PHRs vs. RHIOs and the Rise of the PHS

by | Jan 30, 2008

I do not see a long-term future for Regional Health Information Organizations (RHIOs).  There is no compelling reason for most healthcare practices to participate in an RHIO and in many cases, such participation may compromise a provider’s competitive position. Health Information Exchanges (HIEs) on the other hand will see localized success as these are created by providers, in their own self-interest, to share information among their network of partners to facilitate workflow and optimize business processes.

Today, there are no PHRs in the market that have the clout to directly compete or subsume an RHIO or HIE. Google, and its impending PHR release, may change all that but we’ll have to wait and see.

That being said, a new entity/concept is on the horizon in the likes of Dossia and Microsoft’s HealthVault. These are not PHRs, but what I refer to as PHSs for Personal Health Systems. They are structured much like an RHIO to aggregate all the various bits of a person’s health record (labs, images, clinical notes, medications, claims, etc.) into a secure data repository. This data would then be serve up, via an application programing interface (API) layer, into a Personal Health Application, of which PHRs are a subset. More information about PHSs and how they are intended to work can be found at this previous post on Dossia’s “utility” model.

What I like about the PHS model is that unlike RHIOs, or for that matter HIEs, it is consumer (and in the background employer) driven.  Employers have a strong and vested interest to see the PHS model succeed, and I believe in time, consumers will as well.  But only time will tell if the PHS model will indeed succeed as the healthcare sector has woefully under-invested in IT to date and without digital data, even PHSs will struggle to create sufficient value for their users and sponsors.


  1. DC

    John, interesting take on the landscape, however I disagree and so might the folks at the Delaware Health Information Network, HealthBridge, Quality Health Network, Inidiana Health Information Exchange and the thousands of clinicans, hospitals, labs, radiology centers, pharmacies, etc. involved in these successful efforts. Failure of the HIE or RHIO stems from lack of proper foundation or goverance, wrong choice of vendor and organizational leadership. The funding model of some of the most successful HIE and RHIO’s have not received one dollar of federal or state money and have been sustainable for years. Others used federal and state money as a starting point, but have put into effect plans to be self-sustainable.

    Your point is well made on PHS. Time will tell if there is incentive for the patient to actually participate or if an employeer can aid in adoption by their workforce through some incentive mechanism. Apathy is the biggest obstacle for patient participation. Look at going to vote as a prime example of taking advantage of opportunity to better one-self. Of course there is the entire legal argument over the actually use of PHR (PHS) files by a clinician. This obstacle must be addressed and determined before acceptance is widespread within the healthcare community.-DC

  2. david

    What timing!
    I stumbled upon your blog looking for exactly this question two days ago and viola! It would seem that the various models will proceed at a glacial pace like ships passing in the night

  3. John

    Thanks for the comment and yes, I may have painted to broad a brush by inferring all RHIOs will go belly-up. Sure, some may survive but my guess is probably about 10% of all those proposed/attempted will make it. Also, note that my negativity was reserved for RHIOs as I do see a continuing role for HIEs.

    Agree with your comment about apathy, which will be found among healthy consumers. But even those healthy consumers may have an elderly parent that they are caring for and the use of a PHR will prove useful – and Microsoft’s PHS, HealthVault, is a logical fit here. Among employers you can bet that they will be looking at incentives of all sorts to get their employees to use a PHRs (and onto the Dossia PHS???) to improve the overall health and wellness of their employees. There is a tremendous opportunity here that employers are beginning to recognize which has created almost a stampede in the market.

    As for the legal obstacle you mentioned, I believe this is more of an avoidance tactic by physicians. One need only look at a PHR company like Medem, which was developed by the AMA, is supported by all 50 state chapters of the AMA, has over 70,000 physicians using this PHR today to serve over a quarter of a million patients to quickly throw the “legality” argument out the proverbial window.



  1. ICMCC Articles » Blog Archive » PHRs vs. RHIOs and the Rise of the PHS - [...] among their network of partners to facilitate workflow and optimize business processes.” Article Chilmark Research, 30 January [...]
  2. Naturally, Govt. Looks to Google and Microsoft « Chilmark Research - [...] are few easy answers and the questions are many.  Ultimately, it may be Google and Microsoft (and Dossia) who…
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