The task of integrating EHR's, for purposes of operationing an ACO's, will be crucial, and is being addressed in various ways, at certain granular levels. For example, some hospitals are building private HIE's, which are providing a CCD summary, latest lab results, and active Rx's. Being more granular, for an example of comparing apples to apples, its crucial that all lab providers are LOINC enabled. LOINC codes will make sure that lab abnormal/normal results, are not effected by the various order codes, or out of range analysis, unique to that lab provider.
Another point is that hospitals are buying physician practices, preparing for the ACO landscape. Hence, they have developed their integration plan in advance. Some hospitals are buying practices and replacing them with the hospital enterprise system's, ambulatory application. Other hospitals, are providing funding to community physicians with their chosen, already-integrated, EHR, since Stark Laws allows them to do so up to 85%. This provides them with an already integrated physician base, easy pickings for forming an ACO.
In terms of overcoming integration issues, stakeholders must realize they are on-going. Software enhancements for the various vendors, hardware upgrades, regulations, network security, all contribute to the on-going maintenance of interfaces, and integration among vendors. Also, keep in mind that the discussion of integration standards, is very active, hence issues are always arising. Earlier this year, the Presidential Council on Science and Technology (PCAST), recommended to HHS that XML, with its meta tag capabilities, become the standard, versus HL7, for example. Additionally, hospitals are finding out that some vendors are not truly integrated, like they claim, to their existing infrastructure.