New World, New Infrastructure: Informatics Requirements of Emerging Payment Models

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Tom SmithMuch has been said and written in anticipation of new payment models like the accountable-care organization (ACO), but one consideration that often falls by the wayside, in all the talk of risk and reward, is informatics, Tom Smith says. Smith is CIO of Triad Radiology Associates (Winston-Salem, North Carolina). “With ACOs still in the early stages of being created, there hasn’t really been a clear set of data requirements,” he says. “Early on, I think there will be a lot of different requirements, depending on how the ACOs want to operate and how they will monitor outcomes.” Smith sees two major challenges facing radiology practices that will seek to interface with one or more ACOs, and both relate to the advanced aggregation and use of data that will be required to manage patients better and to demonstrate lower costs and better care. “The first challenge is the number of data points a hospital-based ACO is going to be trying to collect and monitor,” he says. “The second is getting those data back to the ACOs in a usable manner. There are going to be some headaches in the next two to three years.” Building the Interface Exchanging data between radiology practices and ACOs will necessitate sophisticated informatics infrastructures, Smith says. Not only will practices need RIS or modular electronic medical record platforms—which, conveniently, are requirements for participation in the meaningful-use incentive program—to aggregate the data that ACOs are likely to require, but they will also need custom-built interfaces to communicate these data back to the hospital or health system at the center of the organization. “Off the cuff, HL7 is probably the best way to do this, right now,” Smith says. “This raises a fresh set of issues: You either rely on your application provider to create the HL7 messages and set up the interface, or you can do both internally.” The disadvantage of working with the application provider, he notes, is that many practices are likely to try to work with more than one ACO or other integrated delivery network—meaning that multiple HL7 interfaces will be required. With vendors charging a significant fee per interface, that’s no small consideration. At Triad Radiology Associates, “We have our own interface engine, and we use it internally to remap the data and put them in the format the appropriate downstream provider is looking for,” he says. Having the ability to handle the interface in-house will also make the radiology practice more nimble when it comes to special requests or maintenance, Smith predicts. “Working with the vendor is a two-fold hit—you’re being hit with the cost, and you’re at its mercy in terms of its resources availability,” he notes. “There are big advantages to having that skill set in-house. In this day and age, a medium-to-large radiology group without its own interface engine and HL7 development team will find it difficult to respond and remain competitive.” Taking the Reins For radiology practices planning to develop an informatics strategy for ACO participation, Smith recommends beginning with an assessment of the players in the local market. “The number-one thing to be aware of is who key players are, as ACOs take form,” he says. “Once the radiology practice has identified the key players, it needs to make sure that it is working closely and communicating at least weekly with everyone—to show that it actively wants to be part of the overall solution.” By establishing interest and willingness to help build the infrastructure early on, practices can take a leading position in the development of data-exchange standards, Smith says. “You’d rather be on the leading edge, so you can help drive the systems to work best with what you have in place. The alternative is playing catch-up and having to adhere to someone else’s standards that have already been set up,” he says. Down the road, Smith anticipates the formation of management-services organizations (MSOs) that will allow smaller practices to key into an existing informatics infrastructure and will set up their ACO interfaces for them, opening up a potential new profit line for radiology practices with robust in-house development teams. “If that MSO happens to be a radiology group, that ties it to the ACOs that much more,” he says. “That puts it in a much better position, when it comes to bargaining with the ACO.” In conclusion, Smith says, as with the rest of health care, the emergence of new payment models represents a paradigm shift for radiology informatics—one with the potential to be positive, if practices embrace the chance to leverage their IT capabilities. “The next three years are going to be interesting,” he says. “There will be a lot of challenges and a lot of opportunities.” Cat Vasko is editor of RadAnalytics and associate editor of Radiology Business Journal.