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HIT Barriers to Patient Engagement Persist

 |  By gshaw@healthleadersmedia.com  
   October 24, 2011

The correlation between accountable care models and healthcare information technology that connects and engages patients permeated conversations at The Center for Connected Health annual symposium in Boston last week.

As news of the final rules broke, participants weighed the importance of electronic health records in a successful ACO business model. And panelists at two sessions discussed accountable care's merits and pitfalls, touted the model's potential to make healthcare more connected and participatory, and warned that many barriers still stand in the way to patient engagement.

Midday Thursday, the first day of the conference, came word that the federal government had released final ACO regulations with major concessions to the original plan. One of the critical changes: The rule no longer requires that 50% of participating physicians be meaningful users of electronic health records.

Some at the symposium reacted to that news with a shrug.

"I don't necessarily think that's a bad idea because I can't imagine anyone [creating an accountable care organization] without an EHR," Joseph Kvedar, MD, founder and director of the Center for Connected Health, said in an interview.

"What's being required of us to be an accountable care organization is a tremendous level of coordination. And God knows we'll need many more technologies than just EMRs. That's the baseline. So in a way it makes sense for them not to have to prescribe that. If we're stupid enough to try without it, then let the chips fall where they may."

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.

Physicians' dissatisfaction about managed care was contagious—and patient perception that the healthcare system was stinting on their care contributed to its downfall, he added.

Managing patients' and physicians' expectations and better educating them about the differences between managed care and accountable care—such as the increased emphasis on quality of care, for example—could help the new model avoid the same fate, said Jonathan Gruber, PhD, a professor of economics at the Massachusetts Institute of Technology.

Dana Safran, senior vice president of Blue Cross Blue Shield Massachusetts, agreed, saying healthcare organizations must frame the discussion in terms of accountability for both cost and quality. Outcomes are the counterbalance that was lacking in managed care.

"The question is [whether it will] be enough from the perspective of the patient," she said. "There's a lot of room to do this injudiciously in terms of incentives."

The biggest challenge facing accountable care, Safran said, is the fragmentation, chaos, and lack of communication that plaques the industry. That will affect whether patients successfully self-manage their care after leaving the physician's office or hospital or whether lack of understanding and motivation, as well as day to-to-day problems and financial barriers will get in the way.

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