Across 45 states and the District of Columbia, more than 100 regional health-information organizations -- or RHIOs -- are sprouting up in various stages of planning and implementation. But many of them were started with seed money from various branches of government and they still rely heavily on public funding for operations, according to a recent survey by the not-for-profit eHealth Initiative Foundation.
Developing sources of funding is a key challenge to the survival of these fledgling organizations that seek to create links for providers to clinical information across hospitals, physician offices and other healthcare organizations in a community or region. When starting up, 46% of the health information exchanges surveyed reported having received financial help from the federal government, while 24% received money from state or local governments.
"While seed money and grant money are important, the issue is sustainability," says Janet Marchibroda, chief executive officer of the eHealth Initiative Foundation, a not-for-profit that serves as a healthcare IT policy forum.
Marchibroda says she is optimistic that the rise in pay-for-performance plans and their demand for healthcare data will create a financial climate that will provide operating funds for exchanges.
"We're beginning to see sustainable models emerge," she says. "The pioneers are actually embedding the health information exchange in the delivery of care and the improvement of care. We're seeing incentive programs -- such as Bridges to Excellence, where there are bonus incentive programs for putting in IT systems -- are growing rapidly."
For example, soon after the eHealth Initiative Foundation issued its report, the Blue Shield of California Foundation agreed to donate $1 million to fund health information connectivity services to public hospitals, safety-net clinics and providers in rural and other medically underserved areas in the state. The grant was given to the California Regional Health Information Organization. CalRHIO, which serves as an umbrella organization for the development of other RHIOs in the state, has raised
$4.8 million so far to finance its work. CalRHIO spokeswoman Karen Hunt says a survey being conducted by her organization has found about 18 local connectivity programs are under way throughout the state.
Yet, Carla Smith, executive vice president of the Healthcare Information and Management Systems Society, an industry trade group, says the healthcare IT community is still skeptical of RHIOs.
There is hope "that there is a long-term business model for a RHIO," Smith said, "but the vast majority of practicing physicians in the U.S. don't have EMRs, and 80% of care is performed in the practice setting, so this is not an easy goal to achieve and it's not a goal that's guaranteed success."
According to the 54-page survey, there are 65 "advanced stage" exchanges that either are in the final planning stages or are fully operational and moving data.
Even for them, the government remains a sustaining force. Forty-eight percent of these advanced RHIOs reported the federal government as a source of revenue, 24% received money from state and local governments, 19% listed revenues from public health organizations and 15% from public payers.
The online survey was launched in May and includes responses from 109 groups.
SHARE in Mendocino County, Calif., is an example of the successes that RHIOs can have and the obstacles that they face. SHARE, which stands for Securing Health Access and Records Exchange, is more than two years into a three-year HHS grant as a demonstration project aimed at providing data-exchange services to rural areas and small providers.
Right now, data is flowing between three hospitals, which combined have fewer than 200 beds, and a couple of dozen physicians in the county, which has a population of 86,000. Participants are sharing disease-management data on diabetes patients, says Will Ross, project manager for the rural RHIO.
About two-thirds of SHARE's grant money -- between $300,000 and $350,000 -- has been spent developing open-source software to lower the cost for starting up other, small, rural data exchanges.