Are RHIOs for Real?

Joseph Goedert, News Editor
Health Data Management Magazine, February 2006

A year ago, federal officials estimated there were about 100 regional health information organizations across the nation, in various stages of development. That number has more than doubled, according to recent surveys by the University of Maryland and the Department of Health and Human Services.

RHIOs are considered the precursors to a national health information network, a project being spearheaded by the federal government. But many are in the earliest stages of formation and most face significant barriers to widespread use.

The biggest obstacle a year ago-money-remains the biggest today. However, there are other daunting obstacles. For example, RHIOs are being rolled out even though most hospitals and physician practices have not adopted electronic medical records systems, which are prerequisites to electronically sharing patient data within a community or region.

And yet another wrench in the works is that the core functions of RHIOs could significantly change in just a couple of years, believes David Brailer, M.D., the national coordinator for health information technology at the Department of Health and Human Services.

In fact, Brailer wonders if RHIOs need business models and sustainable sources of funding, because a national network architecture may negate the need for RHIOs to perform network functions. RHIOs could see their role reduced to acting as governing or advisory bodies to determine data-sharing policies on a regional or statewide level, he says. (See story, page 46).

Sound familiar?

The premise of regional health information networks rests on disparate health care stakeholders-hospitals, group practices, payers, employers and public health agencies-cooperating to build an I.T. infrastructure to support the local sharing of data from proprietary information systems.

These stakeholders often are direct competitors, or as in the case of providers and payers, have a history of rocky relationships.

If the RHIO concept sounds familiar, it's because the general concept echoes that of community health information networks, which briefly created an industry buzz a decade ago.

Some RHIO advocates shy away from using the acronym because of its association with CHIN. A regional effort in San Diego, for instance, is dubbed the San Diego Medical Information Network Exchange.

"The minute we use the term 'RHIO,' people think of failed efforts, pie-in-the-sky plans, high expenses, and privacy and security concerns," says Stephen Carson, M.D., a pediatrician and chief medical officer for the San Diego County Medical Society Foundation, which is leading the development of the exchange.

However, RHIOs have two major advantages-the focus on safety and the rise of the Internet-over their CHIN predecessors that raise their odds for success, proponents say.

Patient safety has become a high-profile priority due in part to Institute of Medicine reports that exposed serious patient safety problems and highlighted the role that information technology and data sharing can play in improving the quality of care.

The reason President Bush in 2004 made adoption of electronic medical records a national priority was patient safety, Brailer notes.

The need to improve safety comes at a time when the escalating cost of health care is hammering U.S. businesses, which, as a result, are becoming uncompetitive, says Michael Cowan, M.D., chief medical officer of BearingPoint Inc., a McLean, Va.-based consulting firm.

That's creating an opportunity for RHIOs to help the industry increase safety by raising quality. "Medicine is under the gun from the view of quality and from the view of cost," Cowan adds. "What we saw from the Bush administration in 2004 was the president taking our industry to the woodshed."

The other fundamental advantage of RHIOs compared with CHINs is the maturation of the Internet into a reliable, affordable and widely accepted information infrastructure.

"If CHINs had the Internet and a critical mass of people who didn't run from information technology, their chances of success would have been much greater," Cowan says.

The Internet is used daily for personal and professional tasks by much of society, making physicians and others far less afraid of information technology.

"Providers were not ready for technology 10 years ago like they are today, and the change is primarily because of growth of the Internet," says Gregg Martin, CIO at Arnot Ogden Medical Center in Elmira, N.Y. The hospital is leading a fledgling RHIO initiative called the Southern Tier Electronic Medical Record Project.

The Internet has created enough of a cultural change that physicians today will accept RHIOs, says C. Kerry Stratford, M.D., a partner in St. George (Utah) Clinic, an eight-member family practice. He's also vice-chair of the Utah Health Information Network, one of a handful of surviving CHINs. The network now is trying to evolve into a RHIO. (See story, page 46)

"There's a lot of differences between now and 10 years ago," Stratford explains. "I'm sitting on a couch using a Tablet PC to send prescriptions to pharmacies. Having the Internet gives us information anytime and anywhere and we use it in daily life."

Thanks to these cultural and technological advantages, RHIOs are for real and, unlike CHINs, will have staying power, contends Wayne Owens, vice president of health care integration platforms at Sun Microsystems Inc. The Santa Clara, Calif.-based vendor is marketing its integration and networking services to the regional efforts.

"The momentum out there is unprecedented," Owens adds. "This is going to continue-it's not a false start."

Depth of acceptance

Still, RHIOs won't work unless a critical mass of physicians adopt electronic medical records in their practices. While some believe widespread adoption is inevitable, others aren't so sure.

"In general, physicians have known for some time that they'll have to go to electronic records," says Stratford, who automated his practice two years ago. "The question is if they go willingly or put it off as long as possible. There is not a universal feeling among physicians that electronic records are a Holy Grail that will solve all of their problems. A lot of fear remains that electronic records will make the practice of medicine harder."

Page 1 of 8.