Effective HIT: The heart and backbone of a dominant ACO

May 3, 2013 Written By Frank Speidel, MD

A newly published survey of physicians highlights the increasing importance of Accountable Care Organizations (ACOs) in the overall healthcare landscape. The 2013 Medscape Physician Compensation Report finds 24 percent of doctors in an ACO or planning to be one in the coming year. That’s up dramatically from just 8 percent in the 2012 Medscape survey.

What these physicians are learning (or will soon learn) is that Healthcare Information Technology (HIT) is critical for their success in an ACO environment.

ACO bundled payments require all providers collaborate and cooperate in providing care and controlling costs. Eliminate duplicated, ineffectual and even harmful interventions, procedures and studies to achieve cost containment. This is not a rationing of care but the provision of the best test, the best intervention for the best results for the patient.

To realize this future, effective HIT — from EMRs and CPOEs to mHealth apps — must continue to evolve and support clinicians in four critical ways:

1. Comprehensibly acquire and refine data into information,
2. Prioritize information for the clinical decision-maker in a time sensitive manner,
3. Provide menus of interventions, therapies, actions and follow-ups for evidence-based, predictive, and nuanced decision-making,
4. Restrict access according to ethical, regulatory and privacy concerns while optimizing the dissemination to those providing care.

We are currently collecting and sharing patient data in dimensions usually used for cosmological measurements. But turning data into actionable information requires connecting disparate systems to allow access to all patient observations and measurements. Some data exist in an unstructured form in in the EHR; some resides in a best-of-breed machine or application awaiting manual entry by a clinician, respiratory therapist or neurosurgeon, doubling as a data entry clerk.

Sensing, capturing and analyzing this sea of data into meaning is the primal function of Health Information Technology. In doing this we slay the dragon of duplicated testing. When we add evidence-based decision support to the process, ineffectual and potentially harmful interventions and testing likewise will end. Care becomes less costly, safer and more beneficial.

Not all patient data is meaningful. The data that is gathered must be integrated with concurrent and prior data, current clinical condition, therapies and existing co-morbidities. In doing so, HIT filters a message to act apart from background noise.

Effective HIT must then prioritize the information and present to the clinician in a timely, clear, familiar format that facilitates decision-making. Physicians respond differently to a patient with a pH of 6.9 than to one whose BUN has risen to 30 over the past several days.

Winning HIT does more than simply advise the care provider “you have pending lab results” when they log on. Winning HIT recognizes the signal amid a sea of background noise and recognizes that some values are critical. When our patient’s potassium has dropped to 1.9, game-changing HIT pings the covering physician’s personal device, as well as the nurse on the patient’s unit.

Now that the clinician is aware of the life-threatening value, the winning HIT system should provide evidence-based therapies, including a survey of potential causes for the abnormality and recommendations for appropriate corrections. This level of surveillance and clinical decision support is a game-changer for the patient, the caregiver and the ACO.

Frank X. Speidel, MD, MBA, FACEP is Chief Medical Officer for Healthcare IT Leaders and former CEO of St. Luke’s Hospital at the Vintage, Houston, TX.