“We've had significant grants to stand up and build out our service,” Kremer says. “But we have an operating model where the payers have been funding our ongoing operations” using a claims-based surcharge. Payers see clinical improvements from health information exchange as the business case for supporting the RHIO, Kremer says. “We don't exchange claims data, so, absolutely, it's the delivery side of healthcare, the efficiencies there.”
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The RHIO now offers 1,700 healthcare providers, including 500 physicians, a range of services, including electronic prescribing, patient medication histories, electronic health-record support and clinical messaging, including medication, laboratory and radiology reports from member labs, hospitals and radiology centers. Recently, it began offering emergency physicians in six hospital emergency departments access to patient information through the exchange.
In New York, patients must consent to the use of their protected health information, even for treatment, payment and other healthcare operations. To accommodate New York law, the state has developed a privacy guideline that state-funded RHIOs must use. According to Kremer, more than 350,000 patients have signed consent forms thus far. But even patients who have withheld consent can have their records accessed if they are involved “in a life-threatening emergency,” unless the patient has specifically declined consent to a particular provider, according to the organization.
Kremer holds a master's degree in public health from Yale University and is the former chief technology officer of Oxford Health Plans, Trumball, Conn., now part of UnitedHealth Group.