Physicians looking to regional health information organizations as a solution to their electronic records needs may be out of luck. New research data suggest RHIOs are struggling to catch on.
RHIOs facing trouble: survey
Few physicians electronically sharing clinical data
The research, published online by Health Affairs, said that nearly one in four of 145 RHIOs dating back to last year are now defunct, and only 20 existing programs have actually shared information. Whats more, only 5% of RHIOs report posting a profit while 40% of them still rely heavily on grants, said the studys authors, researchers from Harvard University.
The findings cast doubt over current health information technology policies that would have doctors, hospitals, labs and other groups freely exchange health data in an effort to streamline patient care and manage the high volume of clinical data. The study also follows news of RHIOs struggling to survive in Oregon and Pennsylvania (Sept. 10, p. 32). Based on research and a survey, the data found that of the 145 organizations identified for the study, 36 were defunct and seven were not actually a RHIO. Of the remaining 102 RHIOs, 83 responded to the survey.
The studys right, said Jim Walker, a physician and chief medical information officer for Geisinger Health System in Danville, Pa. Its no surprise to people who are trying to do this; it clearly is difficult.
Walker is spearheading a larger initiative to provide health IT outreach primarily to smaller clinics and regional hospitals that may only have a skeleton staffif anyin their IT departments. Some of the services include the electronic processing of laboratory results, remote radiology and an overall initiative to help populate a master patient index that would allow doctors to more quickly pull together patient information, he said.
But like other hubs of health information exchange, the Geisinger model has struggled to find the right business plan. Weve been through 10 hypotheses, Walker said. Three or four show promise.
The Geisinger experience in many ways mirrors much of Harvards findings. The study suggests 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 studys 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, Adler-Milstein said. In reality, were seeing few established RHIOs and those that are established only have a small number of participating groups exchanging a narrow set of data.
J. Marc Overhage, president and chief executive officer of the Indiana Health Information Exchange, however, said thats not necessarily a bad thing. Its still early in the development of health information exchange, he said, adding that the study counted even the smallest of RHIOs as part of its initial survey. Shakeout at this point is par for the course, he added.
The study also found that more funding is needed to help RHIOs gain footing. As is, 5% of RHIO efforts earned sufficient revenue to be profitable, the report states. Many more, however, were reliant on grant money. Indeed, the Ann Arbor (Mich.) Area Health Information Exchange has attracted performance-related revenue for physicians but with the assistance of funding from a technology company involved in the operation (Dec. 10, p. 34).
Researchers said that as a result of the funding issue, 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, CEO of eHealth Initiative, said RHIOs face an uphill climb because the reimbursement system for hospitals, clinicians, labs and other types of providers is flawed. As is, the current reimbursement equation largely encourages both volume and fragmentations in carerewarding those who do more, but in many cases, not those who do better, she said. 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 said. 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 RHIOs No. 1 challenge. A full 91% of those surveyed call it a difficult one at that, she said.
Still, Overhage said that hes optimistic about the progression of RHIOs. I think there is a pathway forward, he said, and you have to take advantage of what folks have successfully done and not be shy about stealing it.
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