RHIOs Should Exist to Enable Critical Data Sharing

I've been meaning to comment on this recent item, "Why RHIOs shouldn't exist" from FierceHealthIT. The editor, Anne Zieger, makes a case for her assertion that RHIOs should not exist because they have unrealistic expectations for trust among competing institutions such as hospitals. She states,

"I certainly like the idea of data following me. I love the idea of my providers cooperating. But at the moment, I simply can't see how this kind of data sharing can work in the near future."

Well, patient data sharing is not some novel concept that needs debating. Its already happening, although some do not even realize it. It happens by the fax machine. Patient data sharing is an essential function of caring for patients.

Replacing the fax machine, an inherently in-secure method of data exchange, by a secure electronic exchange is what a RHIOs should be all about The discussion should not be about whether RHIOs should exist, but rather, what is the best model for a RHIO in order to win trust among entities to enable clinical data sharing to take place.

We made a case recently at the recent MSHUG fall Forum 2007, for a RHIO Trust model, which has been very successful in gaining trust among our participants in SEMRHIO.

RHIOs are still relevant according to Dr Brailer

Neil Versel, who is also a fellow health IT blogger listed on HITSphere, just wrote an article, for Digital HealthCare & Productivity: "Brailer Insists RHIOs Remain Important".
Dr Brailer still remains bullish on the prospects of RHIOs. He admits that RHIOs are undergoing a shakedown. I also believe this is the case.

Take the dot-com boom as an example. The initial exuberance was followed by people questioning whether the Internet could actually produce a sustainable business model. Well, since then we have seen the likes of Amazon.com, Google.com, youTube.com, and the list keeps growing.

RHIOs too, I believe will follow a similar path. Just as with the dot-coms, when funding was abundant, there was a "spend-spend" mentality without regards to sustainability. RHIOs, like the dot-coms, had been flush with significant funding, mainly from state and federal grants. In fact, there is a term for these grant-dependent entities: "Beltway bandits – a group of people who live off government grants", "grant babies" (see HISTalk)

The Santa Barbara RHIO is a good example, where it did not take long to burn through $10M in funding, only to learn in the end, that there really did not seem to be a need for such an entity in their community. Just recently, we learned of the shutting down of the Oregon RHIO, which did so only after spending nearly $500K just to find out that their RHIO was going to be to expensive.

Once you start hiring those consultants and lawyers, and start setting up committees, money can dry up very fast. RHIOs need to evolve, I believe from an entrepreneurial model that enabled the small technology start-ups in the 80s and 90's to beat the larger companies. After all, it was this model that allowed IBM to develop the now famous IBM Personal Computer (IBM-PC). IBM, in the early 80s, after learning from the success of Apple Computer, used a "small start-up company" model to develop the IBM-PC.

RHIOs will start to succeed once they focus on sustainable models that meet true business needs rather than needs decided by committees. They will need to adopt a "start-up" model, depend less on government funding (handouts), and rely more on self-funding and private investments.

Centralization in a RHIO: a safer, less expensive option for community hospitals

Great quote from: RHIO confidential: Experts offer advice for creating a foolproof privacy and security plan for sharing patient information

Koss said. “If you’re in a small community where most of the providers are
small and don’t have a lot of resources or technical expertise, then a
centralized service that does that on their behalf might be more secure and
private. By contrast, if you’re in downtown Boston and you’re connecting three
major medical institutions that already have a robust privacy and security
infrastructure, that’s not really an issue.”

The premise for our presentation at Microsoft MSHUG this past August on forming SEMRHIO was that the ability to minimize IT resources by using a "SaaS-like" or centrally hosted services is very important when it comes to forming a RHIO with community based hospitals. Unlike large hospitals systems, community hospital resources are already fairly stretched. These hospitals are not in a postion to manage their own RHIO infrastructure. This is especially important given that most community hospitals already have "too much on their plate" with other higher priority items such as CPOE, eMAR, P4P etc. Forming a RHIO is not exactly seen as a high priority item.

I came across this today:

Mark Hagland is a contributing writer based in Chicago
Sidebar
RHIO Steps to Success—A Sarcastic Look
Are the real RHIO keys to success more about hot air than about healthcare?
The following comes from Mr. HIStalk's blog, http://www.histalk.com/.

Guide to RHIOs for CIOs, in easy steps:
Participate eagerly in meetings
with your competitors as they talk about sharing data, making sure to speak in
generalities and offering no participation beyond attending more meetings.
Go
back to your co-workers and sneer at how stupid your competitors are and how
backward their systems are compared to yours.
Report back to your fellow VPs
that there's really nothing in it for your organization, but that you'll listen
politely and avoid all commitments just so no one gets mad.
Respond to latest
of 100 surveys asking about RHIOs, making sure to wax poetic about the wonderful
possibilities that will result from the electronic hand-holding that RHIOs will
bring, knowing full well it won't happen until benefits are offered to those
involved.
Go back to your co-workers and make fun of all the folks who've
forgotten CHINs and therefore are doomed to repeat history.
Ignore sales
pitches from vendor RHIO participants who got involved only to troll for new
business.
Go back to your co-workers and make fun of the IT organization of
the local IPA or medical society, consisting of one doctor's brother-in-law
armed with an AA degree and an A-Plus certificate.
Prioritize your IT shop's
involvement in RHIO work somewhere between “get rid of all the cubes and give
everyone an office” and “seriously consider moving all desktops and servers to
open source operating systems.”
Go back to your co-workers and explain to the
bright-eyed among them who ask about RHIOs that it's “no margin, no mission” and
that it will be a cold day in hell when you voluntarily share your exquisitely
created and managed information with the clueless barbarians across town with
their pathetic IT systems.
Get on the speaking circuit and HIMSS advocacy
groups to make sure your attendance at RHIO meetings is rewarded with industry
visibility as a RHIO thought leader.