Right now, as things stand, only a small percentage of medical practices have fully implemented EMRs (about 15 percent), research suggests. But the trend toward integrating physicians in Accountable Care Organizations is moving much faster.
I don’t have stats to hand, but everything I’ve read and heard suggests that the provider community is a lot more comfortable with the ACO concept than EMR adoption.
The thing is, can ACOs advance without higher EMR adoption rates? I don’t think so. To my mind, if you want to integrate medical practices and hospitals — with the goal of managing quality jointly — a shared EMR seems virtually indispensable.
During the first wave of ACO adoption, we’re seeing tie-ups between mid-sized to large practices and large health systems. Those large practices are reasonably likely to have EMR systems in place, and just as importantly, an IT department to support them.
But if ACOs models are to work, they’ll eventually have to embrace smaller practices, which make up the vast majority of U.S. medical groups overall. And if those groups are either EMR-less or just getting started, it’s going to be pretty tough to share value-based payments, coordinate across episodes of care and track quality jointly.
Yes, hospitals can give doctors access to their own, industrial-grade EMRs — and some do — but ultimately, EMR use will have to be part of the smaller practices’ culture for ACOs to work.
And while medical practices will understand ACOs, particularly if they’ve been through lots of fashionable hospital-practice partnership models, EMRs will still be tough to swallow.
So, ACO backers, do you think you can move ahead if your physician partners aren’t EMR-connected and savvy? Or are we looking at a big problem here?
Your analysis is right on the mark Katherine.
EMRs and the broader National Health Info Network that is under construction will enable the full promise of ACOs to be realized. Without it costs will continue to spiral out of control due to excessive manual processes.
I agree, having EMRs with an ability to exchange a comprehensive dataset is axiomatic for ACOs.
However, I am also concerned that we don’t create a large number of write only files, that is, once the data is copied/moved to its new home that it just sits there.
Users have to know what’s there, who is in charge of it, that is, who can modify it, act on it, etc., and who can send it off or see it from outside.
[…] population based ACO care management paradigm. See reasoned speculation by Katherine Rourke ‘Do You Need An EMR To Make ACOs Work‘? My answer: […]
John Goodman has called HIT “a fad” and says ACOs are nothing more than HMOs revisited, intended to be Obama’s trojan horses for complete nationalization of health care.
http://thehealthcareblog.com/blog/2011/02/28/the-hmo-in-your-future/