Core health IT components for these organizations "include electronic health record, disease registry, data warehouse and clinical decision support systems," she said. "However, only 28 percent of ACOs report use of revenue cycle management or a master patient index, suggesting that many organizations may not be well-equipped to manage populations and lower costs."

Without those components in place, "most ACOs also report that their infrastructure is unable to effectively support patient engagement and risk management," said Okubo.

"Similarly, ACO capabilities for distance-based medicine have yet to fully mature, with few organizations able to use secure messaging, referral management tools (or) phone- or video-based medicine," she said. "Given that many of the newer ACOs are forming in rural and/or underserved areas, it is concerning that ACOs may be unable to leverage health IT to effectively manage populations in some of the more remote geographic areas.

Size matters, said Okubo, but only a little bit.

"Generally speaking, small to medium sized ACOs – fewer than 100 physicians on staff – do not have a health IT infrastructure beyond the four building blocks of a data warehouse, disease registry, electronic health record or health information exchange," she said.

"However, capabilities do not change significantly among large ACOs with more than 100 physicians," she added. "Less than half of large ACOs feature clinical decision support, record locator service, revenue cycle management, telemedicine or referral management system. Larger ACOs have more technical capabilities and are better staffed and equipped."

The good news is that once ACOs reach 18 months of operation, "they report substantially more advanced capabilities, data use for analytics and performance improvement associated with health IT," said Okubo.

The big hurdle, of course, is that "many of these things are all interrelated," said Bowles.

"Disease registries are based on data coming out of electronic health records. You've got your data warehouse where you have your inpatient data from the EHR, you've got your ambulatory footprint, you're dealing with adjudicated claims coming from payers, you've got your affiliated physicians that are in your ACO but not necessarily on the same IT platform, the master patient index certainly is central to knowing which patients are which across those systems."

Synergy of that level necessitates a very robust level of technological interoperability – one that's still yet to materialize in most cases.

Premier data shows that right now a majority of ACOs pull data from fewer than 10 different data platforms. However, as ACOs gather information from more and more sources, they're reporting decreased ability to leverage IT infrastructure to support critical tasks such as care coordination, patient engagement, physician payment, population health management and quality measurement.

"There have been significant investments made into health IT infrastructure over the years," said Okubo. "But ACOs continue to report sigificant challenges in being able to use the technology."