TECH: RHIO, RHIO, ree-ay-yo,by anonymouse

OK, the title is a take off on the Police song, but the subject has got a little more influence lately. A sometime THCB correspondent had these thoughts:

The December 11 edition of Health Affairs contains a very important article on “The State of Regional Health Information Organizations.”  At first glance, the article seems to pile on to the prevailing wisdom that RHIOs are a bad idea, because, of course, RHIOs are failing.

A more careful read, though, differentiates the issue of whether fully-functioning RHIOs (or clinical health information exchanges, more broadly) could provide value to a community and its (healthcare) stakeholders and the issue of whether the current model for funding RHIOs is sustainable - two very different issues.

The study takes no issue with the notion of the value of RHIOs: “Electronic clinical data exchange promises substantial financial and societal benefits…”

However, a sentence in the piece’s “Discussion” section really cuts to the heart of the latter issue: “Whether RHIOs represent small businesses that need viable business models, which requires the ability to generate profits as well as value for participants, or public goods that require funding is an important unresolved issue.”

Small businesses – in healthcare and otherwise - are among the most risky of ventures and frequently fail.  It seems – surprise, surprise – that RHIOs are no different: “Our results, in this context, suggest that young RHIOs face substantial challenges, and it is not clear whether even more mature RHIOs have a path to profitability.”

According to the article, the RHIOs that are “making it” are generally focused on the very narrow task of “exchanging results of diagnostic tests,” something for which some hospitals are willing to pay but which falls well short of the scope of functionality and data necessary to achieve most of the broader value of health information exchange. 

A recent iHealthbeat story reflects a similar dissonance between the “business case” for individual providers to adopt EMRs and their benefit to the overall healthcare system and patients. To quote the article, “Despite mounting evidence that IT can help boost patient safety, many hospitals have been reluctant to invest in technology…Only about 11% of hospitals…reported having a fully implemented EHR system. This reluctance is likely tied to financial, cultural and workflow barriers.”