HIT Barriers to Patient Engagement Persist

Daniel Sands, MD, agreed. "Any organization that's not using an EHR—they're not going to make it as an ACO. It's going to be hard enough for organizations that do have computerized data to be ACOs and not go under in the first three years," said Sands, a physician at Beth Israel Deaconess Medical Center and senior medical informatics director at Cisco Systems who was also attending the symposium.

Other legislation, including meaningful use regulations under the HITECH, will incent organizations to use electronic health records, said Sands, an advocate for connected, participatory medicine and one of HealthLeaders Media's "20 people making healthcare better" in 2009. "It may be necessary, but not sufficient for ACOs to be successful. But the government shouldn't be deciding that."

The Centers for Medicare & Medicaid Services did retain the use of EHRs as one of 33 quality measures (reduced from the original 65). EHR use, in fact, will be given more weight than the other 32 measures. 

Regardless of the final mechanics of accountable care, hospitals adopting the model will still need to engage their patients in order to get the better outcomes that are required for success, Kvedar said.

Not everyone at the conference was rosy on accountable care. Among the concerns: differentiating between the capitated model of the 1990s.

Timothy Ferris, MD, medical director of the Mass General Physicians Organization and a senior scientist at Partners/MGH Institute for Health Policy, was an internist in the 90s. Fifty percent of patients at the time felt the managed care model was hurting them—whether or not they were in managed care programs, he said.

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