Stanley Feld M.D.,FACP,MACE

In an earlier post I stated Regional Health Information Organizations ( RHIOs) will fail. I said “One should note that a RHIO is a network of information of all the patients’ charts in a region and anyone can get patient information and physician care activity instantaneously with proper authorization. This would be great if we lived in an environment of total trust. It could work if everyone would keep this information private and would not use the data gathered against the patient or physician. Remember the social contract in medical care is between the patient and the physician.”

Everyone seems to forget this important fact. Medical care is personal. Health is also precious and private. In the information age, technology has robbed us of private interactions. Physicians and patients are reluctant to relinquish this precious privacy. Our experience has been that our privacy has been undermined despite promises to the contrary.

In Hawaii “Physicians would still have to pay $30,000 for something they do not want and they do not perceive will increase the quality of his care. RHIOs are viewed as a tool that will be used to punish physicians and patients.”

The government put massive amounts of money into the development of RHIOs. The goal is to computerize medical information regionally and the ultimately nationally. “The terms “RHIO” and “Health Information Exchange” or “HIE” are often used interchangeably. RHIO (Regional Health Information Organization) is a group of organizations with a business stake in improving the quality, safety and efficiency of healthcare delivery. The benefits of appropriate sharing of health information among patients, physicians, and other authorized participants in the healthcare delivery value chain, are nearly universally understood and desired. Few organizations and systems have taken advantage of the full potential of the current state of the art in computer science and health informatics.

I predicted RHIOs were another complicated mistake. The timing of its formation and implementation is wrong. The money the government would spend would be wasted.

The development of RHIOs was supposed to increase the quality of care of medicine through the use of information technology. It simply can not work because a primary stakeholders (physicians) can not see its value. It could only enable the government and the healthcare insurance industry to punish physicians for his work as judged by a computer program. The punishment would be delivered by the application of a pay for performance (P4P) program to determine reimbursement.

The P4P would presumably reduce the cost of healthcare. I predicted physicians would not make the effort in time or money to make RHIOs work. Practicing physicians know how inaccurate claims data are in determining quality care. Practicing physicians can also see how RHIOs can injure the doctor patient relationship.

Policy makers simply do not understand how medical practices work or the importance of the patient-physician relationship. Unfortunately, the more policy wonks try to introduce improvements into the healthcare system the harder it becomes for physicians and patients to develop positive patient physician relationships.

“A new study finds that despite the widespread interest in regional health information exchanges in recent years, only 20 RHIOs in the United States are fully functional and a dozen are self-sustaining.”

The organizations developing the RHIOs have spent the government funded money. They have failed to achieve their goal. Now it is time to move on and shut them down.

“Calling RHIOs' survival in their current form "tenuous at best," the study questions many of the prevailing assumptions about how a nationwide health information network will emerge.”

After something that should work doesn’t a new study is always done to see why it didn’t work. No one bothered to ask practicing physicians or patients if it could work.

The study, “The State of Regional Health Information Organizations: Current Activities and Financing,” appeared today in an online edition of the journal Health Affairs.

The authors, led by Harvard University graduate student Julia Adler-Milstein, identified 145 RHIOs nationwide that were getting under way in recent years. Of them, “only 20 were functioning at even a modest scale, and only 15 were doing so for a broad set of patients” as of Jan. 1, according to the article.

Nearly one-quarter of the RHIOs known to exist in mid-2006 were defunct by early 2007, it states. “Our results suggest that at most 12 of [the 20 functioning] RHIOs are self-sustaining, since eight continue to receive moderate or substantial grant funding,” it adds.

There you have it. RHIO require practicing physicians to participation in its development. I see no evidence of anyone asking the practicing physicians for input.

I believe the only way policy makers will understand how to Repair The Healthcare System is to understand the needs of physicians and patients. The development of RHIOs should not be a first step in the Repair Of The Healthcare System.