Friday, August 31, 2007

Future of RHIO Movement

Since the recent demise of several RHIOs, there has been a lot of interesting material on the net. I just received an eHealth smartBrief which had several RHIO items, Oregon RHIO plan stalls and RHIO experts talk problems, future of movement.

I have commented items from RHIO experts talk problems, future of movement that really made sense.

With our RHIO, SEMRHIO, based in South Eastern Massachusetts, our focus is on creating value to the physicians. Physicians are the ones actually taking care of patients directly and whose decisions can save and improve their patient's lives.

In order for a RHIO to have value to a physician, it must improve physician work flow by making critical patient data available at the right time in order to make the best clinical decision.

"One problem with RHIOs as they often are proposed is that they provide the bulk
of their benefits to patients and health plans, people and entities that
according to our current healthcare payment structure either don't pay at all
for RHIO startup and operational costs or pay a disproportionately small share."

It seem that many if not most RHIOs are the creation of non-physicians, such as health plans, business groups. They follow the typical game plan of seeking funding for setting up an organization and developing a governance structure. Unfortunately, only after spending substantial funds, they end up with a model that depends on grant funding for sustainability. As a result, several RHIOs have shutdown.

"For many areas, healthcare information exchanges need to address the limited business cases of the providers who will build and maintain these systems, according to John Regula, who served as chairman of the now-defunct Northeastern Pennsylvania Regional Health Information Organization, or NEPA RHIO."

This again highlights the issue that an HIE or RHIO needs to address the business needs of the physician/providers. After all, it is the providers that will use the system on a daily basis for day-to-day patient care.

"It does not make sense for a RHIO to have a consumer-centric model," said Regula, the chief information officer of Allied Services, Scranton, Pa...

"... "It's a noble idea to say put the patient first, but what you have to have are business plans within the provider community," he said. "

Exactly. Too many RHIOs try taking the "High road" of being consumer or patient centric. The only problem is, patients cannot be expected to micro-manage their data within the RHIO. As a physician, my patients expect that I manage their health data, test results, medication and problem lists. Sure, some of my patients do take an active role in this process, but in the end, there is an expectation that I ultimately am responsible for these tasks.

So for a RHIO to have a workable model, it must address the needs of the physicians. Physicians need to make critical patient care decisions based on data. There must be no hindrance to the flow of this data to the physician. For example, if I am prescribing my patient an antibiotic, it is important for me to know if my patient is on Warfarin. If this information is not readily available, I will not be able to safely prescribe medications for my patients.

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