What ACO Features Are Needed in an EHR?
Most EHR systems are based on strategies that predate accountable care organizations (ACO) and Certified EHR standards. The key EHR requirements for ACOs are the ability to electronically exchange patient information, support provider collaboration, and monitor patient care. The EHR focus to date has been on creating patient exam notes and specifically meeting the Evaluation and Management documentation standards. Most EHR products do not adequately accommodate the operational or management needs of the ACO structure.
Many Certified EHR products have structural designs that will not address ACO patient care needs. The active management and tracking of patient service issues and the maintenance of referential integrity for patient care is an area that requires dramatic changes to many EHR products. As important the expanded use of electronic exchanges necessitates auditable tracking of information sources as well as activities associated with those incoming and outgoing transactions.
Certified EHRs can accept electronic transactions such as the Continuity of Care Record (CCR), but mostly do a poor job of tracking CCR related clinical activities. For example, the incoming CCR may trigger some clinical activities that will be reported back to the CCR source provider as well as tracked internally as the trigger for the follow-up patient service items. In most EHRs, each event is treated as a discrete item that is not related to the CCR or subsequent events. The lack of life cycle management and tracking tools makes management of ACO relationships and quality assurance difficult, if not impossible.
The lack of tracking tools could pose a number of patient service and medical; professional liability issues to the ACO as well as participating ACO providers. For example, the lack of tools to track appropriate clinical and patient service responses would make it impossible to monitor ACO activities and standards. In the event of a compliance audit or a medical professional liability discovery process, the EHR would not adequately reflect the due diligence for the patient situation. For example, many EHR products do not consider workflow messages part of the patient medical record. Such workflow messages may be a necessity for collaboration on care issues triggered by an incoming CCR.