A successful accountable care organization must have electronic health records and some degree of interoperability among its information systems, says John Glaser, CEO of Siemens Health Services business unit, and former chief information officer of Partners Healthcare in Boston. While the vast majority of providers currently do not have those capabilities, ACOs will have to reach that goal within three to five years if they are to thrive, Glaser says.

"For an ACO, you need that close collaborative information structure that involves the physicians, the hospital and the post-acute care continuum," says Thomas Enders III, managing director of CSC's health care group. "That's why a lot of pre-ACO institutions are extending their own EHR to independent physicians or connecting the physicians with an ambulatory EHR. That's going to favor the early adopters and the large integrated delivery networks in particular. They're going to be way out in front of the freestanding community hospital that isn't able to do that."

A large integrated delivery network that has a single EHR, such as Cleveland Clinic or Aurora Health Care, has another advantage: Physicians can easily exchange data wherever they are in the system. But this is the exception rather than the rule, and most providers that aim to become ACOs will have to create or use existing health information exchanges to help doctors coordinate care. These exchanges will have to connect the inpatient and outpatient spheres, as well.

Glaser recommends that health care organizations first work out a governance strategy that specifies how to deal with payers, distribution of funds, best-practice clinical guidelines and order sets. Then those agreed-upon approaches can be applied to EHR implementation.

Besides EHRs and interoperability, Glaser says, there are two other key elements to address in the health IT area: analytics and what he calls "patient-facing technologies." The latter include personal health records, patient portals and remote monitoring of patients with chronic diseases. "Analytics" is an umbrella term for everything from quality reporting and performance feedback to the ability to track financial indicators.

"If you're collaborating with other providers in an at-risk model, you'll need pretty good data on the money you've received, the costs of other providers and the funds flow between yourself and them," Glaser says. "Analytics are terribly important, because if you lose track of your performance, you can wind up losing a lot of money, and not knowing that until too late in the game."

Electronic registries also are essential to ACOs, Glaser says, because they enable providers to manage the health of their populations. Included in some EHRs, and also available as separate applications, registries let providers keep track of patients' health status and which patients need particular preventive and chronic care services. Driven by clinical protocols, registries help providers do outreach to patients and also can trigger alerts in EHRs at the point of care.

For information on the health IT tools that ACOs will need, see CSC's white paper, "Health Information Requirements For Accountable Care".