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How ACOs could better utilize EHRs

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Accountable care organizations (ACOs) are “composed of doctors, hospitals, or other healthcare providers that come together voluntarily to coordinate high-quality care for their patients and agree to be accountable for the total cost and quality of the care provided.” The idea behind the ACO concept is to enable independent physicians to realize the benefits of being a part of a larger organization while retaining autonomy in their own practices. ACOs also work to improve population health.

In May 2019, the U.S. Department of Health and Human Services Office of Inspector General published the results of its research into six Medicare ACOs that use health information technology for care coordination. The study offers “insights into how select ACOs have used health IT tools to better coordinate care for their patients.”

The Office of Inspector General conducted interviews during site visits to four Next Generation ACOs and two ACOs that participated in the Medicare Shared Savings Program. The ACOs were selected for the study based on “their performance on a quality measure focused on care coordination and patient safety, a minimum of 3 years of experience as a Medicare ACO, geographic variation, and recommendations from CMS and ONC (Office of the National Coordinator for Health Information Technology).”

After reviewing how each of the ACOs used information technology, including electronic health records (EHRs), the study concluded that “the full potential of health IT has not been realized.” The ACOs that used a single EHR system across all of their provider networks had the ability to share patient data in real time, optimizing their ability to coordinate care for their patients. However, ACOs that used multiple EHR systems faced challenges.

Interoperability, the electronic sharing of patient information between different EHR systems and healthcare providers, is a major concern for ACOs relying on health IT tools. Coordinating care effectively depends on EHR interoperability. “Achieving the interoperability needed for seamless care coordination places burdens on ACOs to either invest in a single EHR system, or use additional methods, such as non-health IT means like faxes and phone calls, to communicate health information.”

The study concludes by suggesting that “Some of HHS’s proposed initiatives might address concerns and challenges that we heard from ACOs. For example, ONC’s Trusted Exchange Framework and Common Agreement has the promise of facilitating interoperability across health IT networks, which might mitigate the problem that ACOs had in accessing data from HIEs (Health Information Exchanges) with little or incomplete data. With interoperability, an ACO would be able to access patient data even when patients visit providers outside the ACO.”