This policy report from the eHealth Initiative makes recommendations for the health information technology infrastructure needed by an accountable care organization model (ACOM).  An Accountable Care Organization Council of diverse stakeholders was convened to develop the report.  Among the report’s findings:

  • Health IT systems must be flexible and support the changing needs of the ACOM.
  • Health IT must support the secure, private, interoperable, comprehensive transfer, collection, and storage of data throughout the ACOM.
  • The health IT system must develop functionalities that are patient-centered. The respective infrastructures of the ACOM should support the education and engagement of patients, their families and caregivers.
  • In order for the ACOM to be successful, the health IT infrastructure within the organizations must promote and support care coordination amongst the healthcare team and patient.
  • The healthcare team, patients, their families and caregivers must have access to complete, relevant, and comprehensible data.
  • Health IT systems must support evidence-based, clinical decision support systems.
  • Health IT systems must facilitate the gathering, tracking, aggregation of patient data throughout the ACOM.
  • ACOMs are hesitant to apply for the Centers for Medicare & Medicaid Services Medicare Shared Savings ACO program.
  • ACOMs are involving multiple stakeholders in their development.
  • ACOMs are in various stages of development.
  • ACOMs recognized the need for a robust health IT system.
  • The patient population served by the accountable care organizational model could dictate the development of the organization.
The report lists the following key attributes for a successful health IT infrastructure for accountable care organizations:
  • The health IT infrastructure must enable care coordination and collaboration.
  • The health IT infrastructure must enable and support the comprehensive and systematic collection, storage, management, and exchange of secure personal health information between and among healthcare providers, patients and other members of a patient’s healthcare team in the process of care delivery and care management.
  • The health IT infrastructure must include revenue cycle management technology to successfully support the financial analyses associated with accepting, negotiating, and managing new and changing payment structures. The infrastructure should enable electronic acceptance, tracking and allocation of payments and should be able to handle the distribution of payments to individuals, practices, and other appropriate organizations within the ACOM based on performance associated with specific metrics of quality, cost and patient experience.
  • Data exchanged by the health IT infrastructure should be maintained in a secure, HIPAA- compliant, online environment that allows role-based access to and sharing of data among and between stakeholders (including hospitals, physician practices, healthcare providers and payers).
  • The health IT infrastructure should support the collection of information embedded in the workflow of healthcare delivery.
  • The health IT infrastructure should support the use of telehealth, remote patient monitoring, shared care plans, and other patient-centered enabling technologies between facilities, healthcare providers, and patients that securely exchange information.
  • The information shared through the health IT infrastructure should be collected and stored in a manner that facilitates ongoing measurement of processes and outcomes related to quality, cost, and patient experiences at an individual and population level. The identified metrics will be important for the assessment of ACOMs.
  • The health IT infrastructure should enable information to be transmitted, and accessible to all patients and healthcare providers authorized to view it.
  • The health IT infrastructure should integrate evidence-based clinical decision support system (CDSS) services into the workflow of care delivered by healthcare providers and their practices.
  • The health IT infrastructure should support and facilitate shared decision-making and care plan development through the integration of information from all healthcare providers involved in the care of a patient. There should be convenient access to user-friendly personal health information organized to be meaningful for patients/ caregivers and presented in a constant format across the organization.
  • The health IT infrastructure should support services for patients and caregivers to help them be informed, educated, and literate about personal health and medical conditions and to enable patient self-management of care.
  • The health IT infrastructure should offer support on-going self-care and wellness management functionalities including, but not limited to, coaching from healthcare providers and ongoing monitoring of progress to promote a dialogue between patients and healthcare providers.
  • The health IT infrastructure should support the analysis of clinical, administrative, and  financial data to support operations, improve care and better patient outcomes while optimizing the overall performance of the organization.

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