NACHC’s Financial, Operations Management/Information Technology (FOM/IT) Conference was held November 16-18 in Las Vegas, NV. While the conference theme was “A Roadmap to 2014”, the majority of the informal discussion focused not on the roadmap or schedule per se but rather on actual deployment issues for EHRs. Health centers are most interested in how to change provider workflows, to qualify for meaningful use.

Three major themes surfaced at the conference. First is telemedicine and how it might be used at health centers. Many health centers are already beginning to explore or utilize telemedicine in their clinical practice; newer issues are using telemedicine at urban health centers and broadening its use beyond behavioral health, otolaryngology practice and the small number of other specialties where it has been used to date.

A second important theme was Accountable Care Organizations (ACOs) and their implications for health centers. The concept of analytically driven care, focused on quality and outcomes to contain costs, has been written about and discussed for at least 30 years , and well documented by a variety of sources including the Dartmouth Atlas of Health Care . More recently the Patient Protection and Affordable Care Act of 2010 directs the Centers for Medicare and Medicaid Services (CMS) to create a national voluntary program for accountable care organizations (ACOs) by January 2012. Such ACOs would be provider groups that accept responsibility for the cost and quality of care delivered to a specific population of patients cared for by the groups’ clinicians. How do CHCs fit into this model? What are the financial and clinical implications of this voluntary program? This was a source of intense discussion and several presentations including an-after conference session that was highly subscribed.

A final, and somewhat less predictable them, was informatics and business intelligence. For several years, there have been presentations at FOM/IT on data warehousing and large-scale data storage. This year there were several presentations, and a lot of discussion, on the use of such data beyond UDS preparation. Representatives from Waianae Coast Comprehensive Health Center (Waianae, HI) and the Pacific Innovation Center spoke about the use of aggregated data to negotiate additional payments from payers for a range of services, including diabetic care.. They presented several examples of analysis products that were seen as valuable by health centers and payers. In addition, the CMIO of QueensCare Family Clinics (Los Angeles, CA) spoke about how health centers could, and should, go beyond clinical use of EHR data. Examples focused mining EHR data using clinical informatics to interact with public registries and the use of such analysis to improve quality of care within the health center or health center network. These two examples are just the beginning of a very important trend – the use of her, and other clinical data, for analysis to improve not just quality reporting, but quality: quality of care and quality of operations. The Hawaii example also shows that data can be valuable beyond the health center, in this case to the payer. Informatics will become increasingly more important following EHR deployment. It is essential for ACO and is the next big thing in HIT.