Related Links

Web Seminars

About four years ago, health care leaders in eastern Tennessee and southwestern Virginia wanted to create a patient data exchange across their region. So they sought advice from several more established regional health information organizations.

While the leaders took away some best practices from the research, they also found a few strategies they believed would not be successful in their new organization. For example, they didn’t want to limit the vendors or stakeholders involved—as some RHIOs were doing—because they didn’t want to be dominated by a single interest, says Liesa Jenkins, executive director of the group, now known as CareSpark. The Kingsport-based organization also wanted to track outcomes of the data exchange — which some RHIOs hadn’t planned to do—to help secure future funding sources, she adds.

“From day one, we knew we’d have to design our network looking at other RHIOs and deciding whether we wanted to be the same or different,” Jenkins says. “We also found things we wanted to do that no one else was doing. I don’t have faith for initiatives that say there’s only one way to do this.”

Lack Of Traction

While CareSpark expected its health data exchange to go live January 31, many other RHIOs — or HIEs — are having difficulty getting off the ground. A few already have called it quits.

A Harvard University survey published late last year found that 54% of RHIOs in existence in July 2006 were still in the planning stages as of early 2007. An additional 26% could be classified as defunct, according the survey. Among those is the Santa Barbara County Care Data Exchange, one of the organizations that CareSpark looked to for guidance.

Meanwhile, a November 2007 report from the Information Technology & Innovation Foundation, a Washington-based technology think tank, contended that most RHIOs are financially unsustainable.

“The strategy of building a National Health Information Network from the bottom up by establishing many regional health information organizations throughout the country is not working,” the report states. “More than 100 RHIOs have been established across the country, but in the absence of clear national standards for sharing medical data, achieving system interoperability for RHIOs has been difficult.”

A few I.T. vendors have echoed the reports’ findings, complaining that connecting members of RHIOs has been difficult to achieve without clear national standards and more electronic health records adoption.

Further, some hospitals have discovered they don’t need to be part of a RHIO to exchange patient data with area physicians, (see sidebar, page 62.)

In an effort to help emerging RHIOs that are struggling to get started, some industry analysts have recommended best practices for achieving a successful, viable data exchange.

For example, the advisory board of the Center for Community Health Leadership released a white paper last October titled “The Best Practices for Community Health Information Exchange.” The center’s advisory board, created by Misys Healthcare Systems, a Raleigh, N.C.-based physician software vendor, includes physicians and consultants. The best practices are based on discussions center leaders have had with executives at several RHIOs over the past few years, says Michael Fleming, M.D., a center board member.

“We’ve pointed out some of the challenges we’ve seen and given ideas about how organizations can meet them,” he says. “Each RHIO’s structure will be unique to its community. But to succeed, they need these pieces.”

For example, the center’s white paper explains how RHIOs should create value propositions for each stakeholder group. It also outlines how RHIOs should build roadmaps and facilitate an ongoing discourse among stakeholders during the planning process.

Skeptics, however, still question whether RHIOs will prove viable given their spotty performance so far, which, in many ways, parallels the failure of Community Health Information Networks in the mid-1990s.

“I don’t have a high level of confidence in RHIOs or HIEs,” says Jeffrey Bauer, a Chicago-based partner in the futures practice of ACS Healthcare Solutions, a Dearborn, Mich.-based consulting firm.

Bauer says RHIOs will never be able to provide access to all of a patient’s relevant medical information. Instead, he advocates creation of a personal health record stored on a patient’s secure Web site. Another alternative, he says, would be for patients to wear a small data storage device containing their complete records.

“We’ve got to build the information exchange around the patient, not around the providers,” he says.

Learning The Ropes

Nevertheless, some RHIO organizers hope to capitalize on the emerging recommendations for best practices. Further, many now understand they must be able to deliver measurable value to their constituents to achieve success and viability, says Lorraine Fernandes, vice president at Initiate Systems Inc., a Chicago-based vendor of identity and data management software. And participants in different RHIOs may have widely varying definitions for value, she adds.

For example, CareSpark organizers decided that decision support would be valuable to its participants, although they were unaware of another health data exchange that planned to offer it, says Jenkins, the executive director. So in addition to working with various vendors to integrate its participating providers’ EHRs and build a master patient index and Web portal, CareSpark is using technology from New York-based ActiveHealth Management to offer physicians decision support when they access patient data.

The vendor’s software offers alerts for physicians based on analysis of a patient’s claims and clinical data. Clinicians use CareSpark’s portal to locate a patient in its MPI and receive their clinical data and the decision support alerts. Some of the RHIO’s payer stakeholders integrated their members’ claims data into the software so the alerts could be functional at go live.

While decision support can offer numerous care benefits, CareSpark also plans to turn it into a revenue generator.