Value-Based Care

Interoperability: What ACOs Need

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Anil Jain, MD, is a Vice President and Chief Medical Officer at IBM Watson Health

Although accountable care organizations (ACOs) are making great progress in their ongoing push toward interoperability, most still have a long way to go.

According to one recent survey of 68 public and private ACOs, although 85 percent have technologies in place that allow them to capture and interpret data from the various information systems within their organizations, most are challenged with integrating data from out-of-network providers.

Despite their investments in health information technology, more than two-thirds are having a particularly hard time assimilating information from specialty-care settings—in-network and out-of-network alike.

This “lack of liquid data” makes it “difficult for ACOs to proactively intervene with needed care,” notes Jennifer Covich Bordenick, CEO of the eHealth Initiative (eHI), which conducted the survey with Premier, Inc. in 2015. Without ubiquitous interoperability, she adds, such organizations face an uphill battle in their “quest to achieve healthcare’s Triple Aim.”

It’s easy to see how interoperability might be the key to coordinated care. However, “Information systems are designed for the unique needs of different settings and specialties,” reads a report put out by the eHI/Premier team in the wake of their survey. Because systems lack a “common language” to facilitate information sharing, interoperability “is often non-existent or requires complex interfaces for standardizing and transmitting data.”

Steps Toward Interoperability

So what can ACOs and their leaders do as they work to make interoperability a reality? Here are a few ideas:

Establish interoperability criteria. Before you attempt anything else, ensure that every stakeholder within your organization understands, supports, and has the opportunity to contribute to your interoperability goals. You must have the backing of everyone involved, from your colleagues in the C-suite, to your clinical analysts, to the many clinicians on the frontlines of patient care. Interoperability is more than just data integration — it’s also about connecting real people and communicating the value those connections provide.

Provide training as necessary. As the eHI/Premier report notes, ACO providers “must purchase and learn to use complex health IT systems that support data exchange for cost and quality outcomes monitoring, performance measurement and care coordination across the continuum.” While some providers may find these systems intuitive, others may think they just make life difficult. Plan on providing adequate training and support so that everyone feels comfortable with the technologies involved. Monitor the use of the technology to identify providers who are super-users who can then work with those with barriers to adoption.

Stay current on the regulations….and choose vendors and partners who do the same. For interoperability to scale and succeed, data must be standardized to common terminologies (ICD9/10, CPT, LOINC, RxNorm, etc.) to be integrated and exchanged. Standardization is a technical endeavor, but thanks to the work of a group called Health Level Seven International (HL7), protocols (like FHIR) are in place that healthcare organizations can follow. Likewise, it’s important to stay up-to-date on all regulations (like HIPAA/HITECH) pertaining to interoperability, and to work with manufacturers, vendors, and other partners who share your commitment to best practices.

Give specialists and out-of-network providers the assistance they need to achieve interoperability. Better communication with specialty-service and out-of-network providers can reduce errors and redundant procedures while minimizing the gaps that are common in patient care. But with incompatible systems, the need for data-sharing agreements, and legal restrictions pertaining to patient information, improving exchange between such providers is easier said than done. A solution may be close at hand as new regulations make interoperability more feasible. ACOs can also facilitate the process by offering incentives that encourage providers to adapt.

Interoperability is Critical

Without interoperability, it’s impossible for ACOs or their providers to know for sure if a patient’s records are comprehensive. And without key information from disparate systems collected and available in a single place, it’s impossible to use data analytics to develop the insights that ultimately improve performance. Although that exchange of information is often not enough, it is a key first step to make information that is subsequently actionable, credible.

Whatever steps you start with toward interoperability, keep the end-game in mind: Every step you take to connect your organization brings your providers and patients that much closer to the future of healthcare.

Vice President and Chief Health Informatics Officer, IBM Watson Health

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