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| The Health Record Review by Mansoor Khan, ScD |
ACO IT Roadmap: Starting Small, Scaling for Growth
Posted on Wed, Jun 29, 2011 - 08:10 amGuest commentary
The Centers for Medicare & Medicaid Services’ (CMS) new regulations for accountable care organizations (ACOs) clearly demonstrate that technology will play a significant role in ACO implementation. Institutions already creating ACOs have begun implementing electronic medical records (EMRs). However, for the multiple stages of meaningful use requirements, hospitals and provider groups must begin the process of integrating substantive population, provider, panel, patient and problem area-analytics into their planning processes and workflows.
As providers assume greater financial responsibility for patient health outcomes, and they push to execute on the objectives of error reduction, standardization and improved coordination, the need for a stronger technology backbone that helps manage a population and individual patients is greater than ever before.
Clinical IT needs at an ACO
Going forward, if healthcare systems are to successfully execute on the objectives of error reduction, standardization and improved coordination, they will require additional information technologies (IT). In general, two sets of technologies are needed.
Going forward, if healthcare systems are to successfully execute on the objectives of error reduction, standardization and improved coordination, they will require additional information technologies (IT). In general, two sets of technologies are needed.
First, systems must capture, standardize and structure health information and transactions. Representative solutions include EMRs, picture archiving and communication systems (PACS), and computerized physician order entry (CPOE). These solutions serve as the informatics backbone -- making data available in more places, removing the known errors associated with the absence or miscommunication of information, and helping to increase clinician productivity.
The second set of solutions includes analytics and clinical decision support. These systems interpret longitudinal data to inform care providers and health system planners. Unlike EMRs, which help standardize the documentation of care, clinical decision support and analytics solutions aim to standardize the delivery of care. Specifically, they intend to improve patient care by providing clinicians with insight and guidance using known patient histories.
Start small and grow quickly
The ACO roadmap needs to be well-planned. To create effective ACOs, organizations need a solid IT infrastructure. The type of continuous quality improvement envisioned in the ACO model also requires comprehensive clinical decision support (CDS) at the point of care -- not to mention population-, practice-, provider- and patient-level reporting to determine whether the encounters are successful and compliant. CDS and analytics must support the clinical and administrative needs of an ACO seamlessly, based on one evidence-based platform that satisfies multiple stakeholders, at many touch points in the care process.
The ACO roadmap needs to be well-planned. To create effective ACOs, organizations need a solid IT infrastructure. The type of continuous quality improvement envisioned in the ACO model also requires comprehensive clinical decision support (CDS) at the point of care -- not to mention population-, practice-, provider- and patient-level reporting to determine whether the encounters are successful and compliant. CDS and analytics must support the clinical and administrative needs of an ACO seamlessly, based on one evidence-based platform that satisfies multiple stakeholders, at many touch points in the care process.
Dressing up static order sets and adding a few hard-coded rules can no longer be called clinical decision support. To meet the numerous requirements of delivering effective care, engaging patients and continuously improving processes, organizations will need to deploy systems that provide multi-parameter, real-time decision support.
Additionally, to meet the continuous improvement requirement, such systems need to provide a large library of evidence-based content that is truly integrated with both population management analytics and analytics showing the financial impact of discrete clinical events. Only when all these technologies are integrated on a web services-based platform that is also able to process the Clinical Document Architecture, will our health system reap the benefits of accountable care.
Focus on what’s important now
When creating an ACO, the best way to facilitate a positive experience within an organization is to choose a specific area that needs improvement. Some health systems will focus on population management analytics first, while others may pick high-volume disease states around which to innovate. A third system may choose to close known gaps in care using alerts at the point of care. While the ideal starting point is institution- and situation-specific, the key is not to try and do everything at once. Selecting one or two focus issues and resolving them will create a platform to grow the ACO.
When creating an ACO, the best way to facilitate a positive experience within an organization is to choose a specific area that needs improvement. Some health systems will focus on population management analytics first, while others may pick high-volume disease states around which to innovate. A third system may choose to close known gaps in care using alerts at the point of care. While the ideal starting point is institution- and situation-specific, the key is not to try and do everything at once. Selecting one or two focus issues and resolving them will create a platform to grow the ACO.
Make it enjoyable, or at least non-disruptive
Moving to an ACO is challenging. Changing clinical workflows and IT tools as part of that transformation can be intimidating to the organization. Ideally, introduction of analytics and CDS, patient-driven orders, or automated patient-education, should be as non-disruptive to clinicians as possible. From a technology perspective, this includes using existing IT tools and frameworks, and augmenting them with data and transactions deployed using web-based services. When entirely new solutions are needed, an outstanding user experience, as well as clinical excellence, is paramount in any selection process.
Moving to an ACO is challenging. Changing clinical workflows and IT tools as part of that transformation can be intimidating to the organization. Ideally, introduction of analytics and CDS, patient-driven orders, or automated patient-education, should be as non-disruptive to clinicians as possible. From a technology perspective, this includes using existing IT tools and frameworks, and augmenting them with data and transactions deployed using web-based services. When entirely new solutions are needed, an outstanding user experience, as well as clinical excellence, is paramount in any selection process.
Ensure that deployment can change over time
As ACOs continue to evolve, the informatics requirements will rightly change as well. Rigid clinical IT solutions may be excellent at accomplishing key tasks specified today in a request for proposal. However, flexibility to grow and adapt to changes in provider needs, clinical priorities, deployment models and information requests is equally important. Any clinical knowledge embedded in a solution must also be flexible when adjusting functionality. The solution provider, whether a vendor or in-house developer, must furnish provider tools and services to manage the content over time, as medical science in general (evidence), and comparative effectiveness research in particular, evolve.
As ACOs continue to evolve, the informatics requirements will rightly change as well. Rigid clinical IT solutions may be excellent at accomplishing key tasks specified today in a request for proposal. However, flexibility to grow and adapt to changes in provider needs, clinical priorities, deployment models and information requests is equally important. Any clinical knowledge embedded in a solution must also be flexible when adjusting functionality. The solution provider, whether a vendor or in-house developer, must furnish provider tools and services to manage the content over time, as medical science in general (evidence), and comparative effectiveness research in particular, evolve.
As the ACO model gains momentum in healthcare, the innovators must be there to give hospital, payer and EMR clients new methods to ensure each care encounter is as informed as possible and continuously improving quality. By taking the appropriate steps to plan IT strategy, providers will be uniquely positioned to reap the financial windfalls associated with consistently providing evidence-driven, informed care to finally close the loop on the care process.
Mansoor Khan, ScD, is chief executive officer at DiagnosisOne, a clinical decision support and analytics company. He has over 20 years of technical IT and management experience in multiple industries. Mansoor earned his Doctor of Science degree at MIT in 1988 and prior that, a B.S. and M.S. from Auburn University, where he worked on predictive modeling. Mansoor started his career at MIT as a research scientist. Prior to DiagnosisOne, Mansoor was founder and CEO of KeyCommerce, where he took the company from a start-up to an established player in the electronic commerce industry; KeyCommerce customers included companies such as Sun Microsystems and Raytheon.
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Excellent comments and