ACO Management Depends on IT
In many ACOs, an enterprise EHR will be out of reach, but other options such as HIE networks that transfer patient record summaries have proven to be an effective compromise, and use of portals that providers can use to review partial EHRs, such as online test results, progress notes and discharge summaries, are a great starting point. Other HIT tools that contribute to cross continuum medical management include:
- Consistent EHR (and HIE) clinical content across venues, such as patient record summaries, health risk assessments, care plans, problem lists, medication lists, discharge plans, standard order sets, visit and other EHR charting templates, and compatible clinical vocabularies.
- Access to online guidelines and protocols—implemented both as look-up features and as built-in content, such as in charting templates—for management of target conditions with an ongoing evaluation (derived from both claims data, as well as clinical transaction data) of compliance by the practitioner.
- Consistent clinical decision support rules and alerts across distinct EHR systems and the continuum of care.
- Provider communication tools, such as options to include notes with referral and transfer orders, and in-box or other messaging modules.
Clinical information exchange
Care coordination and collaboration rests on a foundation of clinical information sharing. A fundamental question ACOs need to answer as they assess HIT requirements is how to provide HIE access. The most popular options are implementing a private network or using one or more public networks such as those offered by regional health information organizations (RHIOs) and being developed for statewide use. Trade-offs are not surprising. Private HIEs provide more control over things like volumes, data and data formats supported, and expansion, but can take time and can be expensive to implement; while RHIOs, for example, often offer immediate access at defined costs, but sometimes cannot accommodate special needs and have rigid data and data format standards.
In order to qualify for Medicare Shared Savings Program and other ACO initiative programs, ACOs will have to provide reports that demonstrate meeting quality of care performance thresholds (among ACO member populations) as defined by CMS and/or other payers and sponsors of their programs. These requirements are increasingly being derived from clinical-based (EHR) data. Furthermore, the pressure from value-based purchasing requirements is spurring the need for real-time quality reporting data and information, such as supporting the collection of clinical core measure information reporting on patient conditions, such as AMI, CHF (including condition on admission and risk for readmission), pneumonia, as well as on hospital-acquired conditions such as sepsis, deep vein thrombosis / pulmonary embolism, and glycemic control. Real-time reporting solutions that provide the clinician with actionable information will be an essential tool in managing high-cost inpatient services and preventing avoidable readmissions.
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