ACOs Struggling With EHR Connectivity Costs

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By Alex Ruoff

Sept. 8 — Accessing patient data located outside their organization remains a difficult and costly challenge for accountable care organizations, according to a survey of ACOs to be released in September by the eHealth Initiative.

The majority of ACOs are trying to analyze a broad swath of clinical and claims data to find gaps in their patients’ care and identify their most costly patients in order to find cost savings, the survey found. However, the cost of connecting their electronic health records to other health-care provider organizations for the majority of ACOs ranged from $100,000 to more than $1 million, the survey found.

The survey demonstrated that the majority of ACOs around the country remain “immature,” meaning they still rely heavily on fee-for-service charges and haven’t adopted more advanced health IT tools, Kevin Attride, director of clinical health outcomes for AMITA Health, a hospital and health clinic chain located in suburban Chicago, said during a Sept. 8 presentation on the survey results in Washington.

“Right now we’ve got one foot on the boat and another on the shore in transitioning from fee-for-service to shared savings,” Attride said. “Health IT is one of the big hurdles. It takes time and money to get data moving to coordinate care and get a picture of your patients.”

eHI and the Premier healthcare alliance in August surveyed 69 ACOs, the majority of which were participating in Medicare Shared Savings Program (MSSP). Most of the organizations that responded to the survey were relatively small, caring for less than 50,000 patients and employing less than 500 health-care providers.

The complete results of the survey will be released sometime in September.

An ACO is a group of doctors, hospitals and other health-care providers who work together to provide better, more coordinated care, according to the Centers for Medicare & Medicaid Services.

Cost and Connectivity

The top challenges identified by ACOs in the survey were accessing data outside their organization or network and integrating new data into their network. ACOs surveyed also said implementing change management and the cost of health IT tools were challenges for them.

Craig Richardville, senior vice president and chief information officer for Carolinas HealthCare System, a hospital network in North and South Carolina, said health information exchange (HIE) organizations are partly to blame. He said most HIEs only allow providers to access fragments of patients’ health records, making it difficult to understand the full picture of their health issues and history.

“Most of the data we get is clinical data, focused on a single episode of care,” Richardville said. “But, there’s some nonclinical data and big picture stuff that can be more important.”

One quarter of the ACOs surveyed by eHI and Premier reported spending more than $1 million to develop connections between their EHR system and the EHRs of providers outside their organization, according to eHI. Twenty-eight percent reported spending between $100,000 and $500,000.

Network Size and Provider Variety

The survey also found that ACOs are typically creating small or medium-sized information networks comprised of mostly primary care providers and laboratories.

Less than 40 percent of ACOs surveyed said they’ve successfully connected to 10 providers outside their organization. Forty-four percent reported connecting to between 11 and 50 providers. Just 10 percent said they’ve connected to more than 50 providers.

Those surveyed said primary-care physicians and laboratories were the easiest to connect with, while specialists, long-term care and behavioral health providers were the most difficult to connect with.

Karen Handmaker, vice president of population health strategies at Phytel, an arm of IBM Health, said ACOs have focused on tackling the easiest technology challenges that offer immediate savings, such as connecting to primary care. She said primary care providers typically have more money to spend on health IT tools and connecting their EHR systems with other providers than behavioral health or long-term post-acute care providers.

However, Handmaker said, ACOs will soon have to integrate data from these harder to reach providers in order to perform the kind of predictive analytics tasks that will give them insights into how to save money caring for their patients and improve the quality of care they offer.

To contact the reporter on this story: Alex Ruoff in Washington at

To contact the editor responsible for this story: Patty Logan at

Additional information about the survey is available at


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