The concept of a regional health information organization is one that’s difficult to oppose. What healthcare organization wouldn’t want to have a data-sharing organization in place that could help provide access to any relevant information about a patient?
Ten years ago, a similar concept called community health information networks emerged, and many long-time industry participants are having flashbacks to that era. Admittedly, times have changed – the technology’s available and cheap now, and the government is pushing the RHIO idea. But a key issue remains.
“Financing,” said Mike Mytych. “That’s the $64,000 question. There are no magic bullets out there.”
Mytych was a proponent of CHINs 10 years ago and hasn’t given up on the idea of sharing healthcare information. Through his Menomonee Falls, Wis.-based company, Health Information Consulting, and with help from other consultants, he is involved in the creation of a RHIO in the Twin Cities, which is nearly ready to enter the testing phase.
While he’s optimistic about what RHIOs might be able to accomplish this year, Mytych draws a distinction between starting initiatives and keeping them going over time.
“We’ll start to see some real substantive delivery in 2007,” he said. “We have some RHIOs up and running, and things are being tested. That doesn’t mean these projects are economically self-sustaining, and that’s the real crux of the issue.”
The success factors for RHIOs are specific to each one, said Pam Matthews, director of health information systems for the Healthcare Information and Management Systems Society, which represents IT professionals in healthcare settings.
“One of the significant challenges will be business sustainability over time,” she said. “The question of what will be their business case or business model and create that sustainability is still a challenge and will continue to be.”
RHIOs may face an uphill battle in finding funding as standalone businesses. A survey last year indicated the perceived benefits of RHIOs might not immediately translate into a business model that can be sustained commercially.
That survey, by the Healthcare IT Transition Group, found that many network organizers expect to need funding on an ongoing basis, and that’s still an issue, said Michael Christopher, the group’s chief technology officer and development analyst. Finding a business case is crucial for the health of the industry.
“RHIOs would love to be able to sell their services for income,” Christopher said. “Healthcare doesn’t need just one more expense; providers are already on very tight margins. The other side of the sustainability question is whether RHIOs are able to sustain the charitable funding that’s coming in.”
Sustaining funds may be coming from other sources, particularly states, said Matthews.
“The significant thing I’ve seen is state-level involvement, either by executive order or some other push,” she said. “In this past year, we’ve seen an increased number of states working with RHIOs. States are becoming very active and involved, looking to see what they can do to promote health information exchange.”
However, RHIO deployment and success will hinge on a variety of factors. For example, RHIOs will struggle to get penetration among providers as long as only a small percentage of physician practices are using electronic medical records, said Christopher D. Sprowl, MD, president of iPN Avista, a Superior, Colo.-based integrated physician network that’s participating in a RHIO effort.
“You can look at all kinds of penetration figures for EMR adoption, and when you look at the practices that are linked to us, the penetration of EMRs is 10 percent,” Sprowl said. “When you consider that 42 percent of healthcare is delivered in a physician’s office, that’s a fairly big number to get your hands around.”
The healthcare industry needs help in fostering RHIOs, said Mike Drake, CEO of Medseek, a Solvang, Calif.-based company that’s helped develop RHIOs.
“A RHIO could be set up as a public utility,” he suggested. “Once it’s in place, then basic commerce and business sense would be used to make a determination about who would achieve the most benefit from RHIO transactions.”
Payers would achieve big benefits from RHIO services and should shoulder more of the cost burden, Drake said.
A return on investment will be achieved by the healthcare system as a whole, said George Schwend, president and CEO of HealthLanguage Inc., an Aurora, Colo.-based company.
“Downstream, there are profit or business models that can support a RHIO,” he said. “Somehow, there has to be a tax on the healthcare system to support RHIOs from those benefits. Whether it’s shorter hospital stays, portability of records, quicker recovery times or lives saved, there’s a way to put a value on that.”