Healthcare organizations across the U.S. are investing significant resources in re-architecting their care delivery infrastructures to enable them to adapt successfully to new, value-based payment and delivery models, such as accountable care.

As these entities prepare to go 'at risk' and take outcomes-based capitated or bundled payments, they face a broad set of challenges – one of the most critical being the development of an IT infrastructure. The infrastructure must enable clinicians and administrators to access and share the clinical and financial information they need, and allow them to streamline and automate their processes to ensure the most efficient clinical and administrative workflows as well. Add to this challenge the fact that the technology must now span and be accessible at multiple, traditionally siloed facilities where healthcare is delivered, and it becomes apparent that this is a new era for healthcare IT in the U.S.

Successful ACOs use a variety of terms and concepts to break down the key elements of their IT infrastructure, but looking across many of these initiatives and the core common critical success factors, we believe that the process can best be broken down into six steps: Acquisition of data, Aggregation of data, Access to data by all stakeholders in the patient's care, Adoption of the technology by users, Analytics to “zoom out” to the macro level population and Action to “zoom in”, create care plans and effect outcomes for individual patients. Over the next few weeks, we'll explore these steps – one at a time – and provide our high-level insights from ACO rollout projects we have worked on, detailing critical success factors and best practices.

We'll start with the first of the six A's – Acquisition. For organizations embarking on an accountable care journey, the data they need resides in a wide range of disparate systems in a multitude of formats – including data found in EHR and practice management systems, claims data gathered from clearinghouses and health plans, and increasingly, patient-generated data from devices and even genomics.

Integration engine technology, part of the ACO IT infrastructure, is essential in supporting effective data acquisition. The technology allows for accurate, efficient and reliable interoperability with a wide array of systems and must be able to work with the “lowest common denominator” – small practices with few financial or IT resources too. It must support traditional and emerging industry standards, from HL7 to IHE to Web Services and X12, so that it is flexible enough to work with the maximum number of source systems in a community, whether those systems are EMRs or even human services data sources and other social information stores. Integration technology facilitates the end-to-end process of receiving and sending personal health information such that it is ready for the next “A”, Aggregation...

Stay tuned for our next post which will discuss aggregation and how one health system aggregated data from 24 different EMRs!