Although most accountable care organizations (ACOs) have the HIT to improve clinical quality, poor interoperability across systems and providers remains a barrier, according to an ACO survey conducted by Premier and the eHealth Initiative. Access to data from external organizations was challenging for 100% of respondents.
The survey, fielded in July to August of 2014, collected responses from 62 ACOs, including members of Premier's PACT Population Health Collaborative.
Compounding the challenge of accessing and sharing data is the fact that 88% of the ACOs face significant obstacles in integrating data from disparate sources, and 83% report challenges integrating technology analytics into workflow—barriers that become more acute as ACOs add new platforms or build on their expansive network of medical settings. As ACOs collect data from more sources, they also report concerns about interoperability and data management. Interoperability of disparate systems is a significant challenge for 95% of organizations using HIT, and could be limiting the abilities of ACOs to exchange data.
Reflecting the provider frustration with interoperability problems, the cost and return-on-investment of HIT has become a crippling concern for organizations today, cited as a key barrier to further implementations by at least 90% of respondents.
"While accountable care organizations are providing quality care for many patients, even more could be accomplished if interoperability issues were addressed," says Jennifer Covich Bordenick, CEO of eHealth Initiative. "However, the cost of interoperability can be prohibitive for many organizations."
Using technology, at least one-half to two-thirds of ACOs reported improvements in clinical quality (66%), preventive screenings and vaccinations (63%), chronic disease management (59%), and health outcomes (55%).
While the diversity of HIT systems and data sources available vary across organizations, the majority of surveyed ACOs pull information from fewer than 10 different data platforms. However, as ACOs pull data from more sources, they also report lower abilities to leverage their HIT infrastructure to support care coordination, patient engagement, physician payment and contract adjudication, population health management, and quality measurement.
"Even when ACOs have successfully adopted and merged HIT systems, they aren't able to effectively leverage data and analytics to derive value out of their investments given the pervasive issues with data quality, liquidity, and access, as well as issues with integrating data from disparate sources," says Keith J. Figlioli, Premier's senior vice president of health care informatics and a member of the Office of the National Coordinator's Health IT Standards Committee. "The survey proves this is a pervasive problem among ACOs, and it could stymie the long-term vision for ACO cost and quality improvements if not addressed."
The majority of survey participants report having an HIT infrastructure that can support quality measurement, population health management, and physician payment and contract adjudication. Core HIT components include an EHR (86%), a disease registry (74%), a data warehouse (68%), and a clinical decision support system (58%).
Most ACOs reported advanced deployment of patient-facing tools that can improve efficiency and reduce administrative bottlenecks such as tethered patient Web portals (94%), ePrescribing capabilities (70%), or patient reminders (61%). However, few ACOs report patient-facing tools that could increase access to care, such as self-service scheduling (33%), phone-based telemedicine (28%), or video-based telemedicine (24%). ACOs are even less likely to offer patients self-management tools such as remote monitoring devices (26%), untethered PHR (17%), or smartphone apps (15%). Given that one-quarter of the ACOs contracting with the Centers for Medicare & Medicaid Services are forming in rural and/or underserved areas, it is concerning that organizations may be unable to leverage telemedicine or mobile applications to overcome access challenges or better manage populations in remote geographic areas.
"Increased use of mobile and smartphone applications and patient-facing engagement tools could bring care to the next level," says Bordenick.
The majority of respondents had been operating for at least 18 months. Thirty-five percent were in mature stages of operation (more than two years), 20% were in advanced stages of operation (between 18 and 24 months), and 20% were in intermediate stages of operation (12 to 18 months).
Nearly all responding ACOs were of a medium to large size with between 101 to 500 physicians (39%) or more than 500 (41%) physicians. ACOs are largely composed of primary care clinics and practices (90%), specialists (84%), acute care hospitals (57%), and health systems (53%). Surveyed ACOs primarily serve between 10,000 to 100,000 patients, the majority of which are on Medicare, and are primarily funded and administered by a health system (33%), medical group (16%), or independent practice association (12%).