Recently, the Office of the Inspector General published a report, “Using Health IT for Care Coordination: Insights From Six Medicare Accountable Care Organizations.” In the report findings, the OIG visited six accountable care organizations (ACOs) that used health IT tools to better coordinate care for their patients. However, as OIG noted, “the promise of seamless integration and coordination across providers and care settings has not yet been realized.”
Report
The OIG report states it completed its review on interviews conducted during site visits to six Medicare ACOs (four were Next Generation ACOs and two participated in the Medicare Shared Savings Program). OIG considered the following factors when selecting ACOs: their performance on a quality measure focused on care coordination and patient safety, a minimum of 3 years of experience as a Medicare ACO, geographic variation, and recommendations from CMS and ONC. OIG discussed with ACO administrative staff and providers how ACOs use health IT to coordinate care for their patients.
OIG’s research discovered several themes. Overall, health IT tools enabled the six Medicare ACOs to better coordinate patient care. ACOs that used a single electronic health record (EHR) system across their provider networks were able to share data in real time, enhancing providers’ ability to coordinate care. A small number of ACOs had access to robust health information exchanges, which give ACOs access to patient data even when patients see providers outside the ACOs’ networks. Most of the ACOs visited used data analytics to inform their care coordination by identifying and grouping patients according to the potential severity and cost of their health conditions.
However, the ACOs visited still face challenges in these areas. ACOs that used multiple EHR systems had to rely on other means to share data among providers, either using additional health IT tools or relying on phone calls and faxes. Although EHRs are intended to streamline, coordinate, and improve care, ACOs report that EHRs can also be burdensome and frustrating for providers. ACOs also faced challenges from physician burnout due to the workload of managing EHRs. Most of the ACOs had access to health information exchanges with little or incomplete data, making it difficult to coordinate care when patients saw providers outside the ACOs’ networks. Few of the ACOs use analytics to customize care to an individual patient’s needs. Finally, few ACOs offer health IT tools to patients, other than online portals to their EHRs.
OIG Conclusion
In its report, OIG concludes the ACOs visited use health IT to aid in care coordination in a variety of ways. However, the full potential of health IT has not been realized. ACOs vary in the extent to which they can rely on health IT tools, in some cases because those tools cannot reach all providers involved in a patient’s care, or because the tools lack the necessary information that ACOs need. Achieving the interoperability needed for seamless care coordination places burdens on ACOs to either invest in a single EHR system or use other methods, such as non-health IT means, to communicate health information.
Commentary
A number of articles were written in trade publications about this OIG report. Modern Healthcare noted new HHS-proposed initiatives might address some of ACOs’ IT challenges. Specifically, the Office of the National Coordinator for Health Information Technology released the second draft of its Trusted Exchange Framework and Common Agreement, which outlines principles for promoting nationwide interoperability between health IT networks. The agreement would set federally recognized data-sharing standards, among other requirements.
Additionally, HealthExec points out that all ACOs faced another major industry challenge: burnout, which recently earned a spot in the international classification of diseases by the World Health Organization. Managing EHRs and their associated alarms, which prompt medical professionals about potential interventions for patients, were found to play a role in burnout.
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