CHIME TIME: Accountable care requires a solid foundation of health IT

Providers realize that reimbursement for healthcare delivery is changing. The economic and cultural forces now buttressing accountable care and value-based healthcare delivery have never been stronger.

In response, providers are integrating, aligning, consolidating and forging new relationships to adapt to new economic incentives. Information collection and distribution—and the technology that supports it—will be crucial to enable a successful transition from a service volume-based model to a value-based approach.

Core IT capabilities will support providers in moving to accountable care. Having gee-whiz technology won't be enough; providers will need to use IT so that they can increasingly optimize care delivery.

Organizations must recognize that these technologies will require a lengthy deployment and adoption period as well as extensive cultural change. It will be costly, and technology acquisition and ownership often requires significant upfront capital, as well as ongoing operating expense and human resources. There's little option here—the future of healthcare demands radical change that will be enabled by information technology as never before.

Here's the core IT that ACOs will need, and how they'll need to use it:

EHRs were once viewed as a strategic differentiator; now, they are considered a routine cost of doing business. They require significant cultural change and expense, but automation of the point-of-care is where care delivery improvement begins. The information needed to support value-based care delivery makes it essential that all venues use EHRs.

ACOs won't be able to function without technology that ensures prompt and accurate patient registration, billing and collections, as well as convenient appointment and procedure scheduling. Organizations will need seamless integration of this platform across all hospital-based and outpatient environments. Current systems will need to evolve to accommodate ACOs' bundled payments.

Providers will need to significantly raise the engagement level of patients and their families in making care decisions. Routine access to health records and care-management materials—as well as transactional capabilities such as appointment scheduling, provider messaging and prescription refills—must become common, and providers must encourage their use.

Clinicians need timely access to information that supports continuity of care across a wide range of providers. HIE has been a big challenge, but it must be solved for ACOs to work well. Those providing and managing care will need to adjust workflows to incorporate health information from many sources.

Proactive management of health status of individuals and populations is essential if providers are to manage risk. Success hinges on illness prevention, as well as the recovery from illness, largely enabled by technologies that are not widely used now. Future care interventions will need to be proactive, based on medical record surveillance and other ways of monitoring patient compliance. IT will help identify patients at risk for health status decline or unnecessary care utilization.

To prevent patients' conditions from declining, providers will need enhanced “in the moment” decision support at the point-of-care. These systems should be configured to deliver appropriate clinical alerts while avoiding overuse that results in provider “alert fatigue.” CDS will become increasingly effective as EHR technologies evolve and cultures adjust to the increasing relevance of alerts.

Data needs to be used to answer not only what has happened and why it happened, but also to ultimately forecast what can or will happen (predictive analytics). Technology platforms for analytics are growing in number, as are those who are skilled in their implementation and use. Organizations will need to guard against creating duplicate or multiple analytics solutions that overlap in functionality or that use common source data; this often yields inconsistent values for the same metric and leads to multiple versions of truth.

Accountable care will drive increased IT investment, most likely requiring organizations to reprioritize spending levels and their related objectives. Successful adoption and benefit realization will demand higher levels of skill and leadership. The culture of healthcare delivery and management must change to reflect the increased importance of process automation and data capture.

Rick Schooler