ACOs are ushering in the “post EHR” era

EHR vendors are starting to come up for air from Meaningful Use certification and take aim at the next target: accountable care. Unlike Meaningful Use, Accountable Care Organizations change the care delivery orientation toward ongoing disease management. What does this mean for EHR vendors, which have been built from the ground up to support the old model? If Meaningful Use was challenging, many EHR vendors might find the move to accountable care models beyond their capabilities.


EHR Limitations

EHR systems were built to capture encounter information at hospitals and clinics. Part of the service that EHR systems have provided is in codifying workflows and matching clinical activities with fee-for-service billing codes. Much time and resources have been put into standardizing workflows and keeping data locked carefully away inside of hospitals and clinics. In the uncoordinated world of pay-for-volume medicine, this has been an acceptable approach.

ACO success means keeping patients well between encounters. If ACOs are ultimately helping patients help themselves, then capturing encounter information, and standardizing internal workflows may ultimately become a relatively small fraction of what ACOs need to succeed.



Foundational ACO Capabilities

It may be too early to predict an ACO's precise technology requirements; however, there are some foundational capabilities that will be instrumental no matter how ACOs evolve. There are four key technology capabilities that ACOs will need:

Disease management: Disease management is not the same thing as a patient portal. It should not be confused with a mechanism by which a patient can make an appointment, pay a bill, and request medical records. Disease management software should enable patients to take control of the day-to-day management of their health. To that end, it is designed with behavior change in mind. This requires expertise not only in user-centered software design, but also in motivation and game mechanics. The software should fit into a patient's lifestyle, which requires a "mobile-first" orientation. ACO disease management software will seem very different from the ponderous, procedure-centered, desktop-centric EHR software that is prevalent today.

Collaboration: A care team should be able to quickly assemble around not only a particular patient, but also a particular episode for a particular patient. Providers might use the system to offer virtual patient visits and to conduct video conferences among a larger care team - including PCP, specialist, case manager, and patient. The distribution of information for the care team should be as seamless as sharing photos on Facebook, but with the security and authentication of a mission critical clinical system. Information from encounters and consults should be automatically captured by the system so that minimal incremental data entry is required. 'Walled garden' EHR systems will not be suitable for an ACO environment.

Reporting: Reporting is not just a means of reviewing progress against the 65 quality measure reports, but is also a means of reporting against underlying trends on a single patient or a provider. For example, a provider should be able to ask the system how many MRIs a particular patient has had over a certain time period - and then zoom out to compare a population of similar patients. The system should surface early warning signs that enable providers to intervene before a complication turns into an expensive care cycle. Finally, the system should support financial "margin management" and forecast progress against financial goals. 

Affordability: What is the ROI on a $100M EHR project? Hospital boardrooms across the country have avoided addressing this pink elephant. ACO technology should be an order of magnitude - or more - cheaper than big-ticket EHR installations. ACO technology should leverage low-cost cloud infrastructure and should offer open interfaces for interoperability with third-party systems. Most importantly, it should be inherently flexible in order to support the evolution of ACO workflows.


The Post-EHR Era

ACOs will usher in a new model of care. EHRs vendors must re-imagine their offerings in order to support this new model. For some legacy vendors, this challenge might be insurmountable. ACOs will require a new category of technology that helps patients help themselves stay well, that optimizes the performance of cross-functional teams, that offers relevant clinical and financial reporting, and that can be deployed and modified at a reasonable price.