Regional Health Information Organizations: Benefits and Challenges

Introduction to RHIOs and Health Information Exchange

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 for North America at dbMotion in 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, and RHIO membership continues to grow. 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). Rather than struggling in the competitive healthcare environment, those entities that 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, RHIOs have struggled for numerous reasons, including funding shortfalls, unsustainable business models, unresolved data storage and access policies, and wavering public support. This paper examines a number of these challenges, as well as the advances RHIOs have contributed to health care and the issues they still need to address. It also investigates how RHIOs impact local physicians' practices and other health providers, and concludes with a personal reflection on RHIOs from a patient perspective.

The article "RHIO/HIE" (2009) explains that the terms regional health information organization (RHIO) and Health Information Exchange (HIE) are often used interchangeably. RHIOs constitute a group of organizations with a business stake in the health arena that aim to improve the efficiency, quality, and safety 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, 2009, ¶ 1). To reach the national goal of developing "a national network of interoperable health records," health care entities at the local and state levels must first develop and collaborate to promote the concept.

Benefits of RHIOs and the Federated Data Model

The benefits of 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 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 has become a contemporary catchphrase. Benefits from data-aggregating products utilized by RHIOs allow physicians and others involved in 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 these benefits, however, Hurd points out that legitimate reasons exist for concern regarding RHIOs. For example, attempts to exchange secure data across various, unrelated provider systems may constitute a complicated and expensive endeavor. Even so, the federated model could likely address these 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 increased dramatically. A number of variables contributing to this change include:

First, 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.

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

Third, there is no standardization of data access or usage policies among the various facilities, let alone within the industry as a whole. High costs, long lead times, the latency inherent in complex database models, 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).

Hurd (2008) asserts that a truly federated data model offers the cure for these challenges. Because the model would not require that data be moved, replicated, or modified, it would consequently eliminate the politics of data ownership as well as concerns about the currency and accuracy of the data. Another argument — that such solutions may not be capable of handling massive volumes of data simultaneously — is countered by Hurd, who explains that "Web portal solutions process data requests using a role-focused filter, which aggregates the data according to the given user's access rights" (Hurd, 2008, "Don't Believe…" section, ¶ 2). Therefore, the portal would not typically need to pull a considerable volume of data to satisfy any single user request.

Conclusion

Freedman and Diamond (2007) predict that participation in RHIOs will significantly impact the future business of healthcare. They assert that organizations looking ahead will take the initial steps "to design data interchanges to streamline access to vital clinical information, with a goal of improving care, enhancing patient satisfaction and, ultimately, ensuring their business stability and success as emphasis on integrated care intensifies" (Freedman & Diamond, 2007, ¶ 3). As healthcare data interchange through a RHIO routinely enhances patient care, it may also prove invaluable during emergencies. Physicians who are not familiar with the history and conditions of displaced individuals may access significant, vital data instantaneously — helping to ensure proper patient care and alleviate patient anxiety. This capability could prove particularly valuable during natural disasters, such as hurricanes or wildfires, or other emergency situations where patients requiring ongoing care must temporarily relocate.

The researcher personally concurs with Freedman and Diamond (2007) regarding the value of RHIOs. "Better care and enhanced patient safety" (¶ 4), as Freedman and Diamond contend, reflect the primary positive results from RHIOs that outweigh the potential negative ones. As these authors also argue, organizations that deliberately opt out of endeavors such as RHIOs — as may some patients in circumstances where certain information provided by RHIOs might otherwise be available — risk failing to thrive in an increasingly integrated healthcare landscape.

References

Conn, J. (2005). After the startup: RHIOs seek sources for continuing support. Modern Healthcare. Crain Communications, Inc.

Freedman, I., & Diamond, J. (2007). Strategies for success: RHIOs that are designed to improve patient care and satisfaction can also increase market share. Health Management Technology. Nelson Publishing.

How electronic health records (EHRs) can help your practice. (2009). Sage Software, Inc.

Hurd, A. (2008). The federated advantage: Data exchange between healthcare organizations in RHIOs is a hot topic. Can federated models end the debate? Health Management Technology. Nelson Publishing.

RHIO/HIE. (2009). HIMSS Foundation. Retrieved July 30, 2009 from http://www.himss.org/ASP/topics_rhio.asp

Schuerenberg, B. K. (2008). 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. Health Data Management. SourceMedia, Inc.

St. Clair, D. (2008). RHIOs in reverse. Health Management Technology. Nelson Publishing.