The health information exchange (HIE) is a critical next step in the digital transformation of health care. With the government’s meaningful use (MU) program driving electronic health record (EHR) adoption, health systems are now challenged to create a network that connects providers together to maintain continuity of care for patients. Motivated by the Patient Protection and Affordable Care Act (PPACA), the advent of accountable care organizations (ACOs), and shared savings programs, health systems also recognize the need for better electronic communication between employers and affiliated providers. In a Healthcare Information and Management Systems Society (HIMSS) virtual event, “Health Information Exchange: Challenges & Opportunities, Bridging Private & Public HIEs,” Dan Paoletti, CEO of the Ohio Health Information Partnership (OHIP), shared his experience in coordinating a state-level HIE in Ohio. OHIP was founded in 2009 following the passage of the HITECH Act as an independent, nonprofit organization to collaborate with hospitals, providers, and health plans to expand the public HIE network in Ohio through the organization’s CliniSync HIE, launched late in 2011. Although originally funded through the Office of the National Coordinator for Health Information Technology, OHIP currently operates independently, governed by a 17-member board. The organization’s goal is to promote the use of EHRs. Over the years, OHIP has advised more than 57 hospitals and 500 providers on the benefits and cost-savings of HIEs. Paoletti drew a clear distinction between public and private HIEs in his presentation. Public HIEs often rely on grants to get established and then require a solid revenue stream to become sustainable. Unless propped up by state governments, a public HIE must generate revenue from services. Private HIEs, on the other hand, often have specific strategic goals and set funding sources. Recognizing that an effective HIE starts with the widespread adoption of health IT, OHIP has helped more than 7,000 providers and 154 hospitals receive Medicare and Medicaid payments from the MU program through its Regional Extension Center. Combined payouts amounted to $306.8 million for MU and Adoption, Implementation, Upgrading (AIU) incentives as of September 2012. OHIP’s “giddy goal” is to help more than 10,000 providers receive MU payments: With more providers using EHRs, the business case for HIEs improves. The Business Plan OHIP determined that volume was key to its business plan in Ohio. For a public statewide HIE to be sustainable and affordable, significant market share was necessary to spread the cost among multiple stakeholders. Since its inception in 2009, OHIP has enjoyed success and currently has 50 hospitals in the implementation phase, 57 hospitals under contract, and more than 500 non-employed providers engaged with its HIE program. The two public HIE platforms in Ohio, HealthBridge and OHIP’s CliniSync, cover 45.4% of Ohio’s population, according to Paoletti. Private HIEs cover 30%, while 24.3% is not covered at all. OHIP focuses on economically depressed areas where resources are scarce. OHIP’s mission is to make HIE accessible and affordable for all providers, but the MU program does not include home health, long-term care, and behavioral health providers, segments seen by Paoletti as key for an effective HIE. The broader and more diverse the HIE, the more value there is for each stakeholder, he says. Whether public or private, community or state-based, sharing health information to provide better care is the ultimate goal of an HIE. OHIP’s mission was to make public HIEs work and build a solid business case so that stakeholders would buy into them. In order to succeed, Paoletti says, trust, stakeholder engagement, collaboration, and building the return on investment are all required. For Paoletti, building the requisite trust demands a neutral environment where multiple stakeholders can work together for patient care, efficiency, and cost savings. No stakeholder should have more say than the other. Trust provides a place for conversation and collaboration, and OHIP’s position as a third party assured stakeholders that health information would be secure. For stakeholders to be engaged, OHIP sought out community leaders at the local level. In urban settings with multiple large health systems, finding stakeholder leaders who are willing to jump on board to make things happen invites more community participation. In Ohio, 70% to 85% of care is provided locally, which makes a grassroots effort very effective. Pleasing All Stakeholders Providers, practices, and payors all have different goals and strategies. OHIP understood that each stakeholder had specific needs for HIE in mind, and to that end, OHIP built scenarios tailored for each stakeholder. For an independent hospital that has implemented a new electronic medical record, OHIP can step in and develop a connection strategy with other providers for discrete delivery of results, care summaries, and admission alerts. To cut down on readmissions, transition of care can be coordinated with long-term care and home health providers. OHIP can provide estimates for costs, a timetable, and a plan to make it possible. DISCREET? OHIP’s HIE can send notifications of emergency department visits or hospital admissions to health plans and primary care providers. It’s a simple process, Paoletti says, but it provides valuable return on investment. In another scenario, OHIP can help large hospital systems with private HIEs to expand beyond their employed network and increase their referral base to include long-term care and independent physicians, which can cause extra volume with ancillary services. For hospitals and practices looking to incorporate HIE into their strategy, it may be best to work with independent organizations like OHIP and join an existing public HIE, Paoletti suggests. The benefits of HIE are accrued through the immediate expansion of referral bases, the opening of new revenue streams through ancillary services, the reduction in readmissions with long-term care and home health providers, and the reduction of paper administrative costs to transfer patient data from one provider to another. By next year, OHIP hopes to have more than 100 hospitals, several thousand providers, at least half a dozen health plans, and home health and behavioral health entities within its fold to become the largest public HIE in the country. Thanh Le is a contributing writer for Health CXO