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Interoperability Challenges Affecting Accountable Care

While accountable care organizations may be struggling with interoperability, they're showing promise that they can carry out patient-centered outcomes, a survey shows.

By Sara Heath

Accountable care organizations (ACOs) may be struggling with EHR interoperability, but are showing promise that they will be successful in their value-based care initiatives.

According to a study from Premier Inc., ACOs are having some of the same interoperability issues most EHR users are having. These technologies aren’t yet able to universally transfer patient health information from one clinic to another.

ACOs are seeing that they are only able to exchange health information with a limited number of other clinics. Thirty-nine percent of ACOs are only able to exchange information with between one and 10 other clinics, while 44 percent are able to exchange with between 11 and 50 other clinics. Only five percent are able to exchange with more than 100.

Considering the large number of providers patients see, and the patient-centered outcome goals at ACOs, these numbers are not promising.

Several factors help to make interoperability easier. Primary care data being transferred between EHRs make interoperability easier for 63 percent of ACOs, while the adoption of universal standards such as LIONC, SNOMED, and RxNorm have eased the interoperability burden for 61 percent of ACOs integrating laboratory information and 42 percent of ACOs that are integrating pharmacy data.

As more of these universal standards get ubiquitously adopted across the industry, the promise of interoperability grows closer. Additionally, EHR initiatives are setting the standard for better interoperability of all heath information, not just for primary care information.

Despite some of the difficulties ACOs are facing with regard to interoperability, they are adopting various health IT systems nonetheless. These different health IT systems foremost allow ACOs collect ample data, delivering improved population health management and giving ACO executives the ability to track provider efficiency.

“Tools like analytics software enable ACOs evaluate population-level data to compare spending and outcomes across different groups of patients and providers,” the researchers explained. “Administrators can use the results to determine which practices are less efficient and intervene to ensure providers are using appropriate evidence-based guidelines for care.”

Health IT products are also helping ACO providers keep up with their patients’ care, and facilitates better patient-provider communication and therefore patient engagement.

“These tools can facilitate patient-provider communication, enable patients to monitor and manage their conditions at home, and relay important data about a patient’s status to clinicians,” the report says.

In all, the ACOs surveyed reported adopting at least 15 different kinds of health IT systems, all at varying levels. The most universally adopted technology was analytics software, with 84 percent of respondents reporting that they have adopted it. More than half of respondents also reported that they have adopted EHRs (74 percent), care management software (61 percent), computerized physician order entry (56 percent), and data warehouses (54 percent).

Fewer ACOs reported adopting some of the more prominent mHealth products such as telemedicine products (26 percent) and remote patient monitoring devices (16 percent).

This health IT infrastructure has reportedly facilitated various patient engagement strategies through different consumer tools. Sixty-five percent of ACOs report that they use their health IT to do post-discharge/care coaching, and 61 percent state that they coach patients in using their patient portals. Other popular health IT uses for patient engagement include patient navigators and notifications/reminders for gaps in care.

Overall, the study’s results show that ACO models, while still new and evolving, are facilitating the adoption of various health tools and practices to help providers transition to value-based care, which is the ultimate goal of an ACO. The report’s authors suggest that as ACO programs continue as important facets of the healthcare industry, program participants will become increasingly capable of carrying out ACO goals.

“Today, more advanced ACOs are only beginning to experiment with evolving their payment mechanisms to accept greater financial risk as they continue to build out their health IT infrastructures, integrate data from new sources and transform the nature of care delivery,” the study authors conclude. “Results from the survey demonstrate the impact ACOs are having on improving various cost and quality metrics, even with limited data. ACOs are also striving to be better partners to their patient populations, offering a variety of tools and programs designed to engage patients and improve health and well-being.”

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