Getting up to speed

Dr. Edward Gold gets a reminder by computer when a patient missed a needed test or clinic visit. But that information stops when his patients visit a hospital or nursing home. Computers at Gold's clinic cannot talk to those on the outside. Not yet.

Connecting Old Hook Medical Associates in Emerson, N.J., where Gold practices, to other independent physician groups and Hackensack (N.J.) University Medical Center has become a high priority as the doctors and hospital seek selection as a Medicare accountable care organization.

“That's the hardest thing to accomplish,” Gold said of the effort to link the group's diverse information technology so that patients' medical history can be analyzed and shared among caregivers. “You can have case managers and you can have education, but the information's got to be coordinated,” said Gold, vice president and chief medical officer for the Hackensack ACO. “It's really not worth much without the information.”

Federal health policy has given new urgency to efforts by clinics and hospitals to use IT to more closely coordinate medical care. The CMS awarded $2.5 billion last year of about $27 billion to promote health IT (Jan. 23). And Medicare recently began to name networks of doctors and hospitals as accountable care organizations, which are eligible for financial incentives to boost quality and curb healthcare costs. The CMS requires ACOs to report use of electronic health records among primary-care doctors as one performance measure tied to incentive payments.

With EHR software to flag high-risk patients, home monitoring for the chronically ill and other IT, doctors and hospitals can better manage diseases and prevent costly and harmful complications, healthcare executives say. And Medicare and commercial health plans will demand better care coordination, disease management and prevention services of ACOs under contracts that call for measuring and rewarding quality and efficiency.

But first, hospitals and clinics must find ways to patch yawning technology gaps across the industry, including paper records and a babel of software.

Growth of accountable care prompted the eHealth Initiative to release guidelines for IT investment necessary to support the various models that providers, the government and private payers are conceiving under that name. The Washington-based not-for-profit said in a January report—developed with comments from 100 individuals and organizations—that information technology should be flexible, secure and able to support care coordination and data analysis.

Jason Goldwater, vice president of programs and research for the eHealth Initiative, said the report sought to avoid overly prescriptive recommendations that would become obsolete as technology evolved.

Information technology should enable care coordination and collaboration and allow for secure transfer of personal health information, the report said. Other recommendations included integration of evidence-based clinical decision support and the means to help patients and caregivers to be informed and play a role in managing their own medical care. Technology should support efforts to improve patient safety, through quick feedback, tracking and predictive modeling, and boost quality for at-risk populations, by aggregating data, giving patients access to their own health records and home monitoring using telehealth.

New payment structures will also require billing and collection technology to support financial analysis, according to the report. Those functions should support data gathering, analysis and financial modeling and identify opportunities for improvement.

Lee Marley, vice president and chief information officer for Presbyterian Healthcare Services' Central New Mexico ACO, said technology investments will enable the eight-hospital organization to standardize medical care along clinical guidelines and allow for data analysis to support clinical decisions. Roughly 70% of Presbyterian Healthcare Services' physician clinics have adopted a uniform EHR system, and its first hospital will make the switch next year, she said.

The push from payers for new payment models such as accountable care has forced hospitals and clinics to accelerate and expand technology adoption.

Banner Health initially moved at a “modest pace” to acquire technology that can analyze medical records for trends and give patients access to personal health information, said Dr. John Hensing, the system's executive vice president and chief medical officer.

That was before the Phoenix-based system became one of the first Medicare ACOs in January. Banner was among 32 networks selected for the CMS Innovation Center's Pioneer Model Program. “There has been an acceleration of interest,” Hensing said, since Banner agreed to manage the treatment and healthcare costs for seniors in Medicare.

Banner's technology and experience leave the system prepared for accountable care, he said, but more technology investment will be needed. The last of Banner's 22 hospitals installed an EHR system last fall. By the end of the year, its offices should all have the technology. But the system lacks the ability to analyze population data.

Independent doctors in Banner's network operate using a “mishmash” of information systems, Hensing said; some have no system at all. Officials are calculating the investment required to ensure all doctors have EHRs he said. For now, Banner must find ways to collect performance data from diverse information systems or paper charts.

The overall effort to adopt new technology and integrate disparate systems, is expected to take two years.

In Massachusetts, where the state has expanded health insurance coverage under a 2006 law with a framework similar to the Patient Protection and Affordable Care Act, one Boston health system has committed

$100 million toward technology since 2008, but also expects more investment will be required to support its accountable care efforts.

Steward Health Care System has begun to evaluate an upgrade for its technology to identify patients who would benefit from intervention to prevent complications or hospital visits, said Dr. Mark Girard, president of the Steward Health Care Network and executive vice president of the system.

Girard, who oversees Steward's accountable care efforts, said the system will require more sophisticated analysis of its patients as a Medicare Pioneer.

The system will seek to expand its IT to capture information from long-term settings such as nursing homes, Girard said. Steward also is developing portals to allow patients to access medical records and caregivers to communicate information about patients.

Spending on information technology increased at AtlantiCare as the Egg Harbor Township, N.J.-based health system prepared for a commercial accountable care contract. Christopher Scanzera, AtlantiCare's vice president and chief information officer, said the system recently bought software to analyze medical records and flag gaps in medical care. AtlantiCare will rely on a regional health information exchange to collect data from independent doctors with mismatched information systems.

Hackensack University Medical Center will also connect its network through a regional health information exchange. Benjamin Bordonaro, chief technology officer for Hackensack University Medical Center, described its ACO as “neck deep” in an inventory of clinics' information technology—including some practices without any.

“We will have to get them up to speed pretty quickly,” said Dr. Peter Gross, former chief medical officer for the hospital who stepped down to oversee the ACO's development.

Independent doctors who have already invested in systems are understandably unwilling to switch, Bordonaro said. But some systems may be outdated and candidates for an upgrade. A single system would be ideal but unrealistic, even as the participants strive to fulfill the ambitious goals of the ACO endeavor. “That's never going to happen,” he said. “It's not a perfect world.”