COLLEGE PARK, MD – The Center for Health Information and Decision Systems (CHIDS) at the University of Maryland's Robert H. Smith School of Business has developed a new framework to help states and Washington, D.C., create self-sustaining and effective networks for the exchange of EHRs.

The center assessed the DC Regional Health Information Organization (DC RHIO), Washington's primary health information exchange (HIE). The DC RHIO is managed by the District of Columbia Primary Care Association (DCPCA) and funded by the city government. The center rated the DC RHIO among the top 20 percent in the nation as a fully operational exchange and provided recommendations to make the organization sustainable through operating revenue.

[See also: DC RHIO to share data among hospitals and community-based health centers.]

"Much of the country has a long way to go to getting electronic health records implemented and able to share health information seamlessly," said P. Kenyon Crowley, associate director of CHIDS. "This work is vital – the development of effective and sustainable HIEs enables better quality of care. With shared patient health information, clinicians can better manage and coordinate care, which improves patient safety, reduces redundancy and spurs quality and efficiency."

The CHIDS HIE Evaluation Framework – co-authored by Crowley; Ritu Agarwal, professor and dean's chair of information systems, and director of CHIDS; and Sunil Mithas, associate professor – offers a methodology for assessing any RHIO across the nation. HIEs are evaluated on five key performance components: the value creation and sustainability of its business model; organizational structure and decision-making processes; technology; community engagement; and trust in the system.

"HIEs are complex organizational forms that engage many stakeholders, sometimes with conflicting goals,” said Agarwal.  “The framework is designed such that it can address the multiple dimensions along which an HIE needs to exhibit superior performance. As more HIEs become operational, the tool can be used to compare and benchmark performance."

[See also: HIE Symposium abounds with lessons learned.]

The CHIDS HIE Evaluation Framework and associated recommendations are based on the information and documents provided by key stakeholders of the DC RHIO, an environmental scan of HIE efforts across the nation, best practices published in the literature, and benchmarking with leading HIEs.

Nationwide, there are approximately 200 HIE initiatives, but only 18 have revenues and cash flow from operations that exceed expenses, according to CHIDS. In order for the DC RHIO to achieve sustainability, CHIDS recommends the organization construct a hybrid revenue model based on subscriptions (that include a set of pre-determined services) and fees for additional services.

The CHIDS assessment reveals that the DC RHIO has made progress in most of the dimensions of the HIE Assessment Model and has reached operational status (transmitting data that is being used by healthcare stakeholders), but much work remains to be done in order to reach sustainability.

Launched in 2007, the DC RHIO has Microsoft's Amalga Unified Intelligence System in place, connecting six community health centers and two hospitals with two additional health centers and two more hospitals that are in the process of adopting real-time access to shared electronic health records.

The DC RHIO is also working closely with the DC Department of Health Care Finance and Department of Health to enable improved health data management for the district’s Medicaid population and the district as a whole.

"The DC RHIO has come a long way in just a few short years, and we have good understanding of where we are today, and now a good roadmap for the future," said Donna Ramos-Johnson, chief of technology operations at the DC Primary Care Association, the parent organization of the DC RHIO. "This study confirmed some of the issues we already knew, provided valuable insights, and lent a great deal of credibility to our current initiatives."