Many experts consider regional health information organizations (RHIOs) essential to the vision of creating a National Health Information Network, which will distribute health information technology costs and patient records across far-flung jurisdictions and hospital systems. In fact, the expected benefits -- safer treatments, greater operational efficiencies, lower risk and eventually lower costs -- have become part of the health IT mantra.
Equally accepted is the role that chief information officers at public health care facilities would be expected to play in deciding how RHIOs are formed. A RHIO is basically an electronic network for exchanging health and patient information among providers, a project that demands the kind of technical expertise CIOs have.
Yet today -- with more than 100 RHIOs announced nationwide -- getting CIOs to sign on to the concept is difficult, health IT experts say. CIOs have been conspicuous by their absence at industry conferences where health IT topics related to regional cooperation have been discussed.
"These conferences have been dominated by representatives of organizations that want to build RHIOs and by consultants," said Bill Spooner, vice president and CIO of Sharp HealthCare in San Diego, who will be chairman of the College of Healthcare Information Management Executives, the main professional organization for health care CIOs, in 2006. "There are usually lots of different vendors there and plenty of [health care] provider involvement -- but I've seen very few IT people and CIOs."
If RHIOs are to operate reliably and cost-effectively, CIOs must be involved. But experts say two main points of resistance are holding them at bay. One is that, up to now, CIOs have focused on developing electronic health record (EHR) systems in their organizations and have not put much thought to exchanging information among facilities. The other is that RHIOs operate on the principle of a shared benefit, and today competition and not cooperation is hospital administrators' overriding concern.
"There's just not enough time and money to do everything," Spooner said. "And there's also the feeling that if they are putting so much effort in giving their own organizations a competitive advantage [through EHRs], why would they want to give that away through membership in a RHIO?"
Ann Donovan, project leader at the California RHIO (CalRHIO), formed last year to promote statewide sharing of EHRs, agrees that incentives for IT executives to delve into RHIOs seem few and far between. "CIOs have been charged with making their own organizations IT-enabled, and they are rewarded for doing that," she said. "There's no natural advantage to them to expand that to reaching across other organizations."
But hospitals and other medical institutions are part of a larger community and CIOs have responsibilities to fulfill, said Dr. Victor Plavner, chairman and chief executive officer of the Maryland/D.C. Collaborative for Healthcare IT, though he agreed "it's a difficult role to play." One of the major concerns for CIOs is justifying any money spent on IT projects to their chief executives, Plavner said. But so far no one has been able to come up with a true return-on-investment analysis for being involved in a RHIO.
"We do know they improve service quality and safety. Studies prove that," he said. "But a lot of the justifications people are coming up with now are of the 'softer' kind. No one has so far been able to provide one with real dollars attached."
Selling RHIOs in San Diego
But although the IT community might currently be out of step with RHIOs, support for the idea among advocates shows little sign of flagging.
The formation of a San Diego RHIO was announced last month, after a two-year process that started when the nonprofit Patient Safety Institute agreed to work with the California Health Alliance and others to set up the San Diego Medical Information Network Exchange (SD MINE).
Steve Carson, chief medical officer at the San Diego Medical Society Foundation and a prime mover in the RHIO effort, has been selling the benefits of the project to physicians, CEOs and CIOs. "What I've been telling them is that [the RHIO will enable] a much simpler and safer patient visit," he said.
"The patient will be able to walk into a physician's office and use an [automated teller machine]-like swipe card and a [personal identification number] to allow the receptionist to view their record so they can see what insurance they have, the deductible, whether they are eligible for certain procedures, what account to bill the visit to and so on," Carson said.
Patients will be happier because they don't have to go through the process of filling out a form every time they go to a new doctor, he said, and doctors will be happier because they will have access to patients' records and can evaluate their continuity of care. That translates into doctors not having to chase down patients' histories or previous lab results, which introduces the possibility for error.
Physicians will also be able to make safer, faster decisions about treatment when they know a patient's history, including what allergies the person has and what X-rays have been done. "There are tremendous safety concerns involved with these kinds of patient visits," Carson said. Alleviating those is "really at the heart of what a RHIO needs to do."
Those and other issues leading to better patient care is why San Diego is forging ahead with its plan, he said, a message that wasn't lost on the system's CIOs.
But what finally convinced them to participate was the detailed plan that SD MINE put in place for who would pay for what, plus where cost savings would come from. "The real reality for the CIO is who is going to pay for this and what the [return on investment] is," Carson said, adding that he would not "want to be a CIO in the current [health industry] scenario because they have so many constituents they need to service."
Local success factors
Although good financial analysis can help overcome RHIO resistance, some areas of the country have intrinsic advantages that could provide momentum for RHIO adoption, health IT experts say. Massachusetts organizations have a history of collaboration, for example, while Indiana is investing in a big bioresearch community for which it sees the RHIO as a foundation.
Still, for CIOs in other parts of the country, facing the initial financial and cultural barriers to starting a RHIO is challenging. "CIOs need hard evidence that RHIOs can actually do what people claim they can do," said John Glaser, CIO of Boston-based Partners Healthcare Systems and president of the eHealth Initiative, a proponent of regional health information sharing.
A number of RHIOs have been announced, but very few are operating and sharing data. Glaser thinks it will take a few more years before CIOs in other regions can push through the barriers. It will be a struggle, he said, as RHIO champions work to convince IT executives and hospital administrators of RHIOs' value.