The economic stimulus package is boosting interest in RHIOs, but long-term sustainability remains an elusive goal. In the sea of acronyms that is the healthcare field, Regional Health Information Organizations (RHIOs) represent the next wave of information exchange among physicians, hospitals, laboratories, insurance companies, and other entities that need to have access to patient data.

In the early 1990s, Community Health Information Networks (CHINs) looked to be the way for healthcare stakeholders to exchange data and create efficiencies. But for the most part, those ships stayed in the harbor. Will RHIOs find clear sailing, or will the concept be dashed on the rocks of organizational infighting and federal bureaucracy?

According to the Agency for Healthcare Research and Quality, more than 150 RHIOs have been formed, but only a few are exchanging information among participants.

Wes Rishel, vice president and distinguished analyst in Gartner’s healthcare provider research practice, sees RHIOs as CHIN 2.0. Lessons learned in earlier collaborations, combined with huge technological advances, make sharing information on a common platform easier than ever. “The need for collaboration is still there,” Rishel said. “There are many issues to be overcome, but a workable solution often can be found.”

Although electronic medical records have become one of the cornerstones of a successful RHIO, Rishel stressed that work on EMRs and RHIOs can occur independently and be joined later. A large EMR provider recently told the analyst that sales in 2009 would increase 25% as hospitals help local physicians adopt electronic practices.

Physicians who use electronic prescribing in 2009 and 2010 will be eligible for a 2% Medicare bonus, a figure that declines and becomes a 2% penalty by 2014 for physicians who haven’t made the switch.

The $787 billion stimulus package President Obama signed in February designates $20 billion toward the development of EMR standards, the implementation of an electronic system for public insurance programs, and payments for hospitals and physicians to go electronic.

RHIOs certainly will benefit from this spending, but even the most successful collaborations are struggling with how to pay for the infrastructure once grant funds run dry. Should patients pay? Hospitals? Insurance companies? Physicians? A combination of these? Another looming question concerns interoperability: how to make various electronic systems work together without data corruption or loss.

Looking for funding

The Bronx RHIO, which went live in June, adopted a single technology platform built on the dbMotion Solution, with additional services and applications provided by Emerging Health Information Technology, Initiate Systems, and RxHUB.

“Interoperability remains a work in progress,” said Don Ashkenase, executive vice president at Montefiore Medical Center and chairman of the Bronx RHIO board. “Vendors continue to make the process easier, but it wasn’t as simple as taking the data and using it. The process has been more expensive than we would have liked, and we’re still looking for funding.”

The Bronx RHIO represents 80% of the providers in the borough of 1.36 million residents. During its first nine months, the RHIO has received consent forms from more than 5,000 patients and has trained 111 “early adopter” clinicians. 

Every borough hospital (save one that’s scheduled to be closed) participates in the RHIO, and there are now 55 care locations where patient clinical data can be accessed with appropriate patient consent. An additional 70 care sites belonging to Bronx RHIO participants have view-only access to patient data.

As tweaks continue on the system and more providers and patients sign up, the emphasis is slowly shifting to sustainability—how to keep the system vital after grant funds are exhausted. Ashkenase said the board estimates it will need $3 million to $5 million annually after implementation is complete.

“The pushback I get is around sustainability,” Ashkenase said. “We at Montefiore believe this is the future of healthcare, and sustainability is an issue we must address in the next 24 months.”

Rishel says that successful RHIOs must have a dynamic local thought leader with the charm and clout to get the right entities to the table and smooth out any concerns, including those about sustainability.

“After a few initial successes, 200 entities got federal grants, but many of them don’t have that dynamic leader or an idea of how to finance themselves once the grant money runs out,” Rishel said.

Clear results

In late February, the first practical exchange of data through the national health information network (NHIN) occurred when the Social Security Administration (SSA) received medical data from a participant in the MedVirginia RHIO that serves central Virginia.

If successful, SSA should be able to take weeks off the 65 days it currently needs to process disability claims. The MedVirginia RHIO is the first RHIO expected to go live with an NHIN interconnection.

Kaiser Permanente has used its HealthConnect EMR in Colorado for a decade, and now 8.6 million members use it in the nine states and the District of Columbia where it operates.

So when discussions for the Colorado RHIO, called CORHIO, began in 2004, it made sense for Kaiser Permanente to take part, explained Donna Lynne, president of Kaiser Permanente Colorado and CORHIO board chair. Other partners include The Children’s Hospital in Aurora, the Denver Health and Hospital Authority, and University of Colorado Hospital, which together with the provider touch more than 1 million people a year.

Unlike the Bronx model, CORHIO pulls data directly from the electronic health record system of each participating organization instead of a central repository, which is believed to be more secure.

The benefits of information exchange are clear, resulting in fewer unnecessary tests and exams as a patient moves through the healthcare system and the ability for patients to take a more active role in their healthcare decisions. 

Kaiser Permanente patients viewed more than 10 million test results in 2007 and sent 3.5 million e-mails to their physicians, Lynne said. She recently had an eye infection recur and instead of making an appointment, she e-mailed her physician stating the infection had popped up again. The physician electronically sent a prescription for pickup.

When these and more complex scenarios involving multiple healthcare providers can occur seamlessly, a sea of change in the delivery of medical care will finally have arrived.

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