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Sep 2 2011   10:57AM GMT

HIT Exchange Live Chat transcript: On ACOs and health IT

Posted by: Jenny Laurello
Accountable Care Organizations, ACOs, Live chat, Reda Chouffani, Transcript

Addressing everything from the types of data exchanged as part of an Accountable Care Organization, to the relationship between the meaningful use stages and ACOs, Reda Chouffani, vice president of development, Biz Technology Solutions, Inc., shared his perspective and expertise as part of this Health IT Exchange Live Chat on the intersection of ACOs and health care IT.

Below is the corresponding transcript from the August 31st webcast and chat with Chouffani, where members of the HIT Exchange community had the opportunity to ask their most pressing questions regarding the future of the model, the technology framework and the building blocks of an ACO infrastructure.

Have a question for Chouffani or other members of the health IT community? Visit the HIT Exchange Q&A forum and ask now!

Transcript from August 31st chat:

11:31 Jenny Laurello:  Good Morning and welcome to the Health IT Exchange Live Chat: The intersection of ACOs and health IT! Today we have Reda Chouffani, vice president of development, Biz Technology Solutions, Inc with us to answer all of your most pressing questions.

11:32 Jenny Laurello:  First question for you today: What are some the top considerations from an IT standpoint when looking at the ACO model? How is IT playing a key role in developing this new framework of care?

11:32 Reda Chouffani: Hello there Jenny. I would have to say the main ones that would be on top of the list are:

  • Detailed Strategic plan that can provide sustainable infrastructure for the ACO
  • One common platform for all components to coexist
  • Secured environment and communication
  • Consolidated systems when possible to allow having data more centralized
  • Unified communication to facilitate collaboration of care across different participating organizations

11:33 Reda Chouffani:  Now for the role IT will be playing in the new framework of care it will be a significant one. It would provide support for components such as EHR, integration engines with HIE, private HIE, Reporting tools, data warehouse, referral and scheduling management tools as well as payment distribution systems

11:37 Jean DerGurahian: What is the relationship between the meaningful use stages and ACOs? Should providers focus on both?

11:39 Reda Chouffani:  an ACO would be a more long term model for care and payment remodeling. So for many hospitals they would initially focus on meeting meaningful use requirements first receive the incentives and when it comes time for ACO some of the work would have been already completed such as:

  • The use of Certified EHR
  • Reporting on the clinicl MU measures
  • Connecting to an HIE

11:40 Jason Harwell:  What type of data would be exchanged as part of an ACO and how would you exchange this data? Recommended tools?

11:44 Reda Chouffani:  Great question Jason. Really this all depends on what model of ACO you are looking at. If it is a hospital lead ACO and most participants are on one platform and using the same electronic health records, then most of the information would already be centralized. But for physician lead ACO, there are several data sets and information that would need to be exchange. Since an ACO model depends heavily on communication, exchange of information and collaboration among payers, patients and providers, the information that would be moving is: billing information, outcome measures reports, Imaging, health records (CCD/CCR) as well as unstructured documents.

Now from a tools prespective there are a handful of solution vendors that provide the framework under which an ACO can operate. Some of the vendors are Premier, EPIC, and few other ones that provide the financial piece . As far as on the clinical side, you are probably going to see more of the HIE vendors provide additional components that are added on top of their HIE solution to support some of the requirements of ACO such Medicity.

11:46 Jean DerGurahian: What about the intersection of business intelligence and the ACO model? What must providers do to ensure they capture and can share all the data needed to take advantage of this shared savings model?

11:49 Reda Chouffani:  ACO will rely heavily on business intelligence tools. From the reporting stand point there are several measures that the ACO must report on. Population health trends will also be needed as well. For physician groups running on different platforms, the formed ACO would most likely need to collect all clinical data of patients participating in the ACO in one central data warehouse. Once the information is made available, the different measures can be reviewed and reported on against that central patient data repository.

11:49 Jason Harwell:  Does it make it easier to be part of an ACO if I use the same EHR vendor as my hospital that is leading the ACO. Not to mention they want me to use their EHR.

11:53 Reda Chouffani:  Yes and no. And here is why. If you are under the same EHR and in the same platform as the hospital then the information is already centralized and ready to be viewed by the care team. But in the case when you might be using the system in one health system and another physician from a different system is using the same product then your challenge would be to have the two systems communicate together. This can be done via an HIE. Ofcourse this is only the case when both organizations plan to work together despite the competitive component of it. In some cases I have seen where two hospitals would not exchange information system there is no state level HIE available to them.

11:55 Indira: The proposed CMS ACO model still has a long way to go, it may never be a mandate or common practice, I think. But do you see private insurers doing ACO-like programs based on quality incentive payments becoming the norm…and we’ll have to do this same HIT infrastructure investment anyway?

11:57 Reda Chouffani: You are correct Indira. We will need to first see that HIE have wider adoption and once that’s established it would make it easier for an ACO to connect and exchange information without having to put forward the large capital for a private HIE.

The advantage for private insurer is that they have already in place tools for case management, payment distribution, and algorithms to measure performance and outcomes. Just from some of the P4P initiatives that they have had for a while.

11:59 Pablo: Will enough data analytics and clinical decision support be built into EHR systems for providers to participate in ACOs, or do you think we’ll need to get separate systems running on top of the EHR?

12:01 Reda Chouffani: Since you will likely have multi-specialty groups working together on patient care and we already are seeing how most EHR do not cross well over other disciplines, it would most likely be where we would have additional products that would centralize the data, manage translation of vocabulary and perform some of the BI for some of the outcomes measures

12:02 Trivikram: What is the most important piece of tech an ACO needs, is it data analytics applications?

12:04 Reda Chouffani: Data analytics is one of the pieces. But to be honest I see that there will be other additional components that would be just as critical. For example, for physicians to properly collaborate on care the system has to be easy to use for the care givers and provide one common view for all the clinical data. Once we succeed in doing that, then we will have tremendous amount of useful clinical information to then use and analyze.

12:06 Scottie: Meaningful use stages 2 and 3 require HIE connectivity. Do you think meaningful use is all a hospital needs to do to prepare for ACO participation, or are those just basic steps and ACOs will be a lot more complicated?

12:09 Reda Chouffani:  Meaningful use 2 and 3 would definitely help prepare the hospitals for some of the ACO participation. From the HIE connectivity standpoint as well as some of the measures reporting. I think for most hospitals the challenge would how to effectively connect and work with the different specialties that are not part of their system. This would require extensive workflow changes as well as restructure reimbursements and referral models that they are used to.

12:10 NSwisher3012: There isn’t much reimbursement for telemedicine services right now. Do you think CMS will reimburse a lot more telemedicine to make ACOs work and connect specialists to patients on the far reaches of their regions? Which specialties should we start within our telemedicine initiatives do you advise would be prudent.

12:13 Reda Chouffani: I agree, telemedicine services reimbursements should be addressed. There are clearly a lot of value they provide to both the healthcare providers and patients. Patient would not have to drive longer distances for follow ups and physicians can benefit from costs savings by using less resources at the site. This will also benefit patients with chronic disease as they can receive much frequent follow ups and such. I know that there are several grants out there that have been made available for community health centers which indicates that HHS and CMS are moving toward that direction.

12:15 Reda Chouffani: I would say PCP would be a good place as well as mental health services.

We can also combine those with some of the mobile technologies available that can provide data for the providers real-time

12:15 Gene:  Patients will have a choice to go in-network and out of network for care in the ACO model. How is the CIO supposed to capture data from those out of network care encounters? Require the patient to bring summary of care files…at least on paper?

12:18 Reda Chouffani: Hey Gene. You are correct it would be very challenging for CIO to ensure that data is available for their clinicians about their visit that was outside of their network. In this case the HIE will come into play. And as you mentioned, really from an HIE stand point not all the data will be available for sharing, some will support just summary records, labs, eRx and such while others will have available CCD with XDS to ensure that even imaging and other unstructured documents are available in the “cloud”

12:19 Jason Harwell: Do you know of any technology solutions that support an ACO that are cloud based. The upfront cost in technology for starting an ACO seems to be very high and I didn’t know if a hosted or cloud based solution would save on the upfront investment.

12:22 Reda Chouffani:  Jason, here is what CIO are going to be faced with. They have limited budgets, shrinking reimbursements and more mandates than ever. So in order for the ACO to be a sustainable model for many it will have to run lean. This means they will need to find ways to drive down operating and staffing costs, while still supporting growth. Cloud computing will reduce your upfront costs and allow to easily scale out. Since our population continues to grow the hospital has to adopt a model that is scalable without having to look at major upgrades every 3 to 5 years.

12:23 Siva: Do we have any standards defined for HIE? As to how we can integrate and exchange data across the systems?

12:25 Reda Chouffani: There are a set of standards that would make be a requirement for an HIE especially if they will be a certified HIE. These standards are outlined and part of the NHIN

12:25 Paul: Is the NHIN standard going to figure into information exchange and especially in ACOs because to me it looks like nation-wide HIE is a long way off, maybe a decade…should we be spending a lot of time on NHIN readiness do you think?

12:28 Reda Chouffani:  I think whatever we implement as far as the standards should be in line with the NHIN recommended standards. Since we are moving toward that national HIE model and the circle of trust (federal and state level entities) are connecting to it using those same standards, it would make it a lot easier to utilize some of the proposed and recommended standards so we don’t need to go through future conversion and data translation.

12:28 Jenny Laurello: Please note: The following will be the last question of the day.

12:29 Brandon: How do you see retail community pharmacies getting involved with ACO’s? Will the claims adjudication systems they use be integrated with an HIE over time?

12:30 Brandon: And do you think it’s possible for ACO’s to outsource all of their care coordination activities to a 3rd party vendor, as long as that vendor has connectivity with the provider’s EMR?

12:30 Reda Chouffani: The good news is that many of the patient’s medication are currently available through Surescripts and such. And we have seen a tremendous success in terms of ePrescribing implementations. So, for many of the retail pharmacy the information would be made available to them through some of the existing systems without potentially having to go through an HIE

12:33 Reda Chouffani: I think it could be outsourced. But of course not all functions of it. Physicians will still need to coordinate on the decision making in terms of appropriate treatment and such. But some of the tasks such as communicating back and forth performance certain case management activities can be done outside. The other piece that we will most likely see outsourced or cloud based would be the infrastructure.

12:34 Jenny Laurello: And that’s all she wrote, folks! Thank you all for your participation, and thank you very much to Reda for lending his time and expertise.

12:34 Jenny Laurello: And please be sure to visit the Health IT Exchange Q&A forum to continue posing your questions to our experts and for a transcript of today’s live chat!

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