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HIT Support of Accountable Care Faces Barriers

As the healthcare industry moves away from a fee-for-service system, a health IT infrastructure needs to be put in place to support the more complex business and clinical processes required for accountable care models. However, interoperability and other technology challenges continue to dog providers as they transition to a value-based payment environment.  

That is the conclusion of a new report prepared for the Office of the National Coordinator for Health IT by Robinson & Associates Consulting LLC. According to the report, while providers are focused on “how to unlock value in the healthcare system and succeed in accountable care models by improving care coordination across organizations, interoperability challenges between electronic systems continue to inhibit progress.”

At the center of this problem are electronic health records, which the report argues are a critical tool in the value-based care environment, electronically capturing and sharing patient information with other clinicians and measuring quality performance. “While adoption has increased, challenges around interoperability between EHR systems continue,” the report’s authors warn. “These challenges impact accountable care organizations especially, where integration across participating providers’ EHR systems is a key strategy for meeting cost and quality goals.”

In addition, the report finds that as quality reporting and measurement tools continue to evolve, providers are reporting challenges around extracting consistent clinical quality data from EHRs, particularly within the context of aggregating reports across different EHR platforms for the purposes of accountable care. The authors point out that in this regard there may be a “gap between the needs of the healthcare sector and the readiness of vendors in the health IT market to meet those needs.”

Although EHRs certified to the 2014 Edition of ONC certification criteria are required to collect a number of electronic clinical quality measures for reporting in standard formats, “EHR vendors may ultimately implement these quality measures in different ways” creating inconsistencies that “may require substantial manual work at the practice level, or the use of translational software tools, to report at the organizational level.”

And, although accountable care models have offered providers access to claims data to inform care, such as the Medicare claims shared with participants in the Medicare Shared Savings and Pioneer ACO Programs, the report also reveals that few ACOs have access to comprehensive, reliable claims data needed to support effective risk stratification across their entire patient populations.

The report makes the case that “providing analytic measurement tools across a patchwork of EHRs can be very costly due to the number of interfaces required to address variability in how data is captured in different products” and that “provider organizations also face difficulties managing different reporting structures when they are involved in multiple accountable care and practice transformation initiatives.”

Not surprisingly, a recent survey of 62 ACOs found that 100 percent of respondents had difficulty achieving data interoperability with disparate partners. Not only did the surveyed ACOs have a tough time sending data to others, but 88 percent reported difficulty integrating data received from disparate sources. In addition, 83 percent of ACOs reported struggling with integrating analytics into workflow.

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