Rhios Allow All Providers Charged

RHIOs allow "all providers charged with handling a patient's condition to be involved in care delivery across the continuum"

(Freedman & Diamond, 2007, ¶ 4).

Regional Health Information Organizations (RHIOs)

Although a myriad of potential benefits accompany the ability to share vital clinical data, inherent in regional health information organizations (RHIOs), Ilan Freedman, vice president of marketing and Joel Diamond, M.D. (2007), chief medical officer North America for dbMotion, Pittsburgh, report that some organizations deliberately opt out of these endeavors. The majority of healthcare members, however, recognize that health information technologies, particularly electronic medical record systems have matured, with members of RHIOs increasing. In "Strategies for success: RHIOs that are designed to improve patient care and satisfaction can also increase market share," Freedman and Diamond (2007) assert that "it could be argued, in fact, that healthcare organizations opting out of these endeavors will fail to thrive" (¶ 2). Instead of suffering in the competitive business environment that includes the medical field, however, those entities that do embrace progressive technologies and service models such as RHIOs will more likely succeed.

Despite the significance of RHIOs to the overall Health Care Information strategy of the United States (U.S.), however, RHIOs have struggled for numerous reasons, including, but not limited to funding, unsustainable business models, acceptable data storage and access policies, as well as wavering public support. In this paper, the researcher examines a number of these challenges, as well as advances RHIOs have contributed to health care, as well as issues they still need to address. As this paper discusses RHIOs and how they may "fit" into the horizon of health care, the researcher also investigates how RHIOs impact local physician's practices and other health providers. Lastly, as a customer, the researcher relates personal feelings about RHIOs.

The article, "RHIO/HIE" (2009), explains the terms, regional health information organization (RHIO) and Health Information Exchange (HIE) are often interchanged. RHIOs constitute a group of organizations, which possess a business stake in the health arena, and aim to improve the efficiency, quality and safety and efficiency in/of healthcare delivery. "RHIOs are the building blocks of the proposed National Health Information Network (NHIN) initiative proposed by David Brailer, MD, and his team at the Office of the National Coordinator for Health Information Technology (ONCHIT)" (RHIO/HIE, ¶ 1). To reach the national goals proposed by RHIOs for the United States (U.S.), albeit, to develop "a national network of interoperable health records" (Ibid), health care entities at the local and state levels must first develop and collaborate to promote the concept.

RHIOs

Benefits RHIOs are reportedly nearly universally understood and desired. Andy Hurd (2008), CEO of Scottsdale, Arizona-based Carefx Corporation, a provider of information aggregation tools, asserts in the journal publication, "The federated advantage: data exchange between healthcare organizations in RHIOs is a hot topic. Can federated models end the debate?" that the term Regional Health Information Organization constitutes a contemporary catchphrase. Benefits from data-aggregating products utilized by RHIOs allow physicians and others involved handling a patient's condition "to access clinical notes, flow sheet views, radiology reports, lab results, clinic and/or schedules, e-mail, secure messaging and clinical content sources"(Hurd, 2008, ¶ 4). Along with benefits, albeit, Hurd points out that a number of legitimate reasons exist for concern regarding RHIOS. For example, attempts to exchange secure data exchange across various, unrelated provider systems may constitute a complicated and expensive endeavor. But then, perhaps this concern may not be such a challenge and the federated model could likely readily address the concerns regarding security, confidentiality and privacy that challenge the expansion of RHIOs.

For more than a decade, data federation technology has drawn upon non-centralized repositories of patient data, Hurd (2008) explains. Adoption of this practice in the healthcare world, has only recently radically increased. A number of variables contributing to this contemporary change include:

1. The growing demand for access to all relevant medical data at the point of care, as well as remotely, has led to the evolution of healthcare it solutions that pull data from multiple applications to deliver a comprehensive, longitudinal view of the patient.

2. The movement of the industry towards RHIOs and, eventually, the National Health Information Network (NHIN), has introduced significantly greater complexity. Past models included the heavy lifting and high cost of centralizing the patient data that was extracted from the various RHIO member organizations into a central (and duplicate) database. The politics of data ownership and the lack of confidence in the complex synchronization that this required often stalled projects before they even started.

3. Additionally, there is no standardization of data access or usage policies among the various facilities, let alone within the industry. High cost, long lead times, the latency inherent in a complex database model, and the politics of data ownership in the central data repository model have opened the door for a more elegant solution (Hurd, 2008, ¶ 3-5).

Figure 1 depicts a number of variables currently contributing to considerations of RHIOs.

Figure 1: Variables Relating to Changes in RHIOs (adapted from Hurd, 2008, ¶ 3-5).

Hurd (2008) asserts that a "truly" federated data model offers the cure for challenges and explains that as the model would not demand that data be moved, replicated or modified, it would consequently eliminate the politics of data ownership, as well as the confidence concerns regarding the newness and accuracy of the data. Another argument, that the solutions may not be capable of handling massive volumes of data volumes consecutively, according to Hurd, does not prove relevant as the "Web portal solutions process data requests using a role-focused filter, which aggregates the data according to the given user's access rights" ( Don't believe…section, ¶ 2). Therefore, the portal would not likely ever need to pull out a considerable volume of data to comply with the request one user may make.

In the journal publication, "RHIOs Struggle to Find a map to Success: Health information exchanges evaluate their predecessors' strategies to determine what to do - and what not to do - to achieve viability," Beckie Kelly (2008) notes that a Harvard University survey published during 2007 reports that as of early 2007, 54% of RHIOs existing in July 2006 had not yet evolved from planning stages, while another 26% merited classification as defunct.

David St. Clair (2008), founder and CEO of MEDecision Inc., stresses that RHIOs provide a better overall perspective of the patient's medical history to clinicians. In the article,

"RHIOs in reverse," Clair asserts information in RHIOs would likely provide more comprehensive and accurate information than the patient might provide. In turn, physicians could utilize the information to conduct a more thorough interview to ultimately help identify gaps that need to be filled in the patient's care. On the questionable side, the information could also entice providers to fulfill particular pay-for-performance practices that may or may not benefit the patient.

By 2005, Joseph Conn (2005) reports, more than 100 regional health information exchange organizations were operating across 45 states and the District of Columbia. In the article, "After the startup; RHIOs seek sources for continuing support," Conn explains that when RHIOs initially beginning to operate, 46% of the health information exchanges surveyed in his study reported they had obtained funds from the federal government, while "24% received money from state or local governments" (Conn, 2005, ¶ 2). As the majority of RHIOs may start from seed money that various branches of government provide, these RHIOs ultimately depend on public funding to continue to operate. Developing sources to fund the start of and maintaining of RHIOs therefore proves to be primary challenge for these organizations to survive.