3. Hospitals can't make the business transformation to an ACO without an HIE. A few years ago, said Crapo, organizations bought HIEs to improve the efficiency of their operation. "They thought 'if we can do things for a cheaper cost, that's going to save us a little money," he said. "There was a physician affinity strategy, where they needed to provide all the physicians in their community with access to data, so they will continue to do business within the hospital." Now, he continued, if a health system wants to become an ACO, they simply can't make the business transformation without first implementing an HIE. "And if they have one, it's probably going to need to be polished up and do more things than it's doing today," Crapo said. "And if they don't have one, they're absolutely going to have to deploy one because they can't be a successful ACO without a robust health information exchange."

[See also: ACOs Part III: patient-centered IT .]

4.  It's critical to think "broad enough" when it comes to physicians. According to Crapo, when thinking about HIEs, CIOs tend to refer to their "more closely aligned" physicians, or those who may be employed or are affiliates of the organization. "But, I think they need to broaden their horizon a bit from their traditional thinking," he said. "Because for an ACO to be successful, you need to have a very broad community of specialists and expertise that are part of your provider network to deliver the access and quality of care an ACO needs to deliver." Not to mention, Crapo continued, CIOs are going to have a broad mix of technology employed in their ACO, as well as physicians who will all need to be connected. "CIOs haven't thought about how they're going to do that," he said. "So, if I was to give advice to a CIO, I would say to make sure you think broad enough about all the physicians and all the other kinds of entities."

5. Essentially, an HIE is a "necessary foundation." At the end of the day, said Dover, it's simple -- perspective changes, and an organization is at risk. "And underlying all of this is the business model," he said. "The other thing I would offer as a suggestion is, HIE is a foundational element, and it's a necessary foundation -- it's like building streets in a city." But an HIE, in and of itself, isn't enough to run an ACO, Dover added. An organization would need to tightly integrate an HIE with population health management solutions, case management solutions, disease management solutions, quality reporting solutions, and more. "So once you have that data flowing, you now need some very powerful intelligence engines that are running on top of that to start identifying at-risk patients," he said. "CIOs are facing that choice of 'Do I go out and buy HIE from one vendor and [these solutions] from another, or do I have an HIE from a vendor who has access in their company to those other layers of intelligence?' That's going to be required for an ACO."