Health Language Blog

Terminology & Analytic Challenges for Accountable Care Organizations

Posted on 05/15/13 | Comments


As the United States strives to get more value out of its health care expenditures, Accountable Care Organizations (ACOs) make sense. As both a clinician and a consumer of health services, I’m enthusiastic about providers, hospitals, and health plans jointly taking responsibility for providing holistic, coordinated, effective and efficient care. But given the at-risk nature of payments to ACOs, only organizations with the right scale of providers and patients – and the right information technology resources – are positioned to be successful ACOs.

ACOs need to analyze diverse streams of health information. Many organizations already make excellent use of administrative and claims data. As the quality of care is further emphasized in the ACO model, organizations increasingly need to analyze clinical data as well. These data are likely to come from a variety of EHRs using different data representations. For example:

  • Lab data can be crucial indicators of quality of care (for instance, hemoglobin A1c in diabetes, microbiology data for surveillance of postoperative infections). In today’s world, these data are largely represented as local laboratory codes. Although Meaningful Use 2 (MU-2) should increase the availability of LOINC-encoded laboratory results, organizations can’t wait for MU-2 to mine the wealth of laboratory data in existence.
  • For patients with chronic diseases, providing personalized support on medication use will be key to improving quality and outcomes. ACOs don’t just need to know whether doctors prescribed the right drugs – they need to know whether patients with chronic diseases are filling those drugs, and if not, why not? With electronic prescribing, organizations can access burgeoning data on drugs prescribed and drugs actually dispensed. But these data often come in incompatible proprietary formats (Medi-Span, FDB, Multum) that need to be reconciled.


Topics: Analytics, Coding Challenges, terminology services, health information, medical data