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At a February HIMSS11 session on accountable care organizations packed with provider I.T. execs, the speaker asked how many were planning to be part of an accountable care organization. Nearly all raised their hands.

If the health reform law survives its legal challenges, they'll soon have the opportunity. Medicaid and Medicare ACO demonstration programs authorized in the law start in 2012, and several private insurers are getting ready to jump in with their own accountable care models.

That said, a scan of the existing health care information technology landscape suggests many providers remain years away from having the capabilities to operate as ACOs.

The HITECH Act of 2009 was designed to position the health care industry to have the information technology infrastructure necessary to support health reform. Nowhere is this more clear than in the I.T. capabilities needed to support ACOs, a model where organizations band together to tightly coordinate patient care, improve quality and population health while reducing the unsustainable annual increases in costs. ACOs that reach those goals will be rewarded via shared savings programs or other reimbursement incentives that divvy up the financial rewards.

But to attain the necessary level of care coordination and embed electronic safety checks, clinical analytics and data exchange into every step of a patient's clinical journey will require an extremely sophisticated I.T. infrastructure.

Jim Adams, managing director at the Advisory Board Company consultancy and a former leader of HIMSS Analytics, says even Stage 7 hospitals-the highest level under the HIMSS Analytics scale of health I.T. capabilities-aren't ready for ACOs. Consequently, providers should beware of I.T. vendors touting their products as fully capable today of supporting ACOs, says Marion Jenkins, CEO at QSE Technologies, an Englewood, Colo.-based systems integrator with more than 150 ambulatory I.T. implementations. "There's a lot of Kool-Aid getting served up."

To support ACOs even in their early stages requires use of an electronic health records system with advanced support for data standards and connectivity-advancements that have built into EHR products only in the past two years, Jenkins contends.

And ACOs over time will require a lot more I.T. firepower, including pervasive connectivity, data analytics and predictive modeling technology supported with robust disease, care and utilization management applications to support care across the continuum while identifying opportunities to reduce costs.

Factor that in, and it will take four years of ACO building to get to data analytics and five years for predictive modeling, predicts Adams.

In recent months, providers have been encouraged to join prospective ACOs and accept bundled payment for an episode of care-split among all providers participating in the care-or receive a share of savings that should result from tightly coordinated care.

However, the encouragement comes before public and private insurers have specified what the bundled payments or shared savings will be. Government officials in February said proposed ACO rules for Medicare and Medicaid were imminent, but in the government mindset that could mean several more months.

Consequently, providers preparing to be early ACO adopters are flying blind on the financial ramifications of their decision. There clearly is not a lot of structure around how ACOs will work in the reform law, says Ken Wilson, system vice president of clinical effectiveness and quality at Norton Healthcare in Louisville, Ky., which launched an ACO pilot last July with insurer Humana Inc. after a year of preparation. The reason for moving early was simple, adds Norton CMO Steve Heilman, M.D. "Either build it the way you want it or have it presented to you."

Norton Healthcare is partnering with Humana to figure out incentives that make sense and get access to payer claims data to analyze gaps in care, patient adherence to treatment regimens and inefficiencies such as over-utilization of medical imaging, among other issues.

Payer data is important to reaching the overarching goal of ACOs: reducing costs while improving health status. Medicare's ACOs likely will require a patient population of 5,000, but what most counts is knowing the 200 patients in the pool who are the sickest and most costly to treat, says Steve Tolle, senior vice president of physician solutions at software vendor Ingenix Inc. "This is payer data that needs to be refocused for providers," he notes.

Norton-Humana is one of five national pilot sites developing an ACO through an initiative of the Engelberg Center for Health Care Reform at Brookings Institution and The Dartmouth Institute for Health Policy and Clinical Practice. The other sites are Carilion Clinic in Roanoke, Va.; Tucson (Ariz.) Medical Center; HealthCare Partners Medical Group in Torrance, Calif.; and Monarch HealthCare in Irvine, Calif.

Some organizations, such as Parrish Medical Center and its physician/hospital organization in Titusville, Fla., initially are building an ACO on their own to learn how to do it, demonstrate benefits, then solicit expanded participation to other stakeholders in the region.

However an ACO starts, it cannot be formed in a vacuum where only a handful of top leaders make decisions, warns consultant Adams. During a HIMSS11 presentation in February, he recalled a CIO telling him that the CEO and CFO were figuring out how to set up an ACO-they'd tell him what they wanted from I.T. and he'd put it in. "That's a dangerous position because you may not be able to do what they want," Adams says.

Dave Garets, executive director at The Advisory Board Company, said a CEO recently proclaimed that his hospital was going to become an ACO and expected to be fully ready by August. But just getting the information technology infrastructure in place to fully support an ACO is a five-year project, he estimates, although ACOs can and will start with more limited I.T. capabilities.

Regardless of the pace that providers will launch their ACO initiatives, CIOs and I.T. departments already are overwhelmed with meaningful use, ICD-10, HIPAA 5010 and forthcoming enhanced privacy/security mandates, and that's got to be considered, Garets says. "In our history, we have never had this much on our plate."