Contributed by Michael Mytych
RECENT PUBLISHED RESEARCH on the state of regional health information organization initiatives indicates a lack of progress on their deployment and sustainability.
The conclusions of those studies may seem somewhat harsh, considering where RHIOs are in their lifecycles, as compared with the evolution of the ATM banking networks of the 1980s and 1990s. However, they do bring to light that achieving true interoperable and economically sustainable healthcare data exchange will be a major, if not monumental, development in the history of healthcare.
What is challenging for the stakeholders and sponsors of RHIOs is the ever-changing landscape of ancillary technologies and, to some extent, the lack of consensus on RHIO requirements. One specific example is the intersection of the RHIO with the personal health record, or PHR.
Many RHIOs base their economic utility on the basis of providing continuity-of-care information for any one patient, especially those with significant issues such as diabetes, cancer and heart disease. With a growing number of payer and employer (economic) sponsors, the PHR appears like it’s here to stay; that’s because it truly can represent the lowest common denominator of clinical data that can be stored for any one consumer.
In a perfect world, we as consumers would control all of the pertinent clinical information that has been produced about the significant clinical events of our lives. Clinical, social and family history can be kept along with future data points, such as genomics and critical disease staging, which can be stored, protected and accessed regardless of source system or provider ownership.
What is missing in many of the PHR scenarios is the lack of definition, transmission, organization and storage of “provider-trusted” data. This is potentially the Achilles heel of PHRs, and this issue is one where RHIOs may play a critical role. Just as today’s banking system relies on accurate sources of data, both inbound and outbound from a wide array of sources, the PHR/RHIO combination represents a similar relationship. Without trusted sources of data, PHRs are viewed more as a consumer tool rather than one that providers can truly trust as a source of a patient’s actual status. Even in a “trusted” state, physicians are trained to treat almost all existing information about a new patient as only a starting point.
RHIOs can certainly become a trusted source of patient data for those consumers who utilize the providers connected to that RHIO for all of their care. The key question is will any particular RHIO contain all, if not most, of the critical elements of a patient’s pertinent events over time?
The current employer-based insurance system doesn’t help this model; it can cause consumers to change providers and fragments their health record. For example, every year employers switch payers, and payers change their provider networks and relationships with health systems, causing patients to change providers. Coupled with other reasons why consumers switch providers or provider networks, this creates the real risk of significant gaps in the overall picture of patients’ pertinent healthcare history.
Unless we end up personally and physically transferring our records, or the industry achieves a truly interoperable national health information network infrastructure in the not-too-distant future, the PHR will continue to grow as the logical transportable longitudinal record of choice for most consumers.
The bottom line is that if RHIOs can tap into the growing development of PHRs and demonstrate that they can feed unalterable, provider-recognized trusted data in an easy-to-use fashion, then they will grow synergistically with the PHR.
For now, it is evident that employers will continue to throw their support to PHR use by their employees, even as the employer community is not necessarily on the front lines in supporting RHIO development.
Michael Mytych is principal and founder of Health Information Consulting, a Menomonee Falls, Wis.-based consultancy.