By Maureen McKinney

May 13, 2008 | The Greater Ocala Health Information Trust has partnered with two vendors—PatientKeeper and WorldDoc—in preparation for the Florida-based health information exchange’s rollout this fall. The HIE, which is also known as Healthy Ocala and Greater Marion County, includes several local hospitals, the Marion County Medical Society, the local chamber of commerce, and community organizations. It has also chosen an EHR provider, but won’t yet say who.

Part of what’s significant about the vendor selection, independent of their particular technology capabilities, is their willingness to work with Ocala on an innovative funding mechanism to help Ocala escape the problems that have plagued most other HIEs in the past.

“We wanted to make sure the organization was not provider-centric or payer-centric and to do that, we had to create a community-based organization,” says Bob Holloran, vice chair of the Ocala HIE. “Our philosophy is simple: keep costs very low and leverage the resources we have available to us.”

To ensure that costs are kept to a minimum, the trust has no facilities and no computers, according to Holloran. That also meant prospective vendors needed to have the appropriate solutions—or very close to them—ready and available from the start. Vendors also had to be willing to accommodate the fledgling HIE during the initial phases of the implementation process.

For instance, the trust chose a physician portal from Massachusetts-based PatientKeeper because the solution was already implemented in a member hospital and could interface easily with other organizations. The fact that the organization would have to make very few changes was a primary motivating factor, Holloran said. In addition, the vendor folded all of the implementation costs into a periodic fee that the trust pays over time so no money was needed up front.

“During the first year, they are letting us ramp up the charges as our number of patients grow, and then it will be a static amount after that,” he said.

On the patient side, the HIE partnered with Las Vegas-based WorldDoc to provide the vendor’s 24/7 Personal Health Management System, a consumer health portal that features a personal health record and medical library. Like PatientKeeper, WorldDoc allowed the trust to roll implementation costs into later payments. The vendor will also give the exchange a license to market the solution to local employers—a feature that will provide most of the Greater Ocala Health Information Trust’s eventual revenue, Holloran said.

“Because of our agreement with WorldDoc, a large portion of the money we pay will flow back to us as revenue when employers purchase PHRs for their workers,” Holloran said. “That will provide the money needed to run the exchange. We’re basically letting the whole community share the financial burden rather than putting it on the physicians.”

In fact, Holloran projects costs of operations will be $200,000 during the first year, and approximately $300,000 for subsequent years—most of which will come from PHR revenue, he said.

Members have also donated their time and expertise in an effort to keep the number of employees small and costs low. For example, the director of information technology at Marion County Hospice will serve as the trust’s privacy and security officer, and health insurance agents will market the PHR to employers.

“Health information exchanges often want to hire a lot of people and buy a lot of stuff, and we tried to stay away from that as much as we could,” said Holloran, who said he thinks the exchange will be sustainable from day one. “We have 325,000 people in Marion County and ultimately, we want all of them to be involved.”

Time will tell if the Ocala approach proves workable.

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