Dan Paoletti is CEO of the Ohio Health Information Partnership (OHIP), a Columbus-based services organization that runs CliniSync, Ohio’s statewide health information exchange (HIE). OHIP’s services encompass not only CliniSync, but also its status as the regional extension center (REC) for its region, a state-designated entity that nonetheless is set up as a privately run 501c3 organization.
A small number of statewide HIEs are flourishing, among them HIEs in Maine, Michigan, and Colorado. OHIP’s CliniSync is another flourishing statewide HIE. Part of OHIP’s success lies in how it was created, Paoletti says. “We were created in the late summer of 2009 by the administration at that time,” he explains. “We spent the first two years planning, developing, and getting the technology in place. In other words, we spent a good two years at a very low budget cycle, with only a couple of employees, trying to get everything arranged. We really started our implementations in 2011, and our first hospital went live in December 2011.” Now, he notes, 143 hospitals across Ohio—all but about 20 in the state—are working with CliniSync, and 73 have gone live in data-sharing. What’s more, 600 practices representing over 3,000 physicians not already connected to CliniSync via their participating hospitals, are also participating.
Three elements in particular have helped OHIP to thrive: providing results delivery, DIRECT messaging for clinicians, and enabling the sharing of continuity of care documents (CCDs). “Results delivery is important, even though it’s very basic,” Paoletti says. “But you’re talking about potentially $60,000 to $100,000 per primary care physician in ancillary revenue, and that’s money that is up for grabs or moving. And us being a delivery mechanism for the community hospitals not only saves them money, but allows them to grow their ancillary services.” Indeed, OHIP is now racking up between 1 and 2 million transactions a month solely through results exchange.
Because of the success of OHIP/CliniSync, Paoletti was one of several HIE senior executives interviewed for the January/February issue of HCI, in the Top Ten Tech Trends cover story package.
Editor-in-Chief Mark Hagland spoke to Paoletti late last autumn. Below are further excerpts from that interview.
When did CliniSync go live with exchanging clinical data?
Our first hospital went live in December 2011.
How many hospitals and how many physician practices are live now?
We have 143 hospitals contracted with us, and 73 are live. Out of those 73, 53 are actually moving data into the community; the other 20 are in production—within a few weeks [December 2014], the other 20 will be. And then we have another 70 that are in implementation, with the expectation that all of those will be live by the end of April. Another 10 or 20 will go live [in 2015].
What percentage of hospitals in the state is that?
We have about 172 acute-care hospitals in the state. And out of those 172, there are 20 some that work with a regional HIE, HealthBridge in the Cincinnati area. So there are really only 20 in the state not actively participating in an HIE and that represents two health systems that are going through some major EHR upgrades, etc. So in the next year or so, everybody in the state will have some connectivity to an HIE.
And how many physicians in practice are currently connected?
About 600 practices, representing over 3,000 physicians. That doesn’t include the 8,000 hospital-employed physicians. They’re already included. The other important piece is that we also have 270 long-term care facilities that are contracted, and we’re working on our first set of payer contracts, with four payers now.
What is the volume of data being exchanged right now?
Our business model is several layers. One of the most important things we do is results delivery. And that’s important even though it’s very basic, but you’re talking one primary care physician—and that can mean $60,000-$100,000 in annual ancillary revenue. It’s money that is up for grabs or moving. So us being a delivery mechanism for the community hospitals not only saves them money but allows them to grow their ancillary services. So we have between 1 and 2 million transactions a month just with results exchange. But the most important thing is not the number of transactions, it’s the number of results we’re delivering.
The other thing we do is DIRECT messaging. We’re a health information service provider. We also provide the REC services for 77 counties; we’re also the biggest REC in the country. We’ve helped 5,800 providers attest to meaningful use so far, and our goal is 6,000—we think we will get there by the end of February.
Meaningful use support is huge, but the transition of care is what we see as key to helping transform healthcare. So that CCDA [consolidated clinical document architecture] and transition of care measure in meaningful use—we’ve tried to propel that across the U.S. We’re building a physician directory in Ohio, and what we’ve been able to build, we have over 12,000 directory addresses in our phone book right now, and our goal is to be one of the most connected states when it comes to DIRECT capabilities, and that’s important in getting long-term care facilities. So we make sure the CCDs move back and forth. We also have a community health record being rolled out so data can follow the patient. That requires consent, but we’ve been able to make it all work.
Is Ohio an opt-in or opt-out state for patient consent?
Technically, we’re opt-out, but we operate as opt-in. And the reason is that there are some state certification criteria for health information services… you can get certified by the state or by the feds through HealthEWay. Since the very beginning, we realized that there are two forces diametrically opposed to that opt-out function. One is we’re putting together the ability to bring lots of data together, and that data is coming from competitive entities. And building trust is one of the most important things we do in order for people to manage that the data we’re sharing is used for care in a proper way and ensuring patients have a right, if their data is aggregated together. And as data truly gets mobile, you’ve got to think there are a lot of patients who will say hey, I’ve got to have a say. So whether because of potential lawsuits or whatever, we felt it was better to manage that now, so that whatever the privacy rules turned out to be, we would be ahead of the game.
You’re subscription-based, correct? And is results delivery a key bankable service? That is part of the strategy resulting in success at HealthInfoNet in Maine.
Well, results delivery won’t do it alone. But I agree with Devore. Being sustainable has to do with figuring out what the needs are. Results delivery is one key, but is only part of the equation. The other is continuity of care, which has become extremely important. And the idea of continuity of care, data following the patient. In addition to reaching out in the community, providing not only delivery but orders in—allowing the physician to electronically order for the patient, to the lab or imaging center, for example.
Going forward, we know that creating connectivity, more efficiently, to facilitate the continuity of care, will be essential, whether that connectivity is on behalf of a payer, an ACO [accountable care organization], or TPA [third-party administrator]. It will all be about allowing those entities to participate in communication around the patient. It is in that context that data is an asset.
A lot of folks [in the HIE sphere] are heading down the analytics path, but it’s a little bit too early, from our perspective. We want to provide, with the proper data governance, the asset needed, and that will include not only clinical but also claims data. So we’re also pursuing an all-payer claims database infrastructure where the two can be connected. We probably won’t be doing the analytics on that… the folks asking us to collect the data are probably going to ask us to do the report cards, and I’m going to say no.
A state agency should do the report cards, then?
Not necessarily. The state is going to be an important player, but is the state the right entity? I’m not sure. But health systems are investing a lot of money in population health and analytics tools and are partnering with the large payer groups… And there’s no reason one entity never has to do that. And our Office of Healthcare Transformation is doing a good job. But we have to create the data structure to really enable it. And also as important is to do it in an environment outside a legislatively created state mandate.
Meanwhile, at the same time that we have to exchange CCDs under MU, the privacy requirements have been amplified, correct?
Yes, the chronic care requirements under the Prospective Payment rules for physician payment just published by CMS [the Centers for Medicare and Medicaid Services], also have been amplified. We’re seeing a higher level of scrutiny around patients’ rights coming out of HIPAA, out of CMS, out of every source, a higher level of concentration on patient privacy, because what’s happening with health IT in the past 10 years is unprecedented. And we are just starting to understand what this means for the patient.
What are the practical implications for your organization of some of these developments and trends?
From a technological perspective, I think everything is manageable. Managing patient privacy, patient rights, and the data, is technically possible. It’s really about getting everybody on the same page to what all this means. If a clinician is managing the care of a patient and referring the patient to another provider, the consent is being established, and now they can send that over electronically, and the patient is engaged in that process—the consent is inferred there. And also inferred in the ordering of a lab test. What’s important is when we start bringing all this data together from multiple entities, that’s where the patient needs to be able to say, that’s OK. And at some point, they need to say that’s OK at different levels. We’re still a few years away from that. Right now, it’s OK to have a patient say it’s OK, and if they need access to my data for treatment, that’s OK—or not OK. And that’s where the patient does and should have some rights, and it also makes people more comfortable when they’re sharing information among each other.
Would you like to add anything else?
The only other thing I would say is, a lot of health information exchange articles I read are about the organization that’s called the HIE. And it’s really not about us, it’s about the folks in the community coming together on behalf of the patients. In a perfect world, people wouldn’t know we exist, and your interview would be with our stakeholders and patients. I’m just bringing people together doing this in a standard technology stack. So the focus on sustainability will have to change the focus from us to the people in the community who are doing this.