Efforts to establish regional health information organizations (RHIO) in various parts of the United States over the past few years have experienced decidedly mixed results. In 2007 alone, we saw failed or otherwise curtailed RHIO initiatives in Santa Barbara, Calif., and northeastern Pennsylvania, just as the Delaware Health Information Network (DHIN) was going online and CalRHIO (California Regional Health Information Organization) received $1 million in grant money to help continue the important progress it had been making.

Efforts to establish regional health information organizations (RHIO) in various parts of the United States over the past few years have experienced decidedly mixed results. In 2007 alone, we saw failed or otherwise curtailed RHIO initiatives in Santa Barbara, Calif., and northeastern Pennsylvania, just as the Delaware Health Information Network (DHIN) was going online and CalRHIO (California Regional Health Information Organization) received $1 million in grant money to help continue the important progress it had been making.

While the achievements of CalRHIO and DHIN certainly deserve the industry’s recognition, along with its support for continued success, the failures in Pennsylvania and Santa Barbara may be of greater significance. Given the current state of healthcare in the United States, the ever-growing need for reform and the potential that health information exchange (HIE) holds for generating positive change, each failed attempt at data sharing is a detriment to the system as a whole.

Actually, the vehicle through which HIE is delivered (be it a RHIO or something else) is of far less importance at this point than enabling the exchange itself. Ultimately, the industry’s prevailing goal should be ensuring that clinicians have access to the richest and most complete information currently available, including clinical decision support, so they can be assured of employing best practices in caring for patients. This will allow them to make better and more informed decisions, which will eventually lead to the improvements in quality, efficiency and affordability for which we are all striving.

Creating a Value Chain

One way to begin building momentum toward full-scale HIE is to create a sort of value chain of simple information sharing between payers and providers. Most payers are currently willing to furnish providers with a patient’s amassed clinical data in order to give clinicians a better overall perspective of the patient’s medical history. If presented to them in a convenient and easy-to-use manner (some existing systems require nothing more than a computer, Internet connection and a printer), it is very likely that providers would gradually become accustomed to having this type of data at their disposal and would integrate it into their standard workflows. Since this information would probably be more comprehensive and accurate than that which the patient provides on clipboard forms during check-in, physicians could use it to initiate a more thorough interview to help identify gaps in care. The information could also likely enable providers to fulfill certain pay-for-performance incentives.

Enabling providers to experience the benefits of basic HIE in this manner – letting them “test drive” it, so to speak – will essentially precondition them to more advanced data sharing. Once the initial value proposition is realized and providers see firsthand the difference that having more complete information can make in their relationships with patients, and the administration of their practices as a whole, chances are they’ll be increasingly eager to more openly exchange data with other constituents. At little or no cost to providers, payers can implement advanced technologies through which the members of the patient’s care team can more easily and openly share richer data with physicians, including real-time best practice and clinical decision support. Effectively, this will form a solid foundation for the larger, system-wide HIE necessary for reforming healthcare.

In many respects, this value chain approach to HIE is the opposite of the “traditional” RHIO concept that has, thus far, seen relatively little operational success. Most RHIO initiatives have been launched under the notion that the complex technical infrastructure necessary for information exchange must first be in place before providers can begin using it and initiate true data sharing. As we’ve seen, this often leads to ongoing debates over funding, business models, data ownership and any number of other issues that bog down the process and either completely prevent or otherwise impede progress.

Return On Investment

One of the primary advantages of the value chain design is that it generates a return on investment of sorts for users at each step. It is a deliberate, cost-effective and momentum-driven way to advance HIE through which all constituents can experience its value and contribute to its development. Once these systems and procedures become entrenched and successful, RHIOs, as originally conceived and intended, will logically (if not a bit ironically), emerge.

While it is certainly worthwhile to deliberate whether the RHIO concept (or some other one) is the best vehicle for bringing forth the benefits of HIE, it is actually a secondary concern in the broader scope of health IT. Of greater urgency is ensuring that the exchange of health information is possible in the first place. And, in order for this to happen, we must resolve some persistent and nagging issues, such as interoperability and collaboration (or the lack thereof) that, until now, have been roadblocks to a more pervasive deployment.

Enabling providers to experience the benefits of basic health information exchange in this manner – letting them “test drive” it, so to speak – will essentially precondition them to more advanced data sharing.

The health IT industry has spent the better part of the last quarter century perfecting stand-alone technologies for healthcare’s various stakeholders, in order to exchange health information within the vacuums or “silos” of their respective operations. This puts us on the threshold of a more robust, game-changing level of HIE wherein these silos are neutralized and each entity can bi-directionally share data with one another. As of today, practically everything necessary to launch this effort (including the all-important clinical information itself), is established but, unfortunately, on “stand-by.” The only thing missing is the constituents’ actual participation.

Why the Delay?

Interoperability accounts for most of the lag in uptake. Since most existing systems are single source, software vendors aren’t in much of a hurry to change them. The tenuous relationship between payers and providers also is slowing things down. Add in the ongoing debates about privacy and security and what becomes apparent is that there are more things working to constrain HIE than there are to advance it.

The good news is that collaboration can solve these issues. It is past time for each of the various entities with a stake in the HIE process to mobilize and engage in a consorted, good faith effort and do what’s necessary to make it happen. Technology vendors have the ability to make their solutions open and interoperable, and payers and providers can work to find some common ground if it means improving the healthcare system itself. Once we do these things and begin the exchange of health information at a level that is currently within our reach, concerns over security and privacy will be systematically addressed and, more than likely, eased.

Despite what the mixed results of RHIO efforts might indicate, the future for HIE is strong. Frankly, it has to be, because it remains our best means for reforming the American healthcare system. What will bring forth its benefits sooner rather than later is an incremental approach in which we take steps to build value among each stakeholder that results in a willingness to participate on a broader scale.

Through greater collaboration and a strict commitment to open and interoperable technology, we could even begin the journey today.

David St.Clair is founder and CEO of MEDecision Inc. Contact him at [email protected].

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