In response to Joseph Conn's "RHIO experts talk problems, future of movement":
As evidenced by Conn's recent article, RHIOs remain a fairly hot topic in health information technology circles. Perhaps more importantly, as the article indicates, it's the potential demise of RHIOs that is getting people's attention. It seems lately we've been hearing more about RHIO failures than successes. What's really interesting is that someone like David Lansky of the Markle Foundation responds "I'm definitely in the category of I don't know" when asked if RHIOs have a future.
I think what has led to the failure of most RHIOs is a serious flaw in the basic concept and design. Most have been launched under the premise that the technical infrastructure required for exchanging data must first be up and running on a systemwide basis before stakeholders can begin using it. I think in many cases this is what has led to the debates over funding, business models, data ownership and any number of other issues that have prevented or significantly slowed the development of RHIOS.
Personally, I still think RHIOs can work. But what we need to do is forget about first establishing an elaborate technical network and instead start small and create a sort of "value chain" between payers and providers that builds on incremental success. Eventually, RHIOs as originally envisioned will logically emerge. Payers are very willing to share patient clinical data with providers. If we delivered this data to providers in a simple, easy-to-use format, they'd be more likely to use it. And I'm willing to bet that the more they use it, the more they'd grow to appreciate and depend on it until they become sort of preconditioned to more advanced data-sharing. Once the initial value proposition is realized and they begin to see the impact that more thorough clinical data can have in their relationships with patients and the administration of their practices, chances are providers will be more eager to share their data with other constituents. Right now, payers could conceivably implement technologyat little or no cost to providersthat would allow all entities on a patient's care team to share richer data with physicians, including real-time best practice and clinical decision support. In effect, this would serve as the foundation for the larger, systemwide health information exchange necessary for reforming healthcare.
So, ironically, the key to RHIO success is to stop thinking big. Instead we should focus on smaller initiatives that generate some legitimate return on investment. Once everyone involved begins to see the results, interest and enthusiasm will build until we have ourselves a legitimate trend. And some functioning RHIOs.
David St.ClairFounder and chief executive officerMEDecisionWayne, Pa. To submit a letter to YOUR VIEWS, click here. Please include your name, title and hometown.