Separate EHRs pose care-coordination challenge for ACOs, OIG finds

Patient care coordination tends to be easier for accountable care organizations whose participants are using a single electronic health record system, HHS' Office of Inspector General said Wednesday.

The need for reliable data-sharing has placed a burden on ACOs to either invest in the same version of an EHR system or rely on non-electronic means, such as phone calls and faxes, to communicate patient information, according to the OIG report. Installing a new EHR can cost provider organizations millions of dollars after taking into account expenses related to purchasing the new system, training personnel and transferring data.

The CMS has suggested that groups of providers who come together to form an ACO have the potential to provide more coordinated—and subsequently better—care to their patients. However, interoperability has proven a key barrier standing in the way of these goals: If a provider can't easily exchange patient data with a colleague in their network, it makes care coordination more difficult.

To assess how ACOs are using health IT tools to bolster care coordination, a research team from the OIG conducted site visits and interviews at six ACOs—four participating in the CMS' Next Generation ACO Model and two in the Medicare Shared Savings Program. All six ACOs had spent at least three years as a Medicare ACO.

The report marks one of the first in-depth looks at how ACOs are using health IT tools to coordinate patient care, said Ivan Troy, a social science research analyst and team leader on the study.

"These ACOs are all using HIT tools with some successes here and there, but we also found that they're all facing challenges of some kind," Troy said. "There's this goal, this promise, of seamless electronic transfer of data across all providers, and we're just not there yet."

Use of the same EHR across an ACO network proved the most consistent health IT effort that improved care coordination. The impact of other health IT efforts—such as health information exchanges, population analytics or patient-facing tools—on care coordination were "less apparent," according to the report. HIEs, for example, often had incomplete patient data.

When it comes to limited data held in HIEs today, "these challenges are not unique to ACOs," the report notes. "Many see a network of high functioning and comprehensive HIEs as a linchpin of interoperability, but the promise of such a network has not yet been realized."

New HHS-proposed initiatives might address some of ACOs' IT challenges.

Last month the Office of the National Coordinator for Health Information Technology released the second draft of its Trusted Exchange Framework and Common Agreement, which outlines principles for promoting nationwide interoperability between health IT networks. The agreement would set federally recognized data-sharing standards, among other requirements.

As it stands today, ACOs that used a single EHR across their provider networks typically were able to share data in real-time, and in some cases share access to a central provider portal. ACOs that used multiple EHRs, by contrast, often relied on other means to share patient data, such as implementing third-party health IT tools or exchanging information via telephone, email and fax.

"In the ACOs we visited, it appears that those ACOs that use single EHR systems were able to maximize that tool for care coordination," the report said. "This may be in part because those ACOs have full access to patient information for all the providers in their networks."

It isn't an easy task for an ACO network to transition to the same EHR, given that many ACOs are decentralized by design. All of the ACOs in the report that mandated a single EHR were ones that employed physicians directly, according to Troy. "The ACOs who didn't use that model relied on whichever EHR systems their providers were using already," he said.

Across the board, ACOs also expressed difficulty exchanging data with those outside their networks. "Getting data from providers not in the ACO network was something that we heard from everybody," Troy said. "That's where the seamless flow of electronic data broke down, and they had to rely on other means."