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.”
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.
“We want to link our hospitals and health plans up with various sources of information,” Srini said. “Health systems are typically burdened by silos, which prevents the ability to provide the right information and the right tools for a consistently high quality of care for patients. We have obtained the technology that is amenable to allowing multiple linkages between vendors, a seamless, harmonized way to access all relevant information and provide it to the physician.”
CareSpark, which encompasses 18 hospitals and nearly 1,200 physicians in northeastern Tennessee and southwestern Virginia, is one of 12 NHIN demonstration prototypes.
Starting with a $100,000 grant, approximately 100 organizers spent 18 months searching for a way to communicate and coordinate around chronic health issues before deciding on a comprehensive strategy in 2004.
Working with a community project specialist called Kingsport Tomorrow, the CareSpark initiative raised an additional $500,000 in funding.
CareSpark Executive Director Liesa Jo Jenkins credits Kingsport Tomorrow as a catalyst for progress in the RHIO’s development, smoothing over many of the cultural and political conflicts that have stalled other networks at the gate.
“They are an incubator for community development projects,” she said. “They are a neutral, trusted entity. They also plugged us into various local resources.”
Using New York-based ActiveHealth’s CareEngine platform, the CareSpark system is designed to compile medical, pharmacy, laboratory and other patient data and compare it against recognized standards of care, said ActiveHealth CEO Lonny Reisman, MD.
“Our fundamentals include relating clinical data that we are able to aggregate from managed care sources and apply them to episodes of care,” he said. “We then couple this data with care guidelines published in journals from various clinical societies. We highlight discrepancies that should be happening with what is actually happening.”
Another RHIO taking off in the heart of the Appalachians is the Western North Carolina Health Network, being integrated by Jackson, Miss.-based MedSeek. Originally organized as a purchasing cooperative, the project includes 16 hospitals, with the 800-bed Mission Hospital in Asheville, N.C. as the flagship facility.
In its third year of development, the RHIO has completed its first phase and now plans “to take integration beyond the four walls and integrate the ambulatory setting,” said MedSeek CEO Mike Drake.
If there is one aspect of the North Carolina RHIO’s design from which others could learn, it’s how the data is stored and shared, he said.
“It shows that collaboration among quasi-competitors can occur without compromising the integrity of data,” Drake said. “We are not creating a huge repository that pools everyone’s data together. We have a virtual setting that looks like a repository, but it is actually a hybrid model where each facility owns and keeps its own data that can be retrieved when needed.”
Provider systems north of the border can also offer some guidance on a RHIO’s genesis, though in Canada they’re called local health integration networks.
Trillium, a consortium of hospitals around Toronto, is growing in small, incremental steps rather than on a grand scale, said Mark Briggs, executive vice president of corporate development for Scottsdale, Ariz.-based Carefx.
“It has been a grassroots swelling of connections rather than one big design,” said Briggs, whose company’s “fusion web” program serves as the virtual switchboard. “It starts with physician practices and grows out from there.”
Emerging RHIOs can also take a cue from infrastructure creators who have cooperated on establishing the NHIN technical framework as requested by the Office of the National Coordinator for Health Information Technology. Among their accomplishments is the conception of the Healthcare Transaction Base and uniform language that is the HL7 Reference Information Model, or HL7 RIM.
“There are so many different ways to categorize things and different lexicons for the language that we use that we must have a means by which we can make data meaningful,” said Michelle Mowry, vice president of global health industries for Redwood Shores, Calif.-based Oracle, one of the participants. “Because RIM is interoperable, it is critical for the healthcare industry.”
As an authorized NHIN contractor, Oracle also has Appalachian connections, working with CareSpark as well as the Eastern Kentucky Regional Health Community and West Virginia E-Health Initiative.
“The government is telling us to prove the technology, to demonstrate that we can accomplish the technical requirements that came out [in the NHIN request for proposal],” Mowry said.
“Because RHIOs are dealing with so many other issues, the technology is actually the easy part.”