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Integration of Outsiders’ Data Highly Problematic for ACOs

"Providers are doing the lion’s share of integration work themselves, making it difficult to establish interoperable connections with those that are not part of the ACO."

By Frank Irving

Integrating data from out-of-network providers was the top health IT interoperability obstacle for accountable care organizations (ACOs) surveyed by Premier and the eHealth Initiative (eHI). In particular, the surveyed ACOs said they had high levels of difficulty handling data from out-of-network specialists.

Premier and eHI published their results Jan. 20, based on a survey administered electronically in August 2015. Sixty-eight ACOs responded to the survey.

Nearly 80 percent of respondents said integrating data from out-of-network providers was their top HIT challenge. Almost 70 percent reported problems with specialists’ data — especially so if those providers were out-of-network. In a similar fashion, survey findings indicated that as settings of care and number of providers increased for patients, the less likely it was that their data made its way back to the primary care team responsible for coordinating care.

The research also revealed ACOs’ general disconnect with entities outside the traditional care circle. For example, more than half of respondents reported no ability to integrate data from behavioral health providers. Additionally, 48 percent said they had no integration with long-term and post-acute care settings, while 46 percent said they could not integrate data from palliative and hospice facilities.

Jennifer Covich Bordenick, CEO of eHI, said the results were not suprising.

“We know that it’s relatively simple for providers within the same organization using the same systems to share information about their patients. The real challenge is successfully moving and integrating that data across dozens of different systems, and we’ve found that out-of-network practices often lack the proper incentives to make investments in the data sharing agreements and interoperable interfaces necessary for success,” she said in a public statement. “This lack of liquid data is creating dry spots in care delivery, making it difficult for ACOs to proactively intervene with needed care. Until HIT systems across the continuum can exchange data freely, we handicap ACOs in their quest to achieve healthcare’s Triple Aim of better health outcomes, quality and costs.”

At the same time, however, the report showed ACOs having success in capturing and using data from sources within their networks. Among respondents, nearly 85 percent said they have installed advanced analytics software for handling disparate data sets — most commonly adjudicated claims data and clinical data from EHR or other quality measurement systems. Less commonly, ACO respondents were able to analyze administrative, disease registry and patient-reported data. The most frequent uses of in-network data were to identify gaps in care, spot cost/utilization outliers, compare clinician performance, measure/report on quality, and identify potential risk areas.

ACOs reported use of the following health IT components to support network operations: EHRs (74 percent), care management software (61 percent), computerized physician order entry (57 percent) and data warehouse (55 percent). Nearly half of ACOs said they’re also using other tools to facilitate population health management.

Nonetheless, only 26 percent of respondent ACOs said they use telemedicine for collaboration and communication. And just 16 percent use remote monitoring tools to facilitate care management outside of clinical settings.

“Although ACOs have successfully merged some HIT systems, data access is just the tip of the iceberg,” said Mimi Huizinga, MD, vice president and chief medical officer of Premier’s Population Health Management Collaborative, in a public statement. “Today, providers are doing the lion’s share of integration work themselves, making it difficult to establish interoperable connections with those that are not part of the ACO. Even when those connections exist, that’s really just the first step in a long process of establishing a technical environment to work with the data, create a full view of the care experience and then digest the results across the care team. We urgently need public policies to require interoperability standards in HIT so that providers can access data from any system and unlock the true potential of coordinated, high-quality, cost-effective healthcare.”

The report recommended that standards-based interoperability requirements be established for HIT vendors in the areas of data and knowledge access, workflow and business logic, health information exchange, telehealth and analytics.





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