Healthcare IT In The Obamacare Era - InformationWeek

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2/18/2014
12:49 PM
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Healthcare IT In The Obamacare Era

Modern technology created the opportunity to restructure the healthcare industry around accountable care organizations, but IT priorities are also being driven by the shift.

five-year rollout of the Epic software, it will still have to deal with a blended environment for some time to come. For example, Partners will continue to refine a patient portal developed internally, even though at least some elements of that portal will eventually be supplanted by Epic's MyChart.

Nor is an EHR necessarily the be-all-and-end-all platform for population health management, Noga says. Caregivers will need analytics dashboards that help them identify individuals and group them into populations with common chronic conditions, such as diabetes, so they can devise strategies for better managing their health. Clinical decision support tools need to guide medical professionals toward delivering the best evidence-driven care. Primary care physicians need to get automated alerts when a patient in their care is admitted to the hospital or visits the emergency room, as well as follow-up reminders. Continuous monitoring of patients via devices in the home will become increasingly important.

"You can't buy, quote, a 'population health management tool,' because it isn't one tool. It isn't a module," Noga says. "You need many things to be able manage populations."

Sharp HealthCare CIO Spooner says he comes to the ACO model with experience in other forms of managed care, since California has long been a hotbed of activity with capitated payments for patient care. However, he discovered that ACOs, as implemented by Medicare, are significantly different. In particular, the government assigns each ACO a pool of patients whose health it is supposed to manage, but it doesn't limit Medicare recipients to getting care from providers in the ACO network, presumably for fear of limiting patient choice.

"There are more patients who are voters than there are providers, so we're outnumbered," Spooner says.

In a Medicare ACO, networks of providers are assigned patients to whom they have historically provided care, but it's up to the ACO to keep those patients coming back and to get them to proactively manage their own health. Online patient engagement is one of the most critical technologies here. It's a means of creating "stickiness" so that patients continue to work with a hospital for the same reason Amazon.com customers keep buying from that website. "You need to be the most attractive, engaging proposition in town," Spooner says.

"Our organization has been able to set up as an integrated delivery network, and that's just a blessing right now."
-- David Lundal, VP and regional CIO, Dean Health System

Sharp created its own patient portal three to four years ago, allowing it to start building an online relationship with patients, although Spooner acknowledges "we're a long way from Amazon.com." Recognizing that commercial patient portal products have advanced significantly in the past few years, Spooner says Sharp will probably convert to one of them soon.

Care management or case management is another essential technology Sharp is struggling to address more effectively, Spooner says. "It's like CRM for healthcare -- you want to be tracking the patient in everything they're doing and be handing off the information more than just transferring medical records," he says. In complex cases such as cancer treatment, it's essential that strategies for follow-up care accompany the patient record, he says.

IDC's Burghard says the biggest IT challenge is probably analytics. Most providers have been relying on their EHR platform vendor, rarely the best call, she says. "Those are all transactional systems, and their strength is not in the analytics," she says, creating an opportunity for vendors of niche population health analytics applications.

In many cases, ACOs are formed by networks of hospitals and providers that use several EHR systems. "Bringing all that data together in a meaningful way is a challenge both from a technological perspective and almost more so from a domain expertise point of view," Burghard says. The software alone can't do the analysis, and there aren't enough talented informaticists and biostatisticians to go around, she says.

The expectations for ACOs are also likely to be ratcheted up, Burghard says. "A lot of successes of the federal programs as well as the commercial programs is pretty low-hanging fruit -- like keeping people out of the emergency room and reducing readmissions," she says. "Clinical improvement is the really tough nut to crack." In other words, the more worthwhile goal is detecting the best patterns of care, feeding them back to clinicians, and then achieving improvements in the practice of medicine.

Not everyone is eager to get started.

Robert Budman, chief medical information officer at Yuma Regional Medical Center, says an ACO could make a lot of sense in Yuma's southwestern Arizona area, given that there's "no other hospital for 50 or 60 miles in any direction" and that the community has a large Medicare population. However,

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David F. Carr oversees InformationWeek's coverage of government and healthcare IT. He previously led coverage of social business and education technologies and continues to contribute in those areas. He is the editor of Social Collaboration for Dummies (Wiley, Oct. 2013) and ... View Full Bio

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David F. Carr
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David F. Carr,
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2/20/2014 | 12:27:42 PM
BusinessWeek on ACOs: Paying Doctors to Shun Hospitals
Paying Doctors to Shun Hospitals http://buswk.co/LYItVE

Points out many ACOs are being built independent of hospitals (which ought to be a concern for hospital leaders)
David F. Carr
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David F. Carr,
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2/19/2014 | 10:18:51 AM
Re: From "death panels" to an improved system of care
Not my intent to give credence to the "death panels" thing. I do have some respect for the law of unintended consequences, however. When lawmakers (or insurance companies, for that matter) say they are realigning incentives to reduce overutilization and emphasize quality over quantity of care delivered, that's a fine goal. Whether it results in denial of needed care bears watching. Then again, the bad, old system we're trying to move away from had a bad habit of denying legitimate claims and denying insurnace because of preexisting conditions.

Most of the people I spoke with are optimistic that this system represents a real improvement.
David F. Carr
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David F. Carr,
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2/18/2014 | 4:13:12 PM
Re: From "death panels" to an improved system of care
Most of the people I interviewed saw the accountable care trend as inevitable, appropriate, and necessary.

I'm just contrary enough to start worrying when so many people agree on something.
RobPreston
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RobPreston,
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2/18/2014 | 3:23:57 PM
Re: From "death panels" to an improved system of care
As with a lot of ambitious policy initiatives, accountable care makes sense in theory, but can it be implemented without a rash of unintended consequences? There will certainly be negative ramifications, but will the greater good be served? (I don't know.)
David F. Carr
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David F. Carr,
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2/18/2014 | 1:50:21 PM
From "death panels" to an improved system of care
I don't deal much here with the politics around Obamacare, but I did address it in this column a couple of weeks ago, Obamacare: Separating Politics From Practicalities.

I suppose it must have been the language in the ACA about attacking overutilization of the system that gave rise to the "death panels" meme of a few years ago. I admit it makes me twitchy to hear all this talk about reducing hospital readmissions (what if someone really needs to go back to the hospital, are the incentives going to change in a way that discourages care when we need it?). The goal, of course is to achieve a greater focus on follow up and preventative care, which are less expensive in the long run than hospital and emergency room care.

Do you believe in the potential of accountable care?
Laurianne
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Laurianne,
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2/18/2014 | 1:50:11 PM
EMR standard
"While it would be helpful to have one EMR standard, for now Rab is trying to steer participants toward four or five preferred vendors." It is refreshing to hear someone be pragmatic about this. Setting one standard would not be practical.
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