Clinical integration represents the collaboration between doctors and hospitals to use proven protocols and measures, in order to improve patient care, decrease cost, and demonstrate value. Following the passage of the Affordable Care Act and the rise of Accountable Care Organizations (ACOs) and other value-based care organizations, Clinically Integrated Networks (CINs) have been increasingly more prevalent. The proposed Medicare Access and CHIP Reauthorization Act (MACRA) rules have provided another push for health networks to maintain and grow their clinical integration efforts and work in greater collaboration with doctors and medical practices and to structure future acquisitions around their clinical goals.
For effective collaboration and successful on-boarding of new acquisitions, IT systems must be appropriately structured and in place. Below are 5 IT components necessary to support clinical integration:
1. Strong IT Foundation
IT infrastructure is the backbone of the CIN’s value proposition and is critical to improving coordination and connectivity between providers of care. To successfully utilize technology in supporting care, the system’s technology roadmap must be built on a strong foundation. An infrastructure that includes the right hardware, software, network, and people to run the IT will prove essential to:
• Improving quality of life;
• Advancing quality of care;
• Protecting Personal Health Information (PHI);
• Decreasing length of patient stays; and
• Reducing re-admissions.
A well-planned infrastructure will take into consideration the requirements for network, servers, end user devices, applications, and security, as well as, help plan the roles for the people and processes to execute an IT strategy. In doing so, the infrastructure should be designed to scale with the system’s growth and provide for communication and integration between members of a CIN.
2. Accessing and Interpreting Data
Accessing and interpreting data is the key to advanced patient care in modern healthcare. In order for a CIN to achieve its mission, the providers working within the network must be able to seamlessly access patient data and communicate and share that data with one another, while being mindful of HIPAA regulations. As providers join the network and begin using a new Electronic Medical Records (EMR) system and other applications, those providers must also be able to access their historic data in their legacy systems. By utilizing a fail-safe data conversion process, providers and CINs will be able to:
• Reduce legal risk;
• Preserve valuable data;
• Better utilize their new EMR; and
• Increase patient interaction.
Furthermore, clinical decision support technology helps providers interpret data and arms them with the advanced analytics and decision support. This technology allows providers to avoid spending time reviewing a plethora of patient data and, instead, focus on providing clinically sound, personalized patient care.
3. Population Health Management & Care Coordination Tools
The population health approach to care establishes that an organization and providers must be able to provide proactive, preventative, and chronic care to a population both during and in between encounters with a healthcare system. Care coordination among the providers and their teams is imperative for creating a successful CIN. Both of these principles require that providers establish and maintain contact with each other and their patients, while supporting patients’ efforts to manage their own health.
Population health and care management tools use technology to help:
• Facilitate care;
• Reduce the cost of care; and
• Improve patient outcomes and experience.
4. Advanced Reporting
At the core of a CIN’s success is performance monitoring that includes feedback and actions to improve care. In order to make strategic progress and to understand the steps needed to improve care and achieve their goals, CINs must understand “where they are.”
To gain that understanding, technology must be in place to accurately measure outcomes and track and report on:
• The whole population;
• Individual patients;
• Health system performance; and
• Individual performance.
CINs need to build a library of clinical quality improvement metrics that can be adapted as the organization evolves and advances. This will help identify where performance is the most successful and areas that need improvement. These efforts should include tools that meet specific government regulations for physician performance tracking and reporting. Furthermore, enforcing performance standards that include initiatives focused on physician feedback and improvement is also essential to meeting government regulations.
5. The Right Partner
As with any initiative, having the right partner to help design and implement IT solutions is essential to success. In designing the technical components for clinical integration, it is imperative to use an IT partner that truly understands the needs of both the hospitals and the providers, has a strong background in implementing health IT, knows HIPAA and other government regulations, and is willing to be flexible to the needs of the CIN. The right IT partner will work in lockstep with the clinical and technical teams at a health system and will advise on all the technical components necessary.
Together, these 5 components provide the groundwork for clinical integration and a clear path toward advanced care, reduced cost and improved patient experience. What components are you implementing to improve your clinical integration?