The federal Pioneer <a href="/directory/accountable-care-organization-aco" target="_blank" class="directory-item-link">Accountable Care Organization Model that was announced last May is asking too much of providers, too soon, according to Brian Yeaman, chief medical information officer of Oklahoma-based Normal Regional Health System.

Hospitals have too much on their plate right now, Yeaman told Healthcare IT News in an exclusive interview. Trying to add the Pioneer ACO project on top of that is too overwhelming, he said.

<p class="MsoPlainText">“As hospitals, we’re trying to build infrastructure to accommodate meaningful use Stage 1," said Yeaman. "This is tying up most of our resources and operational funds. We have ICD10 not delayed this time, so we’re under the gun with preparing for that. Both are putting a significant strain across our health system."

Yeaman has the experience to back up his claims. Norman Regional's 450-bed hospital is one of the top 5 percent of community-based hospitals in the country for health IT connectedness, he says. The health system is poised to participate in an ACO, with almost 90 percent of its ambulatory care doctors having adopted electronic health records and 50 percent ready to attest to meaningful use Stage 1.

[See also: AHA says start-up costs for ACOs higher than expected.]

Norman Regional plans to attest to meaningful use Stage 1 in 2011 and is part of two functioning health information exchanges, a local HIE for two years and the RHIO for four years, according to Yeaman.

“We can stand up the technology,” he said of the organization’s achievements. “The reality of getting nurses and doctors to learn how to use the tool is another matter. They are already overwhelmed. Doctors can’t learn all of these new workflows and keep care safe at the same time.”

“If you go too fast. If you get the least bit sloppy, the potential to do harm is equal to the potential for good,” he said.

Yeaman predicted Norman Regional is at least two or three years away from participating in an ACO. There are still many obstacles. There are issues over where to store data collected at the bedside. There are governance issues about who owns a patient’s data and who can act for the patient. And ACOs require decision support that can move from one care setting to another with the patient, he said.

[See also: Top 4 obstacles to ACO formation.]

In addition, learning cycles take time, said Yeaman. There are workflow improvements that need to be made for each quality measure. It can take anywhere from 30 to 90 days for doctors to adapt to recording one quality measure, he said.

“There are layers and complexity, infrastructure and workflow that first need to be perfected before we can move the needle on care,” Yeaman said. “There’s still a tremendous amount of work to be done. Any amount of risk [to a hospital’s bottom line or quality of care] is too much for hospitals to take right now.”

With the current pay structure based on volume of care, Norman Regional concluded it would take a loss participating in an ACO, he said. 

“I think the federal government is beginning to understand that this is a very difficult project to implement,” he added.

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