The usage of multiple electronic health record (EHR) systems is a common occurrence among accountable care organizations (ACOs). This paper summarizes the results of a survey on EHR usage within ACOs and discusses some of the issues this may present in reporting quality measures, including that:
- Just 9% of surveyed ACOs use a single EHR system throughout their entire organization;
- 77% of surveyed ACOs use 6 or more EHR systems; and
- Among the 37% of Medicare Shared Savings Program ACOs with 16 or more EHR systems, concerns about EHR-based quality measures include access to data, standardization of data elements, and cost of integrating across systems.
Electronic health records (EHRs) have been the centerpiece of modernizing the US health care delivery system, promising everything from greater efficiency to better patient engagement.1,2 The latest ambition is better safety and quality through the use of electronic clinical quality measures (eCQMs). These measures, which are being implemented for accountable care organizations (ACOs) beginning in 2023 as part of the 2021 Medicare Physician Fee Schedule final rule,3 draw on EHR data elements for diagnoses, services, and laboratory values4 and should be a simple extension of current EHR functionality, reducing the burden of manual abstraction and reporting.5 However, ACOs and other complex delivery systems utilize multiple EHR systems, many of which have limited functionality, making it complex and costly to benefit from this new way of reporting quality measures. This study seeks to analyze the key challenges facing ACOs as they move toward eCQMs and the added challenges for ACOs with multiple EHR systems.