New Harvard survey casts serious doubt on future of RHIOs

Electronic clinical data exchange across the United States is far from a reality, with few organizations facilitating such exchange and many failing in the process, reports a new study by Harvard researchers published today on the Health Affairs Web site.

The study, based on a 2007 survey of 145 regional health information organizations (RHIOs), is an assessment of the state of electronic health data exchange in the United States.

Electronic health data exchange between hospitals, doctors' offices, labs, and other clinical settings has been hailed by many in the healthcare industry as the key to improving the quality, efficiency, and coordination of care. But the new survey, funded by Harvard's Program for Health Systems Improvement, identifies serious barriers to achieving this goal with the current approach.

The authors note that at the time the survey was conducted, nearly one-quarter of the 145 RHIOs were defunct, and only 20 initiatives were deemed to be of at least modest size and exchanging some clinical data. Five of those RHIOs exchanged data for a specific population, such as Medicaid enrollees, the uninsured, or patients with a chronic illness like diabetes. Only 15 RHIOs exchanged clinical data across a range of patient populations.

"These findings suggest that nationwide electronic clinical data exchange will be much harder than what many people have envisioned," said Julia Adler-Milstein, a doctoral candidate in health policy at Harvard University and the study's lead author. "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."

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