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RHIOs Fail To Thrive, New Study: Part 2

Stanley Feld M.D.,FACP,MACE

A RHIO is a network of information (Regional Health Information Organization) of all the patients’ charts in a region. Anyone can get patient information and physician care activity instantaneously with proper authorization. The RHIO would be great if we lived in a non litigious society  and an environment of total trust. It could work if everyone would keep this information private. The data collected could only be used for the benefit of patients and physicians and not against patients or physicians.

The recent published study revealing RHIOs failures made several important points. The first being physicians and patients must feel compelled to participate.

“These findings suggest that nationwide electronic clinical data exchange will be much harder than what many people have envisioned,” Adler-Milstein said in a statement released by Health Affairs. “The expectation has been that we will have RHIOs throughout the country that bring together all the providers in their region and engage in comprehensive data exchange. In reality, we’re seeing few established RHIOs and those that are established only have a small number of participating groups exchanging a narrow set of data.”

The second important point is RHIOs must be financially sustainable. Who is going to pay for the data collection and storage? I suspect patients would pay for it in higher costs. 

“According to the article, “it is not clear whether even more mature RHIOs have a clear path to becoming financially sustainable.” Most of those RHIOs deliver results of laboratory and radiology tests to doctors, and the article says this is the where the return on investment is most achievable.”

If RHIOs are not financially sustainable then the government has to provide more funds. At a time when the government is economically stressed there are no funds for failed experiments.

If we want RHIOs to attain the vision of comprehensive health information exchange, we need to increase our investments in them,” Adler-Milstein said. “Otherwise, many of these RHIOs will be unable to sustain themselves under the current market-oriented approach.”

 Dave Minch, Chair of HIMSS HIE Steering Committee published a stunning letter that says it all.

“As a provider who strives to do the right thing, I am not happy when people accuse the provider community of shunning data exchange simply for competitive reasons. That can't be farther from the truth.”
It is simple to point the finger at physicians. Physicians are an easy scapegoat.

 Dave Minch goes on to tell it as it is.

“We have a very large private network that encompasses as many physicians as will subscribe to it because we want our physicians to have as much data about their patients as possible. No, its not competition we are afraid of.”

Patients fear of loss privacy. Physicians fear litigation. Policy wonks who think RHIOs are a great idea might not have taken this into consideration. Once there is significant malpractice reform, adequate safe harbor rules, and appropriate physician incentives RHIOs might work.

“Note the word "private". That's our present requirement, because of the litigious nature of our society, and especially in today's economy when inappropriately disclosed data can be the meal ticket of a lifetime. If HIE is to become truly widespread, there have to be standards and there have to be safe harbors for those of us willing to pay the necessary security costs to keep our patients' data out of the hands of those who would violate patient privacy mandates. The first prosecuted security breech of exchanged data will set the industry back 10 years. And you can bet that it will happen without nationally instituted standards and protections. So, who wants to be first?”

There is nothing more to say. The government ought to fund my ideal electronic medical record. Patients ought to own and have access to their records. It should be patients who are responsible for providing their records to whomever they choose.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.



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