Health IT Certification Group Examines Accountable Care Organizations

Certification Commission for Health Information Technology looks to develop a framework for the technology ACOs will need to function.
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The Certification Commission for Health Information Technology (CCHIT) is developing a framework that will identify the health IT components necessary for healthcare providers to function effectively as an accountable care organization (ACO). CCHIT plans to publish the framework for use by ACO developers. It may also decide to use it as the basis for new certification programs, according to the announcement.

At this point, however, it is not clear what CCHIT would certify or whether the market is ready for such a program, William Jessee, MD, chair of CCHIT's board of trustees, told InformationWeek Healthcare. Up to now, he noted, CCHIT's main customers have been software vendors, and the organization is not sure whether it should certify them or provider organizations that seek to establish ACOs. A decision will probably be made late in the second quarter of 2013, he said.

A blue ribbon advisory panel headed by Karen Bell, MD, chair of CCHIT, is expected to complete development of the framework by early spring.

CCHIT, a nonprofit, private organization, began life nearly a decade ago as the first entity to certify that electronic health records met certain specifications. Later, it became one of the government-authorized bodies that certify the electronic health records (EHRs) that providers can use to show Meaningful Use. In October, the Interoperability Work Group (IWG), consisting of EHR vendors, health information exchange (HIE) vendors, 19 states, and Healtheway, which operates the national eHealth Exchange chose CCHIT to perform the testing and certification of EHRs and health information exchanges (HIEs) that must be done before they can connect with the eHealth Exchange.

[ Is it time to re-engineer your clinical decision support system? See 10 Innovative Clinical Decision Support Programs. ]

CCHIT's decision to branch into ACOs, said Jessee, was partly based on the acceleration of activity in that sector. "It's clear that you can't [form a successful ACO] without a pretty good infrastructure of health IT," he said. "And we felt we were in a pretty good position to create a framework that would help provide guidance to organizations that were on a pathway to ACOs."

In addition, Jessee noted, CCHIT has begun working with IWG and Healtheway to test the compliance of HIEs with their requirements. "We thought a logical extension of that would be to flesh out what are the other IT functions that you need to have in an ACO. Downstream, we might end up creating a certification structure for some of those other pieces."

Nevertheless, he admitted, an HIE is not necessarily a core function of an ACO. Some healthcare organizations have decided it makes more sense to replace their legacy systems with a single integrated system than to build an internal HIE. Others are embracing a big data approach to combine multiple data streams for purposes of population health management.

"I don't think we as an industry have enough experience yet to know what the best way is of trying to make the right information available to the right clinician at the right time so they can provide better coordinated, more accountable care."

So as CCHIT designs its framework, he said, its executives and contributors want to avoid being too prescriptive. "We're approaching it from the perspective that it has to be sufficiently specific to be helpful to organizations, but sufficiently flexible to account for the fact that you're going to have all sorts of variations on the theme."

Meanwhile, the National Committee on Quality Assurance (NCQA) already has an accreditation program for ACOs. That program looks at all aspects of an ACO's operation, including structure, patient access, care management, care coordination and transitions, patient rights and responsibilities, performance reporting, and quality improvement.

Jessee said CCHIT has had discussions with NCQA and doesn't expect that, if it does launch a health IT certification program, it would compete with NCQA. The latter's accreditation program, he said, "is very complementary to what we're trying to do."

But at this point, CCHIT is not sure where to start. An ACO's infrastructure, Jessee noted, is composed of many different parts, ranging from administrative systems to clinical systems to patient messaging applications. He hopes the ACO framework, when it's complete, will give the organization some direction on how to proceed. "We can't take on too many things at once," he pointed out.

Clinical, patient engagement, and consumer apps promise to re-energize healthcare. Also in the new, all-digital Mobile Power issue of InformationWeek Healthcare: Comparative effectiveness research taps the IT toolbox to compare treatments to determine which ones are most effective. (Free registration required.)

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