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DAN PAOLETTI'S TESTIMONY TO HOUSE WAYS & MEANS HEALTH SUBCOMMITTEE
17-May-2018

 

 

My name is Dan Paoletti, and I am Chief Executive Officer of the Ohio Health Information Partnership, which manages the CliniSync Health Information Exchange in Ohio. I want to thank you for the opportunity to comment on Identifying Innovative Practices and Technology in Health Care. This testimony focuses on the evolution of health information technology in Ohio over the past decade and the critical role that collaboration and community trust play in sustaining this model.

 

The Ohio Health Information Partnership is a private, nonprofit organization created in 2009 with HITECH Act funds. Under the direction of the U.S. Department of Health and Human Services, these funds were to be used for the promotion of health information technology to improve the delivery of health care in our state and across the nation. Ohio’s success lies in the collaborative creation of this partnership, established from the ground up by medical and healthcare partners who have a vested, critical interest in the successful use of technology and the creation of a robust health information exchange infrastructure.

A COMMUNITY-BASED APPROACH

Our founders include top leadership from the Ohio State Medical Association, Ohio Osteopathic Association and Ohio Hospital Association. The leaders of this partnership serve as the three-member Executive Committee on a 15-member Board of Directors, also made up of business, medical, hospital, long-term care, behavioral health, consumer and health plan leaders. In addition to serving as stewards of the Ohio Health Information Partnership, these champions have garnered the support of other medical, legal and HIT professionals to serve on committees that generated the policies and procedures that govern the organization today.
We extended this grass-roots, collaborative effort to create seven Regional Extension Centers to help guide physicians in the adoption of electronic health records, which would replace manual faxing, phone calls and other antiquated methods of communication. In Ohio and across the country, physicians and hospitals historically had not been able to share electronic patient data with one another to coordinate care for patients treated in disparate healthcare settings.

Because Ohio is a microcosm of the nation, it reflects a diverse population of 11.7 million who share its flattened farmlands, high-poverty Appalachian peaks and the multicultural, urban centers of our major cities. The challenge to level the playing field in technology at first appeared daunting. While many of the large hospital and health systems already had sophisticated electronic health systems that electronically communicated regionally or within their own systems, our state also had numerous rural and critical access hospitals as well as thousands of independent, one- or two-physician practices that had limited adoption or access to health information technology, often geographically remote from major health systems. Secure electronic access to patient data across multiple care settings over time had the promise to enable effective coordination of patient care that would improve the quality, efficiency and access of care for all.

 

With the right information at the right time and at their fingertips, physicians and other providers of care could break through the brick and mortar of siloed systems to coordinate and manage the care of their patients with different providers. These breakthroughs would be especially critical for patients with chronic conditions. At no cost to physicians, the regional approach worked well and by 2012, more than 6,000 primary care physicians had adopted electronic health records, the largest population of any singular Regional Extension Center in the nation. The guidance and parameters we received from the U.S. Department of Health and Human Services provided the structure to help these physicians go from paper to electronic health records. We also worked with vendors to create standard interfaces that reduced the cost to practices and provided interoperability among 40 plus integrated vendors.

A TRUSTED EXCHANGE MODEL

Simultaneously, we embarked on the creation of the health information exchange – CliniSync – with cooperation first of the hospitals throughout the state, using HITECH funds to offset the cost of hospital implementation. The level of trust displayed towards CliniSync as a neutral, impartial entity only increased over time and paved the way for 157 hospitals to eventually create an interoperable environment for patient health information in Ohio. This market-based approach enabled the CliniSync network to quickly become financially sustainable with little or no cost to community healthcare providers. We chose Medicity, Inc., as our technology partner since it had much experience with other health information exchanges and large health systems throughout the country.

Back in 2012, Mercy Health St. Rita’s Hospital in Lima jump-started the effort as the first hospital to connect, and the collaboration broke down the data silos for the greater good of this combined smaller urban and farming community. Shortly after, all hospitals in West Central Ohio went live as a regional effort to communicate. The same trust environment developed in Southeastern Ohio, one of the most impoverished areas of the state and hardest hit by the opioid epidemic. In Portsmouth, the collaborative efforts of Southern Ohio Medical Center (SOMC) and surrounding clinics and physician practices resulted in a technologically savvy medical community that now electronically exchanges patient health records, where previously couriers delivered paper records between the local hospitals and healthcare providers. This effort finally provided the comprehensive access to health records previously unattainable to these rural areas of the state.

 

By 2013, urban communities and large health systems also began collaborating; this served as a tipping point for broader statewide adoption. University Hospitals in Cleveland became a significant catalyst for comprehensive community sharing of health records in a large urban area.Shortly after, to make sure providers could share information across the Cleveland area, The Cleveland Clinic, MetroHealth, Sisters of Charity Health System and smaller health systems in Northeastern Ohio all joined. During this time, Mercy Health brought up their Eastern Ohio locations, which also encouraged additional community hospitals to join. In Central Ohio, Mount Carmel Health System joined first, followed by nearby rural hospitals in the area as well as large systems, such as Ohio State University Wexner Medical Center and OhioHealth. Across Ohio, the children’s hospitals joined from Akron to Cleveland to Columbus to Dayton.

In the Dayton area, we have partnered with Wright-Patterson Air Force Base, Wright-Patterson Medical Center and the U.S. Department of Defense (DOD) to use CliniSync services, enhancing electronic communication and providing interoperability with neighboring private hospitals and clinicians for active duty troops, veterans and their families. The Veteran’s Administration currently is in the testing phase to ultimately better coordinate care with the DOD, giving a more in-depth view of veterans’ healthcare needs.

IMPROVED PATIENT CARE COORDINATION

The philosophy behind electronic health records in Ohio is that the records follow the patient. So, a patient’s records from Columbus can be shared in Cleveland, in Toledo, or anywhere that specific patient is treated within the community. The Community Health Record allows an authorized, treating physician or staff member to search for a patient, the system matches the patient with accurate identifiers, and the patient’s records can be viewed from any hospital encounter, no matter where it occurs in the state. To date, almost 13 million individuals now have Community Health Records. The consent policy allows these patients to be included unless they choose to opt out of having their records accessed by their physicians. Providers can view face sheets, treatment history, hospital encounters, problem lists, allergies, lab results, radiology and other transcribed reports, in many cases directly from their own electronic medical record system (EMR). They can check the latest patient demographic and insurance information captured by other providers and can view, print or download full summaries of care that provide even more comprehensive information. Providers can customize what they want and do not want to view, based on their needs and the care of the patient. This service is extremely helpful in emergency situations when a patient is unconscious or uncommunicative. But it is just as beneficial when staff prepare the physician with information for the next day’s patients.

 

 

Along with the Community Health Record, an integral solution now enables notifications to physicians if a patient is admitted to or discharged from the Emergency Department or the hospital. Follow-up notifications inform the physician of the patient’s status and allow primary care physicians to immediately follow up on hospitalized patients after discharge or when transferred to another facility, such as long-term or rehabilitative care. This notification also allows specialists, dialysis centers and other providers to intervene if care should be given in a different setting than the hospital. Again, once the notification occurs, accountable staff can immediately access additional records on the patient to see what occurred in the hospital, the prescribed medications and after-care instructions. Since late 2016, there have been over 6.7 million notifications sent.

STAKEHOLDER SUCCESSES

An example where the use of notifications identified an avenue of intervention was for an Accountable Care Organization (ACO) that received alerts for a patient from three different emergency rooms on the same day, indicating a possibility for opioid addiction. These notifications allowed the ACO to determine the appropriate steps for action with the patient.  (There is more testimony below in the PDF.)

The full panel testimony is here.