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Chicken or the egg – the HIE or the ACO? INFORMATION EXCHANGE

With fi nancial, clinical and regulatory pres-

sures increasing steadily, and the new and confounding acronyms appearing daily, many hospitals and health systems today are wondering where they should fi rst put their focus – building a robust health information exchange (HIE) or preparing for an accountable care organization (ACO) or other payment reform model?

Glenn Keet is president of Axolotl, part of OptumInsight (formally known as Ingenix). For more information on Axolotl solutions:

Each variety of HIE (statewide, regional or private/ IDN) has different goals. Privately held HIEs are rooted in the desire to achieve clinical and operational excellence among physicians within a health system, while regional or statewide systems are focused on sharing patient information across providers in a geographic area. We all know that trying to connect these disparate systems can be challenging, and that linking into a larger network requires additional infrastructure investment. But rather than implement- ing a less robust system that

will need to be replaced in two years, the inevitability of some kind of payment reform and shared risk model coming to a town near you means that healthcare organizations need to invest in an HIE that both enables meaningful use now and has the power to support collaborative care models later. Regardless of whether the shared-risk model adopted in the area is an episode of care, bundled payment, full capita- tion or per-member per-month model, the functionality that is inherent in a robust, full-featured HIE will be a require- ment for any successful ACO. Primary caregivers, specialty physicians, the hospitals, the health plans, employers – any group assuming risk for the healthcare of a set of patients – are going to need to be able to communicate effi ciently

and electronically about patients and their health data. Moreover, they need to be able to access key analytics on that data so that they can segment their riskiest patients and treat them in ways that make them healthier while controlling costs. They also need to enable real-time decision sup- port and alerts to the caregivers with actionable intelligence to reduce gaps in care.

The reality is that HIEs can be up and running for years before

By Glenn Keet

any payment reform model is adopted or implemented, and those healthcare organizations that have HIE experience will be best positioned for the change. With the inevitable shift toward collaborative and accountable care on its way, there is no reason to wait. But providers need to make sure that the HIE system they select is fl exible, scalable and “ACO ready,” avoiding the trap of implementing a less robust system to tide them over until the time comes. When ACOs take hold, the last thing organizations will want is to have to make a square HIE peg fi t into a round ACO hole. Both HIEs and ACOs are on the mind of every hospital

C-level executive, and faced with these big changes, it can be extremely diffi cult to know where to start and how to prepare. But regardless of the ACO or collaborative care models that are adopted tomorrow, these systems need a fully functioning HIE today – one that will help them ex- change information securely and operate more effi ciently now, providing the data and analytics to support continued care and workfl ow improvements that will be core to models we adopt in the future.

PUBLICATIONS Determining the root operation, or intent of a

procedure, is essential to accurate coding and illustrates the precision of the code values defi ned in the ICD-10- PCS system. “Root Operations: Key to Procedure Coding in ICD-10-PCS” by Ann Zeisset, RHIT, CCS, CCS-P, and Ann Barta, MSA, RHIA, is an e-book that offers coding professionals and students the tools to differentiate and contrast procedures coded in ICD-9-CM with those

6 October 2011

coded in ICD-10-PCS. The strategies presented address all sections of ICD-10-PCS, offer a snapshot of anatomy and physiology for ICD-10-PCS, and defi ne and illustrate code structure for each section. Root operations of ICD-10-PCS are highlighted to clarify and explain critical factors to consider in correct code assignment. This title is available through the AHIMA Web store at


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