Health Management Technology

Without a doubt, momentum for the development of regional health information organizations (RHIOs) is building at an ever–increasing rate. As health information technologies—electronic medical record systems in particular—have matured, all members of the healthcare continuum have recognized the potential benefits of sharing vital clinical data.

It could be argued, in fact, that healthcare organizations opting out of these endeavors will fail to thrive. Providers that share information will be recognized as delivering better care and better service. In a competitive business environment— a description that clearly fits healthcare today—entities that embrace progressive technologies and service models will succeed. Those that do not will suffer.

RHIOs Improve Care and Customer Service

Within this context, there is little doubt that participation in RHIOs will have a significant impact on the business of healthcare. Forward–looking organizations have already taken initial steps to design data interchanges to streamline access to vital clinical information, with a goal of improving care, enhancing patient satisfaction and, ultimately, ensuring their business stability and success as emphasis on integrated care intensifies.

A RHIO allows all providers charged with handling a patient’s condition to be involved in care delivery across the continuum. Specialists have fingertip access to medical history and current concerns as they consider treatment options. Primary care providers can monitor what actions specialists take, which may have an impact on other illnesses or co–morbidities they continue to treat. The result: Better care and enhanced patient safety.

But RHIOs provide unprecedented opportunity for increased patient satisfaction as well—an important consideration as patients increasingly view themselves as consumers of healthcare. They will select their physicians and request referrals to specific healthcare facilities based on their perceptions of quality and service. Today’s push towards transparency by Medicare and other payers means that patients will have access to specific information about their physicians, local hospitals and other provider organizations. RHIOs advance participants’ efforts towards the delivery of quality care—allowing them to provide a “better product.” Information about these efforts will be available to consumers, who will be more likely to select providers that achieve a higher standard.

Enhanced Communication
Advances Patient Satisfaction

A RHIO can provide a convenient means of communication among various providers, which likewise promotes the patient’s sense of receiving superior care. For example, ED physicians, attendings or hospitalists can automatically notify an internist or family physician about an admission. This, in turn, allows the primary care physician (PCP) to provide additional information to enhance the current episode of care, perhaps alerting the hospital–based physician that the patient balks at oral medications or has an intense reaction to injections. The PCP can be apprised of the patient’s prognosis and discharge, and proactively check on progress or follow up with subsequent care.

Health data interchange through a RHIO is invaluable during times of emergency, as well. Physicians unfamiliar with the history and conditions of displaced individuals can instantly access vital data, ensuring proper care and relieving patient anxiety. For example, during the conflict between Israel and Lebanon in July 2006, providers that were “linked” through the national–scale RHIO in Israel could deliver effective and uninterrupted care to patients that were evacuated from specific regions and cities during the crisis. Such functionality would be equally vital during natural disasters like hurricanes or wildfires that cause patients requiring ongoing care to temporarily relocate.

In addition to boosting patient care and satisfaction, RHIOs can provide direct financial benefits. Providers have access to complete disease management and health maintenance information, which allows full participation in pay–for–performance (P4P) programs. It may be difficult for physicians practicing outside of a RHIO to demonstrate the comprehensive nature of care their patients may be receiving. A PCP, for example, may be able to monitor certain aspects of care for a diabetic patient, such as HbA1c levels, but not have easy access to the full breadth of data required by P4P programs (e.g., whether the patient is getting regular vision exams). Conversely, all of this data would be available in a shared medical record through a RHIO.

Mistakes that can Derail RHIOs

While healthcare leaders may acknowledge there is great value in RHIOs, many express trepidation about the feasibility of constructing viable data–sharing networks that protect private and proprietary information, while simultaneously making relevant information available in formats that actually improve care and reduce costs.

Some healthcare leaders committed to the concept of RHIOs have found their initial efforts impaired due to 1) Over–simplification, where the scope of functionality of the RHIO is so limited that it does not provide the value required for viability, nor prepare for the longer term needs of its constituents; or, 2) Paralysis by analysis, where participating organizations doom efforts by striving to achieve perfection from the onset.

Because of the need to bring together many independent and differently motivated players, some RHIOs prefer to limit the scope of the exchange—in order to minimize friction. For example, the RHIO may only allow physicians in hospital emergency departments to view patient records, or primary care physicians to view medication lists. While making it easier for participants to reach consensus about information–sharing and simplifying technological deployment, this approach nevertheless can lead to choices that prevent the exchange from sharing a more comprehensive— and valuable—data set in the long term. In addition, it could limit the RHIO’s ability to deploy applications required in years to come.

At the other end of the spectrum, some RHIOs are committed to creating a perfectly synchronized, standardized solution from day one. However, this “perfect solution” is virtually impossible because of the complexity of the various information systems and interfaces that make complete data sharing possible. Therefore, since the identified objective cannot be achieved, it fails and further efforts are abandoned.

Successful RHIOs Developed Incrementally

Development of an effective RHIO requires those directing the initiative find a middle ground between these two extremes. To do so, the RHIO must first discover a technological approach that can serve as the backbone of the organization. The solution must provide inherent functionality to support initial efforts and be scalable to advance incremental efforts for full access to patient data. Moving forward, successful RHIOs will then identify discreet elements to establish a successful foundation for the organization and create a plan to expand the scope of the exchange over time.

For example, a RHIO may begin by providing access to a limited set of shared information, rather than investing in the complex integration of all the information available in participants’ EMR systems. The RHIO then limits the data available for viewing—initially including only allergies, current problems or conditions, medication lists and immunization records from members’ discreet EMRs. Because this shared information represents little threat to any of the participants, it’s relatively easy to come to an agreement and establish a working partnership. After further trust is built, the RHIO can expand, perhaps by sharing lab and radiology reports. Subsequently, it can develop a portal that allows primary care physicians or specialists not using an EMR to view records in the repository, even if they don’t contribute information themselves. Finally, it may expand further to allow all providers within the participating areas to contribute data from their EMRs, whether they are formal members of the RHIO or not.

A second incremental approach may include initially limiting the geographic scope of the RHIO. For example, instead of covering an entire region, three regional hospitals could develop the data exchange. Later, the organization can allow other constituents to participate. This makes implementation of the technology infrastructure less complex because there are fewer systems to consider. However, it also means future participants will be limited in their ability to determine the policies that govern the RHIO as a whole.

For an incremental approach to work, RHIO participants must keep two important considerations in mind: 1) There must be a long–term plan, focused on the development of a comprehensive set of shared data, as well as technological services that add value to each participant’s operation; and, 2) Participants must be flexible about how future services will be developed. While each will agree that additional features are desirable, they must also recognize that form and function cannot be fully defined at the onset. Future direction will depend on past successes and lessons learned along the way.

By relying on these strategies, physicians and facilities will be poised to reap the full benefits of RHIO participation— improving care, enhancing patient satisfaction and, in doing so, positioning themselves for continued business success.

Ilan Freedman (left) is vice president of marketing and Joel Diamond, M.D. is chief medical officer North America for dbMotion, Pittsburgh. Contact them at Ilan.Freedman@dbMotion.com and Joel.Diamond@dbMotion.com.