RHIO Reality

Healthcare information remains, for the most part, imprisoned within the four walls of a doctor's office or a hospital. Even if providers agreed to share information with each other electronically, the technological challenges associated with incompatible record keeping and divergent systems would remain an enormous barrier.

But grassroots efforts across the country are working to change that.

While much of the discussion swirling around RHIOs deals with tangible and immediate concerns related to finances and interoperability, the fledgling organization must contend with a formidable host of "soft" issues as well.

Undoubtedly RHIOs need money: 91% of the health information exchanges responding to eHI's most recent survey cited obtaining start-up funding as a challenge. But RHIOs need more than dollars. They need to establish formal governing bodies and operating rules. They need to build consensus among participants and they need to develop sustainable, value-based business models that will enable them to succeed long after the seed money has dried up. In short, they need everyone involved in the healthcare delivery process to commit to sharing information.

A SENSE OF SHARED PURPOSE

While RHIOs across the country count themselves lucky to land grants and foundation support, the Massachusetts eHealth Collaborative, in Boston, finds itself in an enviable financial position: Blue Cross Blue Shield of Massachusetts is providing $50 million in backing. The RHIO is using the money to establish a first-in-the-nation pilot program for EHRs in three community-based settings. In January, physicians in Brockton, Newburyport and North Adams will begin using EHRs, and all providers are expected to be networked by mid-2007.

Significant as that investment may be, Micky Tripathi, president and CEO of the collaborative, says it's only one of the factors working in his favor. "Everyone focuses on the money, and the money is wonderful, but the other part of our success is the buy-in and support I get from the 34 organizations on my board. Having every one of those players on board is unbelievably important and hard to get."

That's because RHIOs call upon competitors and stakeholders with different interests to sit at the table and solve problems when it's unclear whose financial interests will be best served. Establishing and managing a RHIO is a little like promoting world peace: everyone agrees with the goal, but getting participating organizations to look beyond their individual interests is an enormous obstacle.

"Trust is the essential factor for everyone," says Liesa Jenkins, executive director of CareSpark, which serves the Central Appalachian region from Kingsford, Tenn. "If patients are going to trust their personal information to a system, they have to trust who will hold it and how it will be used: 'Are you going to sell my information to a drug company?' At the same time, physicians are leery that insurers will use patient information to limit pay back. Provider organizations want to know how the data is going to be used: 'Are you going to plaster this on the front page of the paper to say the results from one hospital system are better than the results of another?'"