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Will ACO IT Models Be Walled Gardens or Open Platforms?
Will ACO (accountable care organization) IT models be walled gardens or open platforms? i.e., will ACO IT platforms focus on exchanging information within the provider network of the ACO, or will they also be able to exchange information with providers outside the ACO network? (If the question still isn’t clear, click here for a further explanation.).
One POV: ACO’s Will Need Open IT Platforms
Mike Cummens, M.D., associate chief medical information officer at 750-physician Marshfield Clinic in Wisconsin, is quoted in a recent article in Healthcare Informatics. Dr. Cummens argues for an open ACO IT approach:
There will be an emphasis on transfer-of-care summaries and how to facilitate information sharing across the full continuum of care, he said. “For instance, you will have to work into care management plans the notification of home health agencies,” Cummens added. “In an ACO model, you will have to have methods in place to communicate all this information to providers who are not part of your own organization. People will have an option to see providers outside an ACO, so you will need to be able to transfer care summaries and discharge summaries outside the ACO.”
Also, because patient involvement is a key part of ACOs, the IT infrastructure will have to support patients signing off on their care plans and document their progress toward reaching goals, he noted. That will involve some type of self-management tools and personal health record access to their own data.
Cummens noted that the patient-centered medical home is geared toward an individual practice, and meaningful use metrics are geared toward providers, but ACOs will require managing data across enterprises. “When we visualize this and realize we are dealing with multiple electronic health records, the infrastructure for ACOs really has to ride on top of that,” he said. He sees the need for a new type of system, probably outside the EHR, that can bridge organizations, allow for risk assessment and analytics and reach down into tools for day-to-day management. That’s a tall order.
Reality: ACO’s Don’t Appear to Be Planning for Open Platforms
A report by PwC issued in June — Designing a health IT backbone for ACOs — found that providers are all over the map in thinking about IT requirements for their ACO.
Have you considered the IT requirements of an ACO?
No — 26%
Yes — 74%
(If “Yes”) How do you plan to address the IT requirements of an ACO?
Use existing internal systems — 39%
Utilize a planned local/regional HIE once developed — 19%
Through an existing local/regional HIE — 15%
Partner with another organization (e.g. a large IDN, a payer-driven initiative, community EHR, etc.) — 12%
Build own new IT infrastructure, systems — 11%
Other 4%
I found these answers illuminating:
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26% haven’t thought about IT requirements
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“existing internal systems” of today are not geared for the specific needs of ACOs
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Existing or planned HIEs are still immature –– many (most?) aren’t yet up and running, they won’t include all providers, and they initially will share limited types of information
PwC concludes:
Most ACO discussions remain internally focused despite concerns about accessing external data
I predict that IT systems will quickly emerge as one of the biggest headaches for ACOs.
How Will this Play Out? Walled Gardens or Open Platforms for ACOs?
We’ll need to consider the question along several dimensions — both technical models and business models. For example, its possible that ACOs might emerge having open technical models–yet have walled garden business models.
It’s also more useful to think about this question as a continuum of possibilities, rather than two discrete options. Walled garden IT and business models can have “walls” of varying heights and permeability.
My guess is we’ll see a lot of permutations. What are you seeing out there?
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RT @VinceKuraitis: Will ACO IT Models Be Walled Gardens or Open Platforms? http://bit.ly/hYGfMo #ACO #EHR #HealthIT
Why is it that doctors want someone else to purchase the tools necessary for their occupations? Do investment bankers demand others to supply them with financial databases so that they can track individual stocks? Do journalists demand special software so that they can access privileged info and break a story first? Do CPAs insist on someone funding the tax prep software they use to file income taxes for their clients?
We all require tools for our jobs. The stethoscope is no longer the tool to invest in for MDs; rather it is sophisticated EMRs that allow them to oversee the care of hundreds of their patients simultaneously. That investment should be made by the professional benefiting from the investment. That’s what happens throughout the business world. That’s what the physician community should be doing now.
RT @VinceKuraitis: Will ACO IT Models Be Walled Gardens or Open Platforms? http://bit.ly/hYGfMo #ACO #EHR #HealthIT
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Rick, you flag a really important issue and it will be interesting to watch how this plays.
Hospitals evolved as doctor workshops in the last century — they bought high priced technology and created services and infrastructure that could be shared across the community’s physicians.
IT becomes much more strategic in the 21st century. Dr.s that wait for someone else to buy their IT for them miss a proactive opportunity to shape their own futures.
I wrote this blog post with the idea of getting the issue of ACO IT on people’s radar screens. This question is very important, even if the answers aren’t yet clear.
Will ACO IT Models Be Walled Gardens or Open Platforms? | e-CareManagement http://ow.ly/3qC49
“IT becomes much more strategic in the 21st century. Dr.s that wait for someone else to buy their IT for them miss a proactive opportunity to shape their own futures.”
Vince, I total agree with you on “IT is strategic in the 21st century.” Nevertheless, it’s extremely difficult to have an excellent/seamless quality ACO unless the leader has a full devotion, focus, and passion along with strong investment support the R&D. We have experienced this pathway leveraging the ViSTA platform, a very painful R&D (5 years) for customization and make it fit into being virtual. Nevertheless, it is absolutely beautiful once done.
Next, you got me again right there. “IT platform can be open as a PaaS, but “business models can have “walls” of varying heights and permeability.” It’s a continuum of possibilities. Still a long, fun and exciting road ahead. Really, alot of fun. Pray for us Vince. Linh.
Linh, thanks for your note. I’m pleased to hear that you could cusomize ViSTA and make it work, but 5 years?! Wow. V
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