The participation of the West Central Health Information Exchange (WCOHIE) in Ohio's statewide HIE, CliniSync, marks a major milestone in the state's efforts to get healthcare providers connected and sharing patient information for improved continuity and quality of care.

"There are no exchanges actually occurring in the rural areas of Ohio, which is the majority of counties in our state," explained Dan Paoletti, CEO of the Ohio Health Information Partnership (the Partnership), the state-designated entity responsible for building out and operating CliniSync's infrastructure. The priority of the $14 million grant received from the Office of the National Coordinator for Health IT (ONC) - and where most of the statewide HIE's energies have been focused - has been to "help those that didn't have other means to get linked together," Paoletti said.

The contract between WCOHIE and the Partnership and CliniSync will ensure connectivity for six hospitals, an integrated healthcare services organization and two labs with local physicians and other healthcare providers. It's a significant step forward, although Paoletti emphasized that "there's a lot of work yet to be done."

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Thus far, only two types of HIEs are in operation in Ohio - the larger hospital systems' private HIEs that connect them to their affiliated physicians and HealthBridge, a veteran regional HIE which has served the greater Cincinnati-Northern Kentucky tri-state region since its formation in 1997. "We are working with both of those scenarios to figure out the best way to move information back and forth," Paoletti said.

By the end of the year, the Partnership is looking to help physician offices share patient information via ONC's Direct Project. "This is an easy way for physician offices to get engaged and it's also free," he said. "It's a nice way to get these physicians that are still in the process of EMR adoption or have not quite gotten there to participate in the digital exchange of information relatively painlessly." The Partnership will also be working with HealthBridge and other stakeholders to roll out Direct Project pilots.

With Ohio as an opt-in state, the Partnership is also working through patient consent issues. It released a policy stating that patient consent is to be managed at the enterprise level, which is aligned with HIPAA and works for the "vast majority of providers" in the state. The policy took into account the critical components of patient involvement, the incorporation of patient consent into the entity's existing workflow and the management of patient consent at the enterprise level to minimize the work required at the provider level, Paoletti said. The Partnership has been successful in establishing patient consent policy for simple exchange and is currently working out the same issues for the advanced exchange of information among multiple entities.

[See also: Maine's HIE stays with the opt-out consent model.]

The Partnership, a public-private nonprofit comprising the Ohio State Medical Association, Ohio Osteopathic Association, Ohio Hospital Association, BioOhio and the State of Ohio, determined that providing the backbone for communities to build their own HIE was the best strategy for the state. "We think it's essential that communities drive this because the majority of healthcare is obtained within a certain geography, and that geography is different for each community," Paoletti explained.

Communities can bring together the components that comprise continuum of care, including behavioral health, emergency medical services, long-term care, home health and other services. As communities adopt the CliniSync platform, which is powered by Medicity, they can self-brand the technology, which creates grassroots ownership and greater buy-in, thereby speeding up adoption and critical mass. "That's really our goal," he said.

From the beginning, the partnership has really been a grassroots stakeholder-driven organization, Paoletti said. "This is about enabling the coordination of care." In order to accomplish this, however, there has to exist at the statewide level a master patient index and the abilities to locate where services were obtained, manage patient consent and enable different entities to move information as seamlessly as possible, he said. Technology must be used meaningfully to advance coordination of care and reduce cost of outcomes and get better results. "The idea is to bring all these pieces together using the statewide backbone that is being used within the communities, which ultimately folds up to the statewide HIE," he added.

[See also: Ohio initiative to test multi-payer Web portal.]

The Partnership is leveraging the regional extension center (REC) model of helping physicians adopt EHRs for HIE adoption. As one of Ohio's two REC centers, the Partnership is responsible for reaching out to priority primary care physicians (PPCPs) in 77 out of 88 counties in the state, and in less than a year has gotten more than 5,000 PPCPs committed to adopting electronic health records (EHRs).

By building on those commitments and strategically carving out regions across those counties by logical referral patterns, the Partnership is laying the foundation for a "natural progression" in which "one community can talk to another community" as connectivity expands. Communities recognize the need to improve patient care within their boundaries, said Fred Richards, CIO and COO of the Partnership. "The REC program is a community effort," he said. The REC program helps providers prepare for EHRs to help improve care. The next natural progression is to "light up" the EHRs with data exchange, which further adds value to patient care.

The Partnership has been working closely with hospitals to find the business case for HIE, which includes striking a balance between current investments and future directions to ensure that all of their business functions are aligned, said Richards. Coordination of care is of utmost importance, as is improving patient care and patient safety, he said. "They understand the value of the HIE, but the HIE has to scale within their community, within the state and within the country," he said.