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Practice Fusion · Oct 6, 2014

Building the right foundation for clinically integrated networks from the ground up

Builders and home-buyers in quake-prone regions of California prefer neighborhoods erected atop bedrock to those that rest on landfill, which are prone to crumble and slide when an earthquake hits. Portions of new buildings in San Francisco’s Mission Bay district rest on steel pilings driven through 150 feet of unstable landfill to reach solid rock. Without a firm footing in bedrock, these buildings could be at risk of catastrophic “ground failure” in the next quake.

As hospitals and physician groups build clinically integrated networks (CINs) and accountable care organizations (ACOs) to deliver coordinated, quality-oriented care, they face a similar challenge. Despite the well-known importance of clinical data exchange to effective patient management and quality measurement, complaints about the lack of functional “interoperability” seem universal. In fact, according to an ACO survey conducted by Premier, Inc. and the eHealth Initiative, interoperability of disparate systems is a significant challenge for 95 percent of organizations using healthcare information technology (HIT); the paucity and difficulty of data exchange undermines the core purpose of a Clinically Integrated Network or ACO, and will inevitably dent clinical and financial performance. Disjointed, inconsistent and outdated information frustrates providers, administrators, and patients alike.

In a very real sense, the problem is foundational. The critical technology for any Clinically Integrated Network or ACO is at the ground level where care is delivered, data is captured and codified, and decisions are made. In nearly all cases, that key technology is an electronic health record (EHR). Famously, however, traditional EHR software is often poorly designed and difficult to replace or update, given the disruption to provider workflow. As a result, many providers often choose one of two options: They rely entirely on paper or continue to use old software that was installed locally and that stores patient information on disconnected hard drives in hospitals, clinics and physician practices. Too often, then, Clinically Integrated Networks and ACOs launch with fragmented, outdated and incomplete technology at that ground level, which is the HIT equivalent of porous and unstable landfill. As one structural engineer said of Mission Bay’s mud and rocks – “it’s like building on a bed of Jell-O.”

Using cloud-based software and web services integration can deliver a step change in technical efficiency while enabling simpler user workflows and data exchange – the bedrock for the modern ACO. Cloud-based software can be quickly and regularly updated to optimize information collection at the point of care. Information housed in a single cloud-based database can be mapped, mined and transmitted at scale. And data centers don’t go missing like hard drives, CD-ROMS and manila folders.

Perhaps most importantly, cloud-based tools can power a cycle of constant clinical improvement – a learning network – in a way that will never be possible with traditional software. With cloud-based technology as the foundation, it becomes far easier to aggregate, analyze and disseminate information, and then far easier to use that data to create and refine a consistent provider and patient experience.

The success of a Clinically Integrated Network or ACO turns on the ability to improve care constantly, often in ways impossible to define at the outset. As healthcare leaders design the architecture of new care delivery networks, the best investment that they can make is to start with the foundation. Construction will be simpler (and probably cheaper), and the benefits will be obvious every time the ground shakes.