CAMBRIDGE, MA – Organizers of regional health information organizations continue to talk to lay the groundwork for data exchange, but there are only a handful of initiatives that are operational.

While hundreds of RHIOs are in the talking stage, most are still sorting out governance, and it will be some time before they begin exchanging data, according to a new report by Cambridge, Mass.-based Forrester Research.

RHIO proponents acknowledge few initiatives are up and running, but they say many factors will prompt quick adoption, including provider willingness, government support and technological progress.

The Forrester report lists only seven RHIOs in operation today, and those vary widely in architecture and governance, said Eric Brown, Forrester vice president of healthcare and life sciences.

While a torrent of talk has surrounded the RHIO movement nationwide, Brown is predicting many of the initiatives now in the discussion phase will be implemented more slowly than expected.

“We’re clearly in a time where there’s experimentation and learning,” Brown said. “People are building things, and different regions are taking different approaches.”

Cataloguing existing networking initiatives is a daunting task. A recent effort by HIMSS and the Center for Health Information and Decision Systems at the Robert H. Smith School of Business, University of Maryland identified more than 500 state, federal and private initiatives.

The seven RHIOs included in the report – HealthBridge in Cincinnati, Indiana Health Information Exchange, Michiana Health Information Network, Northwest RHIO, Philadelphia Health Information Exchange, SAFE Health in Massachusetts and Taconic Health Information Network and Community – all take a variety of approaches to governance and financing.

The effort to study successful RHIOs for general lessons, announced in February by David Brailer, MD, head of the Office of the National Coordinator for Healthcare Information Technology, could help the initiatives from moving off into the “chaos” of too many different directions, Brown said.

“That’s been (Brailer’s) strategy,” Brown said. “It’s not his intention to let a thousand wildflowers bloom and see what happens. There’s a role for some directional influence by his office, but many people in the industry are looking for a little bit more influence. We have a lot to learn before we agree on the future architecture of a national network.”

But Brown fears the RHIOs will take a long time to get going and could lose momentum by trying to achieve too much at the start.

“Getting to the ideal end-state has huge value, but huge cost and huge transformational inertia,” he said. By contrast, many of the operational RHIOs have implemented services gradually, starting with more easily achievable projects that can quickly return some results.

RHIOs that succeed will need to find common ground that solves vexing problems that all participants are experiencing, said Gail Gulinson, vice president of health industry for IBM Business Consulting Services and a vocal proponent of community health information networks in the 1990s.

“Some networks have no marginal need to move information,” Gulinson said. “Participants have to find the pain point and have the right constituents in the network to make the initiative of value to them.”