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Accountable care organizations aim to provide efficient, effective, high-quality care. They must demonstrate the provision of evidenced-based, patient-centered care and report on cost and quality measures. The challenge for health care organizations is that ACOs are essentially a learn-as-you-go endeavor. It's too soon in the process for organizations to demonstrate proven best practices.

"No one is an expert yet," says Barbara Adams, vice president of information technology services, Texas Health Resources, Dallas. "There aren't any benchmarks to help build the ACO."
Despite the unknowns surrounding ACOs, there are commonalities, according to Grace Terrell, M.D., president and CEO, Cornerstone Health Care, High Point, N.C., and member of the Certification Commission for Health Information Technology ACO HIT Framework Advisory Panel. ACOs require that health care organizations change the way they practice and deliver care, change the way they are paid and have the appropriate technology in place.

Accordingly, developing IT systems to support ACOs is a unique process. No two systems will be alike. ACOs will need access to information beyond what was needed and available in the past. "The technology is still immature and under development," Terrell cautions.

Organizations looking to form ACOs should start with a gap analysis to assess potential needs in the organization's health information infrastructure. Following the assessment, the organization must prioritize its investments and assess its options.
Involving physicians early in the process is critical. Physicians and other caregivers will need to be educated about documentation and care requirements under accountable care, says Joseph Boyce, M.D., chief medical information officer, Heartland Health, St. Joseph, Mo. "We need to make it as simple as possible for them to follow the processes," he says. The goal is for accountable care to have little impact on their workflow.

This gatefold looks at the key IT components of the accountable care organization.


Key IT components for accountable care organizations

Information technology is the backbone of accountable care organizations, providing real-time access to patient information, facilitating the transfer of financial and clinical data, and supporting population health management. Below are key IT components for accountable care organizations.

Electronic Health Records
Electronic health records are essential to the exchange of patient information across the continuum of care. EHRs can serve as useful communication tools, supporting case management and ultimately enhancing patient engagement and satisfaction.

Population Health Management
Population health management systems help to aggregate patient data, helping organizations understand the risk intrinsic in a patient population and proactively manage the population to ensure the best possible outcomes. Population health management systems help to coordinate care across the continuum and track patients in need of care management.

Disease registries
Disease registries help to ensure that patients receive appropriate care based on predetermined guidelines. The use of disease registries for such chronic conditions as congestive heart failure helps providers to track the patients' conditions and supports preventive health care.

Patient portal
Patient portals enhance patient-provider communication, providing patients with access to their health care information and support between visits. Patient portals can be useful educational tools and also can be used to send treatment reminders.

Health information exchange
Health information exchange supports the transmission of data across disparate technology systems. The establishment of a health information exchange allows providers to securely access and share a patient's medical information electronically, regardless of IT platform.

Data warehouse
Accountable care depends on access to real-time, meaningful data. The amount of data collected across the continuum of care will require significant storage and support. The data warehouse can help ACOs to aggregate and analyze patient care data. It also can support business intelligence and reporting so organizations can analyze the clinical and financial risk of the patient population.


An ACO health IT framework from the Certification Commission for Health Information Technology

Goals of accountable care organizations

• High-quality health care

• Cost efficiency

• Customer loyalty: providers and patients

Primary IT requirements to support accountable care

• Information sharing among clinicians, patients and other authorized entities

• Data collection and integration from multiple clinical, financial, operational and patient-derived sources

• HIT functions supporting patient safety

• Strong privacy and security protections

Key processes to meet the aims of accountable care

• Care coordination

• Cohort management

• Patient and caregiver

• Clinical engagement

• Financial management

• Reporting

• Knowledge management