Organizations hoping to exchange health data within geographic regions are struggling to achieve their chief goals, and many are failing financially.
Electronic clinical data exchange is far from a reality, with few organizations facilitating such exchange and many failing in the process, concluded the study by Harvard researchers published yesterday on the Health Affairs Web site.
The study, based on a 2007 survey of 145 regional health information organizations, found that about 25 percent of the RHIOs were defunct, and found that only 20 were said to be of at least modest size and exchanging some clinical data. Of those 20, only 15 exchanged clinical data across a range of patient populations.
It's expensive to start a RHIO, especially initially, said study author Julia Adler-Milstein. Grants typically fund RHIO startup costs, but the survey found the data organizations are struggling to achieve self-sufficiency.
The survey found eight of the 20 moderate-size RHIOs continue to depend heavily on grants. By contrast, nine never received grant funding, and some 13 RHIOs said they collected recurring subscription or transaction-based fees from participants.
"If we want RHIOs to attain the vision of comprehensive health information exchange, we need to increase our investments in them," Adler-Milstein said. "Otherwise, many of these RHIOs will be unable to sustain themselves under the current market-oriented approach."
The findings of the new study corroborate findings of previous RHIO funding studies of the Healthcare IT Transition Group, a Tulsa, Okla.-based consulting firm, which issued two reports in the past two years citing RHIOs' dependency on grant financing.
"It is disappointing to watch the continuing struggles that RHIOs are going through," said Michael Christopher, chief technology officer and senior development analyst for Healthcare IT Transition. "This study may help bring to light what we see as a key disconnect in the RHIO movement, namely that expectations of commercialization are premature and that public investment, whether in the form of government support or private philanthropy are going to be required, and at greater levels than what we're seeing right now."
Financing is only one of several serious barriers to RHIOs achieving their potential, said the survey, funded by Harvard's Program for Health Systems Improvement. Electronic health data exchange between hospitals, physicians' offices, labs and other clinical settings has been elevated by many in the healthcare industry as the key to improving quality, efficiency and coordination of care.
"These findings suggest that nationwide electronic clinical data exchange will be much harder than what many people have envisioned," said Adler-Milstein, the study's lead author. "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."
Adler-Milstein said that most successful RHIOs started by focusing their efforts on exchanging test results from laboratories and imaging centers. She believes that is where the clearest return on investment lies. Exchange of other data, such as clinical notes, is much more difficult to achieve, she said, partly because cost savings from such initiatives are less tangible.
"While many RHIOs are struggling, some have figured out a way to sustain themselves and that is a reason for hope," said Ashish Jha, an assistant professor at the Harvard School of Public Health and a study co-author. "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."