Businesses with more than 50 employees got a one-year reprieve recently on the new federal requirement to provide health insurance or pay a government-imposed penalty. However, other parts of the Affordable Care Act continue to barrel forward, including big changes rippling through health care IT.
Already under ACA, state health insurance exchanges are cranking up, an effort heavily dependent on information technology. The law also offers further incentives for making records electronic, and pushes for the creation of Accountable Care Organizations (ACOs).
In these, physicians, hospitals and other providers coordinate care, aiming to curtail costs (in part by eliminating repetitious or otherwise unnecessary tests) while maintaining quality of care. Under the Medicare Shared Savings Program, ACOs are rewarded financially for hitting benchmarks of cost-containment and favorable health outcomes.
Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services, has described IT services as a “critical underpinning” of ACOs and other main strategies of the Affordable Care Act, through allowing physicians and other providers real-time information about a patient’s illnesses and prescriptions. She credited the law with a one percent drop last year in Medicare hospital readmissions.
But Is There Trouble on the Horizon?
On the other hand, many involved in helping health care IT catch up with other industries are already sounding the alarm that the transition is headed off a cliff because of the short ramp-up. IT glitches are one of the likeliest reasons for the new law to fail.
“Nothing like this in IT has ever been done to this complexity or scale, and with a timeline that put it behind schedule almost before the ink was dry,” Gartner research director Rick Howard told Reuters recently.
Consider the complexity of what is being attempted:
- Hospitals, clinics and doctors’ offices are working with teams of IT support staff, IT consulting experts, government officials, lawyers, ethicists, insurers and other to create an interoperable “meaningful use” system.
- They must integrate strict patient privacy considerations imposed by the Health Insurance Privacy and Portability Act (HIPPA), including ensuring that only appropriate workers have access to electronic patient records.
- They must protect the data from continual attempts by hackers to steal information or crash networks. A cyberattack that interrupts health care would be a disaster.
- They must work with other health are organizations to ensure that records “follow the patient” wherever he or she goes next.
It’s no wonder many are pessimistic.
Health Care Organizations Can’t Do This Without Help
With such a tall task, health care must learn from other industries and seek help from firms with IT expertise, said David Boone, CEO of Paranet, which provides IT consulting and managed IT services to a range of businesses, including hospitals, medical practices, surgical centers and hospices.
“Health care is now on an evolution, and if ‘10’ is cutting edge, they’re more like a ‘3,’” said Boone, former senior vice president of Innovation and Retail Health services for Methodist Health System in Dallas. “They’re going to get to `8’ rapidly. They’re going to adapt … But if the health care industry tries to do this all on their own, they’re going to fail.”
Boone has an unusual perspective, having helped devise and implement HMOs early in his career. To him, something like an ACO is really the same idea – that of having a physician, usually the primary care doctor, working with a team of specialists to address each patient’s needs effectively and efficiently. He believes there are a multitude of reasons that HMOs didn’t live up to their promise.
“Lack of technology was one of them,” he said.
Boone believes the health care industry, if it plays its cards right, can make that concept and others work to the benefit of patients and providers alike.