ACOs with multiple EHRs may struggle to meet eCQM targets

Many providers have banded together to compete for risk-based contracts, but diverse records systems may stand in the way of quality reporting requirements.

While healthcare organizations participating in accountable care organizations have used electronic health records for years, many will struggle to use them to demonstrate quality performance.

That’s because many ACOs comprise providers that use a diverse set of electronic records systems, and the lack of interoperability means that most will struggle with gathering quality data and submitting it as electronic clinical quality measures (eCQM).

As a result, many ACOs will struggle to comply with requirements to submit eCQMs, set to begin next year, as part of the 2021 Medicare Physician Fee Schedule final rule, according to results of a recent study published in the American Journal of Managed Care.

Beyond results of the study relating to quality measures, the findings have profound implications for the ability of ACOs to bring together results from diverse records systems to improve care and relieve physician burden.

The report, based on a survey of ACOs, found that more than 90 percent of them have multiple EHRs, which “has the potential to cause serious delays when (the Centers for Medicare & Medicaid Services begin requiring ACOs to report their quality measures through their EHRs.”

The electronic quality measures use data already in EHRs or other health information technology, note the authors of the study, Jennifer Perloff and Sam Sobul. The eCQMs are required for acute care, critical access and dual-eligible hospitals participating in the Promoting Interoperability programs of CMS.

But early studies indicate that deriving eCQMs from EHRs is not automatic, and the authors cited waiting times of several months for data reporting, or missing data from submissions. For ACOs, the problem is complicated because they typically represent a group of providers that come together as an entity to take risk for managing the total cost of care for a given population of patients.

Most ACOs represent unrelated organizations banding together, and newly formed ACOs rarely share the same EHR system. “This diversity poses challenges for data integration, quality reporting, care coordination and other functions for which the ACO needs to extract and shared information stored in an EHR,” the authors note.

The researchers sent surveys to all 477 ACOs that were active last year, receiving responses from 163. Of those, only 9 percent used one EHR, while 37 percent operated 16 or more EHRs. “Those in the group with 16 or more EHR systems are also least likely to have software to integrate EHRs … and most likely to report challenges with adding needed integration infrastructure,” the survey results found.

Those ACOs with a multiplicity of EHRs expressed the greatest concern about the short-term viability and accuracy of EHR-based quality measures, the authors concluded. These integration challenges are likely to exacerbate submission of eCQMs through EHRs. Access to data, standardization of data elements and the cost to integrate are also worries for ACOs whose members have large number of EHR systems.

The researchers put the onus on technology developers to help solve this conundrum.

“To fulfill the potential of EHR technology and advance the use of eCQMs, EHR vendors have to increase sthe availability of data integration tools and software that allow ACOs to efficiently gather data from across different platforms,” they wrote. Application programming interfaces (APIs) that are standardized may facilitate data exchange, but the timeline for such standardization is not clear, awaiting implementation of the Trusted Exchange Framework and Common Agreement, which was recently announced as final.

“CMS also is behind in implementing its interoperability agenda,” the authors note. “This leaves CMS in a difficult position; they are required to begin reporting at least one eCQM in 2023. “Without timely solutions to the issues of data aggregation, any movement toward eCQMs has the potential to create more problems, in the short term, than it solves.”

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