Back at the beginning of the year, I did a Top Ten Predictions post where one of the predictions was the continued struggles of Regional Health Information Organizations (RHIOs) and the steady rise of Health Information Exchanges (HIEs). Since much of the ballyhooed National Health Information Network (NHIN) is built upon the premise of RHIOs and their success, the NHIN is basically dead in the water.
Sure, NHIN supported by RHIOs is a great and grand vision, but that is about it – a great and grand vision created by policy folks in government (and their academic counterparts) that has little basis in reality. That divorce from reality stems from a lack of a true, justifiable business case. There is simply no compelling business reason for the vast majority of health industry stakeholders to invest in RHIOs. (Note: those that have invested in RHIOs are most often doing it for political reasons, not business ones.)
This is not the case for HIEs. These networks are created by entities, typically large hospitals, that do have a compelling business reason (one reason: encourages referrals to their hospital) to share health information within a network of business partners (their provider network). This is quite similar to a supply chain network within the manufacturing sector. In manufacturing its about sharing bills of materials, design drawings and the like to accelerate time to market. For hospitals its about delivering value to smaller practices, most often giving a physician a window into the HIE host’s EMR to facilitate care and insure referrals. The August cover story of the publication Health Data Management has an excellent story that goes into greater details on why HIEs are growing in popularity.
It is an expensive and time consuming endeavor to build these HIEs. RHIOs, well, there are another order of magnitude more difficult to accomplish and likewise costly to support. And let’s not even begin thinking about NHIN – that is one vision that is at least a decade away, if not longer.
How might we move the proverbial ball forward?
First, discontinue investing federal/state funds into RHIOs.
Second, redirect energies (not necessarily funding) towards supporting HIEs.
Support for HIEs can come in multiple forms, but maybe a tax break or rebate to the sponsoring entity of an HIE is possible with some caveat to the effect that th HIE will support open, interoperable standards. This will insure that the HIE will be capable of participating in a broader entity e.g. RHIO and further down the road the NHIN. Taking this approach will provide a logical, stepwise strategy to growing the connections towards a nationwide network that begins at a very local level delivering incremental value every step along the way.