  Decision Support Services - care management requires alerts, reminders, pathways, and guidelines.   Ideally, all members of the care team will receive decision support inside their electronic record based on enterprise rule sets.  At BIDMC, we've used the concept of Decision Support Service Providers to to turn data into knowledge and wisdom inside our EHRs and web applications.    

Of these five tactics, the biggest challenge is defining the care management rules - what conditions, wellness measures, home care interventions, best practices, and evidence should be incorporated into the point of care and analytic systems?   Yesterday, at the BIDMC Clinical IT Governance Committee, we agreed to to charter a working group of experts to set these priorities so that our care management strategy is well planned and not a random collection of individual projects, driven by individuals with specific niche requirements (squeaky wheels or siloed departmental requests).  It's a good start.


Dave said...

The link to the slides goes to a Harvard login page.

Given that ~75% of healthcare spend is on chronic disease management and the patient (or family) is control of decisions that drive outcome, I'd like to see how your org will achieve #4 (PHR availability). My observation is that most health systems are woefully unprepared for that 75% and this will drive their success/demise in an ACO model.

That topic is expanded upon in a Forbes piece this week - Health Systems Spending Billions to Prepare for the "Last Battle"

Medical Quack said...

Keep up the good work. I looked at this comment and you know one can be a Monday morning quarterback anywhere but "you" are living and working it John and are one of the best out there. Sure we all know where budgets are and it's not a good thing. I just read this comment here and again there's nothing that can compare to "hands on" experience and you are the expert there for sure.

Sure we would all like to know about the future and analytics give us some good insight but they don't do it all as of yet I have not found any "crystal balls" out there with analytics yet:)

My experience was back a ways and I don't write anymore and my old brain was just flat stuck in VB6:) I'll admit it but the knowledge that I gained from writing from the ground up, unlike platforms was huge. If you can visualize the mechanics from the bottom us, there's nothing else that can compare to that wisdom and you are the best. When I had my HL7 interface work I about fell off my chair when it worked and again those were the very early days and we are far from that now by all means:)

There's software written to sell software today and telling the difference is challenging at times as there are those queries and algorithms written for "accurate" results and those written for "desired" results and the 2 should be the same, but not always when profits and dollars roll in and all of us have to look at each and every angle and you do it well with honesty.

Sure we are going to run out of money and occasionally I get there a little bit with my opinions as the other day I wrote about taxing and licensing the data sellers with getting some real transparency out there too with a disclosure page in a drill down format so at least consumers could see who sells what kind of data to who as the privacy statements written by attorneys don't do much for the average consumer other than confuse.

As taxpayers we a gas tax to keep up our road infrastructure so why not tax the banks, corporations and so forth making billions to help keep up the government IT infrastructure:) States servers are slowing down to a crawl as they have to now kick out some of the mining bots and the states license data miners for a mere pittance. It costs government big dollars to support the miners anymore. We could call it a Buffet alternative:)

Anyway keep up the good "accurate" information and work as there are those that appreciate it versus one more "so called expert" who has never touched a stick of code but seems to think they know it all, kind of like the "Dave" comment:)

Software AG said...

Information exchange is critical! Everyone needs to have access to the same information so the whole system can function properly. When everyone involved has access to the same data, there is less chance for confusion or miscommunication. Everyone always has the most up-to-date information.

Unknown said...

This is an excellent summary. Thanks for sharing it. I would add to the list, that a succesful ACO wuold also benefir from a strong Telemedicine infrastructure, allowing telemedicine to apply to most areas of patient care delivery.This is a smart strategy that certainly decreases the cost, expands the reach of the system, keps the patients where they need to be (safely), decreasing medical errors, improving satisfaction and optimizes communication between patients and providers, and among providers themselves.Please watch the TEDxDirigo talk summarizing our experience with "iPod teletrauma". Here is the link or you can search for tghe term "iPodteletrauma". Please spread as much as you like.

Rafael J. Grossmann, MD, FACS

Will said...

is the webinar recorded anywhere with public access?

Jeremy Engdahl-Johnson said...

What are the risks and opportunities posed by the Pioneer ACO model?

Anonymous said...

Wow, Is this ONC PIN003 progress? Can a local or regional HIE afford to comply with this let alone administer and document it? I wonder if the drafters have ever seen or lived with the budgets of a regional HIE.

If you had the choice why would you join a state HIE effort? Is this PIN one of many to come--to help us??

When will they begin to try to regulate ACOs and CI networks or PHOs as HIEs?