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Accountable Care Organization

Need for setting up a network infrastructure at SPA ACO
During the transformation phase of the rehab to SPA ACO, activities of a pharmacy and a physician group can also be integrated through use of IT systems. Networks can be used by enterprises to enhance operational effectiveness, enhance organizational agility, and increase ability of the management to control operations across the organization (At & T, 2007).
While changing the process system at the rehab to accommodate IT changes in the way computers are connected has to be done. By using Electronic Health Records information can be shared amongst identified parties. To ensure information is transferred effectively amongst physician groups, and pharmacies, networks have to be established amongst the rehab, and identified organizations.
Information systems needed in an ACO
At present Accountable Care Organization (ACO) are being advised to make use of advancements offered by Information Technology. Information systems that are most required by health organizations are data management systems, systems to maintain electronic health records, and personal health record exchanges. By automating the process of documenting and managing vast array of information about patients, coordination of activities at the hospital can be achieved, and the hospital can be accountable for the overall care provided within its premises (Glaser & Salzberg, 2010). Information systems are required for maintaining registries, and through use of such a system all registries, labs, pharmacies, performance reporting data, and claims can be integrated. Compliance, and performance of physicians can be can be enhanced by making use of information systems

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which enable electronic prescribing, and frequent monitoring of physicians through use of
Information Technology enabled systems. Information systems have to ensure processes and workflow within the organization are integrated, and automated towards increasing efficient operations of the ACO (James & Grube, 2011). In detail common Information systems needed in an ACO are identified as below (Glaser & Salzberg, 2010);
Electronic health record (EHR)
According to requirements of an ACO, medicines given to patients have to be recorded.
Through use of Information Systems to capture health records electronically, patient related information, clinical decision support, and care related transactions can be monitored, and stored. EHR must also allow for identifying patients for whom AHO is accountable, offer registry facilities for tracking patient’s medical progress, and it has to incorporate communication tools that can support team oriented care.
Data Management applications
Data management systems can be used to ensure hospital services are of good quality.
Hospitals can make reports which can be used to show their efficiency, and they can make improvements in areas where needed. High risk patients can be identified though such data management systems and alternative care settings can be assessed if required for patients.
Personal health records
Patients can be allowed access to their health records, and through Information Systems they can also have access to interact with telehealth, care management, and health

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information tools. Care performance of organizations can be improved by allowing for active interaction of patients with their health related information.
Health information exchanges
Clinical data can be shared amongst providers in ACO by making use of Information
Systems to make such data transfers.
Difference between Information Systems, and traditional systems
Traditional systems do not have the advancements offered by Information Systems.
Information related to patients have to be communicated between providers through medical courier, over the phone, and at times clinicians who have no interactions with medical personal have to make use of knowledge had by the patient. As interpretation of a patient may be inaccurate, and traditional communication systems may be inefficient, many organizations started making use of Information Systems. Patient safety risks are increased and patient care is decreased when traditional systems are used for communicating amongst various health care providers. Electronic Health Records offer complete record of a patient, and this single view of the patient record can be used amongst multiple departments at ease using EHR applications. Better clinical decision making is supported by such electronic health records, as patient wait time is reduced, transparency in medical procedures is present, and incompatible treatments can be avoided. The workflow with an ACO can be streamlined
(Orion health, N.D).
Data management is another major issue while making use of traditional systems. In traditional systems to maintain registries from pen and paper method, applications like MS
Excel were being used. Such applications are time intensive, and integrating registries across

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departments is difficult. By making use of information systems data management becomes simpler, and data can be made available across multiple departments. Information transferred through traditional communication systems cannot be said to be reliable, as the record maintenance on the part of the health care organization is minimal. This may lead to inappropriate diagnostics, which may pose to be risk to the patient. Risk management can be done by using Information systems, patient registries can be actively managed, and transparency in operations at hospital can be attained, thus improving performance of the organization. (Baylor health care systems, 2011).
Implementing concept of ACO – Process changes necessary
To incorporate processes that are aimed towards promoting an organization into becoming an ACO, strategic planning has to be done in a patient centered fashion. Clear benchmarks and management goals have to be set before proceeding with implementation of the process. The key stakeholders in an organization have to be consulted in before implementing the concept of ACO. Participants in an ACO have to take help from financial professionals while making changes in the organizations for offering patient care in an integrated manner (DeMuro, 2012). The key competencies that are expected of ACOs are, to formulate a management structure that is formalized, to formulate a structure that allows for coordinating operations amongst participating providers, and creates a system that can be used to distribute payments. A robust financial model is necessary while making the shift to becoming an ACO (Harris, Elizondo & Johnson, 2012).
As ACO’s involve working with multiple partners, apart from traditionally looking at the hospital component only the ACO has to make process changes to coordinate patient care

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with its partners. Formal structure of ACO has to be established, and shared savings have to be distributed. The governance process of ACO has to be changed to become shared governance. Roles and responsibilities of all employees with the ACO have to be defined clearly and transparently, as the number of physicians in an ACO is significant. The needed
Health Information Technology systems have to be identified, and deployed. The employees have to be trained with relevant Information Systems, and technology. Traditional information transfer mechanisms have to be replaced by effective Information Systems gradually. Professional staff members, for increasing quality of healthcare provided by organization have to be hired by the ACO. Recording audits, collecting data, analyzing, and monitoring data, and enforcing compliance requirements have to be incorporated into the organizations daily activities. Health care has to be integrated, and innovative compensation systems have to be used for paying physicians. Patients have to be made involved in the care process, and through adopting informed decision making procedures ACO’s can strive towards making their health care processes, and procedures patient centered (Sadowy & Holloway, 2010).
The pharmacy which has to be connected with the rehab is located within the premises of the rehab, while the physician group is located within 30 miles from the hospital. For connecting the rehab with the pharmacy, LAN network can be used, as the pharmacy is located within the organization. The physician group is located at a greater physical distance, and so a VPN network can be used to connect the rehab with the physician group.

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IT requirements for setting up networks
For setting up connectivity within an organization, Local Area Network (LAN), is the best choice. LAN has the ability to act as a server in a network and by making use of LAN a focal point for all activities over computing stations can be established. Major network equipment needed while setting up a LAN are, wires, network interface cards, and hubs.
Network interface card (NIC) is to be used for connecting wired Ethernet networks, and they can be used to transmit data at high speeds. Cables are required to connect the computer hubs to one another. Hubs or repeaters can be used to connect multiple computers. Router also has to be used in a LAN in order to connect the computers to the internet (Wait & Kane, 2005).
Wide Area Networks (VPN) can be used to connect offices that are located physically apart.
VPNs can connect with other LANs, thus enabling complete connectivity of organizations.
For setting up VPN, IT equipment needed are routers, concentrators or hubs, work stations, subnets, and data storage unit links for establishing the VPN links (Regan, 2003). Instead of hubs in both cases, switches can be used to further increase the operational efficiency of the communication system. Driver for NIC has to be installed after physical installation of NIC has been done. Apart from the hardware as identified above, software applications have to be installed on preset workstations while setting up the networks
Forming the network
At the rehab, by making use of LAN, and VPN networks communication can be established between the pharmacy, and the physician group. A possible network configuration that can be adopted at the rehab is presented below.

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LAN connection that can be established at the rehab with the pharmacy is shown in figure 1. As it can be seen multiple workstations can be connected to a centralized server. By making use of Ethernet wires, hubs, cables and Ethernet cards all computers are connected into a network.

Figure 1 LAN connection
The router present in the network serves to connect the LAN, and the VPN networks.
Operations at the company can be coordinated better by making use of the LAN and VPN technologies as shown in figure 2. To ensure information within the premises of the organization are secure, firewall, and other related applications also are used.

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Figure 2. Overview of network setup in an organization
Effect of potential changes in quality of care provided at organizations
ACO can be said to be a structural healthcare reform. An ACO agrees to be accountable for cost, quality, and the overall care of beneficiaries in Medicare. Clinical integration is an important and vital component in becoming an ACO. Reduced costs, and improved quality can be achieved through such clinical, and physician integration. Organizations by adopting measured to incorporate changes in processes needed to become an ACO can benefit from
(James & Grube, 2011);
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Having means to integrate their medical records electronically

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Making use of coordinated review systems, and utilization management

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Incorporating proven management systems

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Incorporating ways through which the organization can offer effective services functionality for its members

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Making use of incentive payment systems that are efficient

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Taking help from capital planning, and financial management experts

ACOs will have to include more technological advancements, and by incorporating
Information Systems the operations within the hospital can be made Information Technology drive. The ACO organization can increase the quality of health care and noted changes in quality of care observed in organizations are;
1. Cost savings for organization and the patient, as lost productivity owing to absenteeism can be averted.
2. By adopting generic prescribing compliance of medical practitioners can be improved. Value creation can be promoted by adopting such prescribing practices.
This results in quality care for patients, and performance of the organization can be improved. 3. ICU mortality rates can be decreased
4. The turnaround time of reports can be reduced by making use of Information
Systems. This can help in offering effective diagnostics, thus improving patient satisfaction 5. Loyalty with partners can be strengthened. By allowing for multiple partners to collaborate with one other, multiple managed patient care can be offered. Through

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Recommended network specifications, and network diagram for use at SPA ACP Visio diagram
A basic view of the network can be created using a Visio diagram. The primary equipments in a network, and the way in which these equipments are to be connected can be depicted through the Visio diagram. The basic outline of network at the rehab was derived based on the concepts of LAN, and VPN, and the network topology is shown in figure 3.
Workstation at
W Workstation rehab at physician
VPN

Workstation at rehab W Workstation at

G Gateway

Router

R Router

GGateway
W Workstation

pharmacy

at physician Workstation at pharmacy Figure 3. Outline of IT connectivity at rehab between rehab, pharmacy, and physician group

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Computers within the rehab are interconnected through Ethernet, and they are all connected via servers. Hubs or connectors have to be used when multiple computers are connected to ensure signal strength during communication process does not occur. Inside the rehab through a router wireless connection to internet can also be established, apart from offering wired interconnection through Ethernet. The workstations available at the physician group are connected wirelessly to the router present in the rehab. The structure of the network is a general outline to basic IT materials required at the rehab for implementing the recommended network system.

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References
At & T. (2007). Integrating network infrastructure for competitive advantage. FIS event coverage. Available at http://www.corp.att.com/ap/docs/atnt4.pdf
Baylor Health Care System. (2011). 12 ACO must haves from Baylor Health Care systems.
Summer 2011 leadership report.
DeMuro. (2012). 7 strategies for success in governing an ACO.
Glaser, J., Salsberg, C. (2012). Information Technology for accountable organizations.
Health & Hospital Networks magazine
James, P., Grube, M. (2011). Getting to there from here: Evolving to ACOs through Clinical
Integration programs. KaufmanHall
Harris, J., Elizondo, I., Johnson, M. (2012). 3 steps to analyze your organization’s ACO opportunity. Healthcare Financial Management
Orion Health. (N.D). Electronic Health Record. Orion
Regan, P. (2003). Wide Area Networks. Pearson education
Sadowy, H., Holloway, A. (2010). Introduction to ACOs for IPAs. IPA Association of
America.
Wait, J., Kane, J. (2005). LAN switching first – step. CISCO systems Inc.

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