The recent faltering of a regional health information organization in Portland, Ore., and the outright folding of a RHIO in northeastern Pennsylvania could be indicative of a scaling back of some of the more ambitious goals of the RHIO movement, several industry observers are saying.
Others, however, including those involved in both of the recently stalled projects, remain optimistic about cooperative data exchange.
Its not yet clear if the incentives exist for healthcare organizations to share information, says David Lansky, senior director of the health program at the Markle Foundation. Markle joined a consortium to develop a prototype of a national health information network that moved electronic messages between RHIOs in Boston, Indianapolis and Mendocino County, Calif.
Are patient-centric RHIOs like those proposed in Oregon and Pennsylvania between competing organizations and multiple information technology systems dead?
Im definitely in the category of I dont know, Lansky says. So I think its become time to have more discussions about getting the incentives right. How? Thats a deep question. Ultimately, it will be how we pay for healthcare.
In many areas, healthcare information exchanges need to focus on the business needs of the providers that will build and maintain these systems, says John Regula, who served as chairman of the now-defunct Northeastern Pennsylvania Regional Health Information Organization, or NEPA RHIO.
It does not make sense for a RHIO to have a consumer-centric model, says Regula, chief information officer of Allied Services, Scranton, Pa., a not-for-profit provider of rehabilitation medicine, senior-care, home healthcare, vocational and residential services. Its a noble idea to say put the patient first, but what you have to have are business plans within the provider community, he says.
Computer systems engineer and consultant Sabatini Monatesti, president of ES Enterprises, Berwick, Pa., and a founder of NEPA RHIO, says that RHIOs are, by definition, patient-centric, while health information exchanges, are provider-centric, and the problem we have is that people are thinking these two things are indistinguishable.
The RHIO model is more a distributed model and it mimics the telephone network, Monatesti says, describing it as an asynchronous, node-to-node infrastructure. Health information exchange is a provider-centric model for the purposes of controlling market share. The provider-centric point of view is an antithesis to a RHIO. It (the RHIO model) puts the control of the records, the personal health record and the continuity-of-care record in the hands of the consumer, Monatesti says. Thats why the provider groups had a difficult time; they couldnt take that (RHIO model) back to their boards and sell it, because they cant demonstrate an ROI (return on investment). With an HIE, they can best control the flow of information in a way that suits them, and thats what brought this thing to its knees.
Andy Davidson, president and chief executive officer of the Oregon Association of Hospitals and Health Systems, worked on the Portland RHIO, an effort backed by the business community to develop a Web-based portal and a record-locator service that would provide a clinical-messaging service connecting hospitals and physicians in the Portland metro area, which has a population of 1.6 million. A board overseeing the project voted in May not to go forward with a $17 million, five-year funding plan. Asked whether he thought the Portland RHIO was stalled or dead, Davidson says: The honest answer is, I really dont know.
Part of it is, you have to step back and see whats going on nationally, Davidson says. Ive worked on other (RHIO) efforts in Seattle, Cleveland and Long Beach (Calif). The common theme in Seattle, Cleveland and Long Beach is that none of them got off the ground. But all of them faced different barriers, Davidson says. One key challenge is system usability at the provider level.
If you build a system, youve got to ensure its valuable enough that physicians are going to use it, he says. Youve got health systems and hospitals investing huge amounts of money in their own IT systems, and theyre not necessarily seeing a return on investment in those systems.
A common stumbling block to RHIOs is the unwillingness of likely participants to collaborate because of provider and payer rivalry and mistrust, but that was not a factor in Portland, Davidson says.
Regula says that the northeastern Pennsylvania RHIO involved eight hospitals and about 75 active members in total. It formally incorporated as a not-for-profit, selected and seated a board of directors, but after six months the board met in June and voted the corporation out of existence.