5. Payer, billing and pricing data sharing. Sharing of clinical data is one thing, said Shah, which we're used to doing in the "analog world" – think charts, documents, faxes, etc. "However sharing of financial and billing data is something most organizations don't do today and will need to get better at," he said. Regardless of how good your EHR is, or how much money you've spent on meaningful use implementations, billing and pricing data sharing is something that can't be implemented without a "sophisticated data integration strategy, so you'll need to look beyond your traditional health IT vendors here as well."

[See also: EHR Association supports ACO proposals - with more IT.]

6. Aggregate data sharing. If you're not sure you can do granular data sharing for billing or clinical data, which is likely an early possibility, said Shah, you can try aggregate data sharing. "Aggregate data sharing is easier to get past governance, but most of the HIEs aren't ready to do aggregate sharing yet, [since] the standards aren't in place," he said.

7. Sharing clinical effectiveness evidence (evidence-based medicine, EBM). One important feature the CMS Shared Savings Problem for ACOs is promoting is more evidence-based medicine, said Shah. "Most of us aren't good at tracking care through EMR practices – this is another area that isn't a technical problem." In fact, he continued, everything IT professionals need for EBM exists technically. "What don't exist are the sophisticated, repeatable processes during daily care management that can track and report the EBM appropriately," he said. This isn't a standardization problem, he added, but a "typical Six Sigma business management problem."

8. Population management. According to Shah, future EHRs that want to be relevant in the ACO space will need to become "sophisticated managers of not just charts for patients, but comprehensive patient population management." This includes tracking the latest eMeasures, understanding the needs of groups of patients, and allowing the creating and execution of worklists to help manage patient populations, "such as help desks and calling out to patients [who] need special attention," he said.

9. Change management. "ACOs will require numerous changes in the various organizations that take part in it," said Shah. "EHRs that understand that change management, which allows tracking of multiple projects and tasks, will be most useful." Today's EHRs are more focused on retrospective document management, Shah continued, but tomorrow's EHRs need to help define, encourage, and manage change within the organization.