The accountable care organization (ACO) is shaping up to be the model of health care delivery for the future, providing IT managers can solve a wealth of technology issues, from interoperability to clinical decision support (CDS) systems. In this second story of a two-part series, read how one provider organization is applying real-time, mobile health solutions to traditional care problems.
Read Part 1 of this series
Physician group ACO takes 'smartphone app' approach to CDS
Of course, all this talk about a bright future for clinical decision support systems doesn't help the first wave of CMS-funded Pioneer ACO pilots, which are forming now and will soon learn upon which measures federal funders will require them to report. One ACO called Plus -- formed by 600 physicians and the health information exchange (HIE) it operates, the North Texas Specialty Physicians -- currently is testing a new real-time clinical decision support tool specifically for ACO use. The tool is a system-level app called Metrix that resides outside the electronic health record (EHR) but monitors activity as physicians enter data, polls the data warehouse (in the case of NTSP, its HIE) and feeds back alerts based on quality measures the doctors have set it to watch.
The alerts pop up sort of like reminders on an iPhone or iPad, but with a twist: As envelope icons, colored yellow or red depending on urgency of the information contained in the alert, such as a missed diagnostic test or identifying a candidate for depression screening. Once the physician takes action, Metrix sends a note to the EHR system in the form of a continuity of care document (CCD), which the physician accepts into the patient's record.
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NTSP's commercial software spinoff company, Sandlot Solutions, developed Metrix to support a host of quality reporting and analytics initiatives, such as CMS' Physicians Quality Reporting System, meaningful use and NCQA's Healthcare Effectiveness Data and Information Set (HEDIS). While it hasn't been formally announced what quality measures CMS will require its ACO pilots to report on, many believe the agency will select from HEDIS measures used in Medicare Advantage managed-care organizations, said Sandlot Chief Medical Officer and practicing gastroenterologist Thomas Deas, M.D.
The reason Sandlot developed Metrix to work independent of the EHR, the company said, was because of the lack of interoperability and consistency between EHR systems; it would have been too cumbersome to integrate the tool.
"It's not the way we want it to be, we would love to be able to automatically inform the EHR and have it natively display that information -- that's the way it will eventually become, we think, over time," said Paul Steinichen, Sandlot vice president of solutions engineering. "But it could be years before all the EHRs get to that point. We need that point-of-care notification to help direct quality prior to that."
The IT of ACOs not that different from Medicaid managed care
Deas said that since NTSP has operated as a Medicaid Advantage managed care provider for a decade and a half, it's not that long of a leap to ACO participation. The technology improvement that Metrix will bring for ACO use is its real-time feedback.
Unless all that information from across the community is in the HIE, then you've got a database that's profoundly deficient.
Thomas Deas, M.D.,
He hopes the tool will catch more missed tests and other problems while the patient is still in the office, saving time and bandwidth wasted in follow-up calls and ultimately higher success rates in getting those problems solved.
"While the patient is sitting in front of you, you can print out a list and say to the patient: 'These are important [things] you need to have done at X intervals,' and they leave the office with the knowledge of what needs to be done -- and you can get done what needs to be done at the point of care," Deas said.
CDS, ACO and HIE: A tangled Web
It's an interesting idea; a CDS tool customized for ACO measures unfettered by the disparate EHR systems an ACO has by necessity because of all the different players within it: primary care docs, specialists, hospitals, clinics and whoever else might be in the network.
The catch? NTSP also operates its own private HIE. For Sandlot's system to work, ACOs also will have to operate its own HIE.
"Yes, absolutely beyond a shadow of a doubt, yes," Deas said, qualifying that statement by adding, "they may be fortunate enough to be in a place like Indiana where they've got a good HIE, or in other areas where these exist.
"But I would guess that 70% to 80% of these ACOs do not have a good health information exchange. They may have one that exchanges lab, or collects documents from the hospital, but it's not an exchange that pulls in problems, medications, allergies and claims data. Unless all that information from across the community is in the HIE, then you've got a database that's profoundly deficient."