Challenges and Opportunities Seen in ACOs

With the March 31 release by the Department of Health and Human Services of the proposed rules on accountable care organizations, many health providers are assessing their readiness to participate in the development of ACOs. I recently had an opportunity to ask Jacqueline Dailey, who since January has served as the vice president of IT solutions for medical science, research and patient-centered accountable care for the University of Pittsburgh Medical Center. Previously she was the CIO of Children’s Hospital of Pittsburgh of UPMC.

What she said reinforced for me the importance of meaningful use and implementation of electronic health records as a foundation for ACOs. “These accountable care regulations come on the heels of the fact that people have been studying and moving towards meaningful use,” she says. And meaningful use has helped both healthcare provider organizations as well as vendors, which have become standardized in the delivery of their products. The result, she says, is an IT platform that allows for the exchange of information in standardized ways, allowing providers to monitor and take care of patients outside the boundaries of the health system.

To be sure, there are many challenges as well. One of them is managing patient consent. According to the proposed rules, patients have a choice as to whether or not their personal health data flows through the ACO. In Dailey’s view, allowing patients is completely appropriate. One potential model is health information exchanges, in which patients must consent to having their information flowing through the HIE as well. A large part of the challenge can be met by educating patients why it’s important for their information to be available at the next venue of care, so the care can done safely and efficiently. This is the responsibility of the ACO, she says.

In the arena of data infrastructure, Dailey sees a challenge in maintaining total integration of all the providers’ applications, and making sure the technology is consistent and reliable for endusers. UPMC has begun using technology staff as part of the patient care team, to make sure the technology is operating properly and when clinicians need to use the technology, it is reliable.

Dailey also notes that UPMC has been implementing electronic health records (Cerner on the inpatient side and Epic on the outpatient side) aggressively, to make sure that all of its venues of care are automated and that the workflow is enhanced. It has also implemented an aggregate program (dbMotion) as a central repository for all of the information that is captured electronically. She adds that UPMC has been laying a foundation for accountable care organizations, by building patient-specific registries, population registries and disease-specific registries, which will allow for timely evidence-based research.

Dailey credits Dr. David Blumenthal, who stepped down from his position of national coordinator for health Information technology of the ONC, as laying the groundwork for change through his work on meaningful use. “He lit a fire under all of us, saying we have a lot of opportunity and we should be leveraging it,” she says.