South Nassau Communities Hospital in Oceanside, N.Y., is forming an ACO called New York Medical Partners, consisting of the hospital and approximately 200 physicians. John Mertz, vice president and CIO of the hospital, describes his role in creating the new organization and how health IT will play into supporting New York Medical Partners' patient care goals.
Editor's note: Responses have been lightly edited for clarity and concision.
Question: What will be your role in the formation of this new ACO? How does health IT play into this?
John Mertz: We are trying to leverage the expertise within the hospital to support the management services organization and ACO until they can fully stand on their own. This includes support from IT, [health information management], case management and other hospital departments. The majority of the physicians in the ACO are small one or two practitioner groups. Many of these small practices have reached out to us to help them implement technology into their practice. To fully support the shared savings or risk sharing arrangements the insurance companies are looking for, IT will play a large role.
We will be looking to aggregate both episodic data from all patient encounters and claims data from the individual payers in order to create the analytic reports we will need to satisfy the ACO quality requirements. Care management software with care plans for patients will need to be available across the entire continuum of care. Point-of-care patient information from the entire service will also be required by clinicians at each patient visit.
The goal is to be proactive in treating the patient before an admission to the acute care setting is required. If we can make sure diabetic patients follow their diet, their plan of care and have their A1C test done timely, we may be able to prevent an emergency department visit or even a hospital admission. This logic will follow many chronic conditions such congestive heart failure or chronic obstructive pulmonary disease. Today there are many apps being created to help monitor the patients in their homes. We may be able to integrate those apps into our EMR to help track our patients and verify adherence to their post-acute care instructions.
Q: Will all of the physicians within the ACO be using the same EHR?
JH: South Nassau uses the Allscripts EMR in the hospital and our affiliated clinics. For our owned physician practices we use athenahealth. If a physician is looking to purchase an EMR, we recommend athenahealth, and we are working on a model in which the MSO can help them pay for it. We are not requiring they purchase athenahelath's EHR or convert to it. We are only recommending it. We are working with the ACO to limit the number of other EMRs we can support.
Q: How will the ACO increase the need for interoperability?
JH: As the patient traverses the various points of care in the ACO, each point will need to be aware of the care provided all along the continuum. This will require a health information exchange, a clinical data repository and patient-facing technology, such as portals and monitoring devices. There will also be the need to normalize this patient information. Population health management will require a strong, care management infrastructure with nurse care managers in primary care offices. It will also be necessary to stratify our covered lives and identify higher-risk patients.
Q: How will South Nassau Communities Hospital's cybersecurity strategy evolve during this process?
JH: The ability to provide readily available access to patient information at many diverse locations while maintaining the confidentiality of that information will be challenging. Some of the ACO membership will be comprised of otherwise unrelated providers. This will create a heightened risk as a result of sensitive information being passed around among more individuals through some non-integrated systems with varying degrees of security. As a result, the data security of the ACO is only as strong as its weakest link. All members should be considered covered entities though and will be responsible for meeting all the HIPAA requirements. Another challenge will be the growth of patient monitoring devices used in the patient's home and how to securely transmit that information back to the ACO.
Q: What will be the biggest health IT challenges during this process?
JH: The biggest challenge we are facing is building the infrastructure, both technology and staffing, to support the population health requirements of an ACO, while still living primarily in a fee-for-service environment. Most ACOs have not been successful in reducing costs if they could not properly manage their covered lives care and referrals.