Making molehills out of mountains

Contributed by John Andrews

Regional health information organization that are fighting an uphill battle in their formation might do well to look toward the Appalachian Mountains for guidance.

While concerns over funding, leadership, standardization and data sharing are tough obstacles for many RHIOs, participants from Pennsylvania’s Allegheny country to Tennessee’s Great Smoky Mountains and North and South Carolina’s Blue Ridge range all report having scaled the steepest part of the organizational process, though they have taken different trails to climb there.

Specifics aside, frustrated coordinators should first consider the underlying principles that support a RHIO’s existence, said Robert “Rim” Cothren, Ph.D., chief scientist for Northrop Grumman. The Los Angeles-based aerospace and information technology corporation has been integral in developing electronic health records for the U.S. Department of Defense as well as offering architecture prototypes for the Nationwide Health Information Network.

“There isn’t a formula for organizing RHIOs at this point, but what gets overlooked is really understanding the long-term business model,” Cothren said. “A lot of failed projects will get money to build it, but then don’t have a sustainable business model in place. RHIOs aren’t just an academic exercise in information exchange – it is a business. Grant money is good for exploration, but without a good business model, it will live only until the grant money is gone.”

RHIO rundowns

Officials from the various Appalachian projects credit a number of factors for their success and say their methods could serve as blueprints for others.

“We believe ours is the right approach,” said Jay Srini, vice president of emerging technologies for the University of Pittsburgh Medical Center. “It is very feasible for rural areas where there are only small players. It likely can be translated to other regions as well, but maybe not exactly. But they could take the basic model and customize it.”

The Pittsburgh RHIO network consists of 19 hospitals and 5,000 physicians and has an IT support staff of nearly 1,000. The interoperability effort has moved forward with Eatonton, Ga.-based dbMotion’s platform. Its plan is to bridge clinical and technical areas, combine administrative efficiencies, harmonize data and connect it with evidence-based medicine for decision support tools. Over the past two years, the network has forged agreements for storage infrastructure and “best-in-class” technology to facilitate the transition.


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