8 questions to answer before buying IT for ACOs
Execs need to make process and strategy decisions before turning attention to technology purchases.
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Success starts with engagement
Many healthcare organizations are anticipating the shift to value-based care and are ramping up plans to form an accountable care organization. While information technology is crucial, it’s not the place to start, contends Gregg Malkary, founder of Spyglass Consulting. In fact, it may jeopardize success—if an organization does not have a robust patient and provider engagement plan for the ACO, no amount of IT will matter.

Earlier this year, Spyglass surveyed more than 100 hospital professionals, asking them to identify clinical process gaps in engaging patients and families within the care process. Here are crucial questions to answer before IT decisions are made.
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1. What specifically is the engagement strategy?
One-quarter of survey respondents admitted that they had no patient digital engagement strategy, Malkary notes. Typically, respondents admitted that they don’t understand engagement, and no one in the organization knows what to do, so they lack the personnel and expertise to move forward.
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2. Which strategy can everyone use?
Some hospitals struggle with multiple patient engagement strategies and technologies—every department has been buying its own engagement tools, and each strategy is separate from the others. What can help to reboot and build a digital experience strategy is to include the initiative in the organization’s mission statement, Malkary advises. “It’s culture, people, processes and tools—note that tools are the last step. You don’t throw technology out in the environment until you know what you’re trying to solve.”
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3. Is engagement a key priority?
A core finding from survey interviews was that no one would commit to having all the answers and demonstrating a robust patient and family engagement program, Malkary notes. The reason why emerging ACOs have experienced little success in engagement is because engagement isn’t yet a priority for them.
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4. How does education mesh with patient engagement?
Patient portals offering health information, education and access to medical records were mandated under the EHR Meaningful Use Program, and hospitals tried to respond by offering educational content to improve patient satisfaction over their internal television networks. They found that TV was used only for entertainment, in part because patients couldn’t figure out how to use the educational features, so education hasn’t been a priority.
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5. How will portals be marketed and taught to patients?
Too often, nurses don’t talk to patients about the value of a patient portal, and while they may explain the basics of how to sign up for the portal, they typically don’t provide any specific training for getting patients to use the portals, the Spyglass survey found. As a result, when patients are discharged, neither they nor their family members know how to use the portal, Malkary says.
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6. How will education be taught to patients?
Hospitals typically have little documentation that a patient was prescribed educational content, viewed it and reviewed findings with a nurse. Nurses already are overwhelmed, Malkary acknowledges; they have no time to educate patients on the technology they can use to stay engaged, so education is not coordinated within their clinical workflow. Doctors are focused on the brief minutes they have to talk to patients, and are aware of being scored on performance and volume, so there’s no time to educate.
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7. To whom will initial efforts be targeted?
Malkary suggests that providers focus for 12 to 18 months on patients with chronic conditions, because these are the individuals accounting for much of the care delivered, and these patients can support digital engagement, he adds. “The low-hanging fruit is chronic care and congestive heart failure.”
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8. What’s the strategy to coalesce portal strategies?
Still, barriers remain and continue to confound patients, Malkary bemoans. “I’m in the hospital signed up for a portal. Now, I’m in the community and have another portal, and my cardiologist has a different portal.” What’s needed is portal technology that provides a longitudinal patient record with consistent content supporting acute care and ambulatory environments, as well as bringing ancillary providers into the fold. “This requires clinicians to actually be engaged,” he says.