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.

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.

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.

We just presented at Microsoft MSHUG Tech Conference

We just presented our RHIO project, semrhio.org at MS-HUG, the Microsoft Healthcare Users group Tech Conference in Redmond. Our topic was "Winning Trust and Minimizing IT Resources".

Roberto Ruggeri , a Senior Technical Strategist with Microsoft Worldwide Health gave a review of our presentation on his blog. Roberto was very helpful and we would like to give him our thanks

Eric Stott, our "famous" BizTalk architect, was with us and commented on his blog. Byron Byfield, a fine specialist in healthcare payor-side data analytics, promises he will have something to say soon on his new blog.

I was joined in the presentation by Kate Sullivan, who provided an excellent background on SEMRHIO and the current RHIO climate.

The topic was on how choosing the "right" Trust model for data sharing and minimizing IT resources by centralizing common services, there is a greater chance for getting buy-in from competing community hospitals to join to form a RHIO, since the two main barriers to forming a RHIO, trust and IT infrastructure can be overcome to a large degree.

Typically, cost and security issues end up being why many RHIO fail to go beyond the planning phase. In fact, several RHIOs, after spending anywhere from $500,000 to a few million, end up closing their operations. A few weeks ago, the Portland RHIO, and a few months ago, the very high profile Sanata Barabara RHIO.