Nearly one in four of 145 regional health information organizations, or RHIOs, dating back to last year are now defunct, and only 20 existing programs have actually shared information, according to a new study by Harvard researchers and published by the journal Health Affairs. What's more, only 5% of RHIOs report posting a profit while 40% of them still rely heavily on grants.
Based on a survey of the 145 RHIOs, the findings cast a doubt over current health information technology policies that would have doctors, hospitals, laboratories and other groups freely exchange health data in an effort to streamline patient care and manage the high volume of clinical data.
"These findings suggest that nationwide electronic clinical data exchange will be much harder than what many people have envisioned," said Julia Adler-Milstein, a Harvard doctoral candidate in health policy and the study's lead author, in a written statement. "The expectation has been that we will have RHIOs throughout the country that bring together all the providers in their region and engage in comprehensive data exchange. In reality, we're seeing few established RHIOs and those that are established only have a small number of participating groups exchanging a narrow set of data."
The study also found that more funding would be needed to help RHIOs become viable hubs for information exchange. As is, 5% of RHIO efforts earned sufficient revenue to be profitable, the report states. Many more, however, were reliant on grant money. Researchers said that as a result, young RHIOs face "substantial challenges, and it is not clear whether even more mature RHIOs have a clear path to becoming financially sustainable."
Janet Marchibroda, chief executive officer of eHealth Initiative, said that RHIOs face an uphill climb because the reimbursement system for hospitals, clinicians, laboratories and other types of providers is so flawed. As is, the current reimbursement equation "largely encourages both volume and fragmentations in care—rewarding those who do more, but in many cases, not those who do better," she said in an e-mail. "As a result, there are actually disincentives for (providers) to share information."
All of which works against the development of successful business models for RHIOs, Marchibroda added. A survey that eHealth Initiative conducted on health information exchanges, set for release later this month, shows that the development of a sustainable business model is the No. 1 challenge RHIOs face. A full 91% of those surveyed call it a difficult challenge, she said.
Ashish Jha, co-author of the Harvard study, said, "Either we have to create the right market conditions or have much greater public investment, but the vision of a national health information network is unlikely to come to fruition without one or the other."
