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We are seeing the second phase of HIT adoption….the leaders have come and gone, and how the second and third tier of users are multiplying.

It is easy to explain and visualize from a TED talk by Derek Silver

The same mechanism will apply to the Accountable Care Act and perhaps Accountable Care Organizations.  The challenge with ACA is to make it a financially sustainable business model.

The same applies to Integrated Health Systems. 

However in the case of IHS the first indications are a decrease in individual practitioners with some collaboration and business solutions to reduce overhead and hopefully improve efficiency. This phase is largely driven by economic concerns and market dominance in a region. 

The current planned changes in reimbursement will be a driver for the next phase of integration.  This phase will require a sophisticated data analytical approach to determine changes in outcomes based upon  treatment models.  It is expected  that outcome improvements will lower costs.

The further growth of HIS will be at the expense of the present individual, and small medical groups.   Eventually the Integrated Health System will provide the most efficient administrative and clinical organization.

The team approach will become mandatory for clinical  excellence.

Integrated health systems such as Mayo Clinic, Kaiser Permanente, Cleveland Clinic, Henry Ford Hospital Systems and many others are at a distinct advantage to develop the accountable care organizations described by CMS. University Systems also provide an integrated system with their own faculty medical groups or those physicians already employed by the University.

The investment necessary to develop these organizations will be felt the most by the smaller entities that will require information technology infrastructure outlay, as well as C-suite reorganization. 

In many cases this will also require physical relocation and not be isolated to just IT and/or administrative functions.

The pushback against the ACA has become considerable, however organization and communicating with all of Congress is essential, both Democrats and Republicans.


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