Regional Health Information Organizations Research Articles

Engaging Patients For Health Information Exchange

Health information exchange (HIE) offers tremendous potential for the future, but its widespread adoption and sustainability depend upon engaging patients and earning their trust. Patients' willingness to allow their data to be shared will drive the usefulness of HIE and therefore the sustainability of regional health information organizations (RHIOs). The Massachusetts eHealth Collaborative (MAeHC) is one of a few organizations that have developed a successful community-based collaborative model, with more than a 90 percent opt-in rate among patients to participate in widespread electronic data sharing. Lessons learned from MAeHC's three pilot programs could be instructive for other HIE projects around the country.

HEAL NY: Promoting Interoperable Health Information Technology In New York State

Through a novel, ambitious program called HEAL NY, New York State plans to invest $250 million in health information technology (IT) that can be linked electronically to other health IT systems. In contrast to high rates of closure by other organizations attempting health information exchange (HIE), 100 percent of HEAL NY Phase 1 grantees still existed two years after awards were announced, 85 percent were still pursuing HIE, and 35 percent had actual users. The number of grantees meeting basic criteria for regional health information organizations (RHIOs) increased. Although it is early, lessons learned can inform state-based initiatives nationwide.

Moving Health Information Technology Forward

Moving Health Information Technology Forward

Privacy Policy Analysis for Health Information Networks and Regional Health Information Organizations

Regional Health Information Organizations (RHIOs) are forming in response to President George W. Bush's 2004 mandate that medical information be made available electronically to facilitate continuity of care. Privacy concerns are a deterrent to widespread acceptance of RHIOs. The Health Information Portability and Accountability Act of 1996 provides some guidelines for privacy protection. However, most states have stricter guidelines, causing difficulty when RHIOs form across these jurisdictions. This article compares several RHIOs including their privacy policies where available. In addition, studies were reviewed considering privacy concerns of people in the United States and elsewhere. Surveys reveal that Americans are concerned about the privacy of their personal health information and ultimately feel it is the role of the government to provide protection. The purpose of this article is to look at the privacy issues and recommend a policy that may help to resolve some of the concerns of both providers and patients. Policy research and action are needed to move the National Health Information Network toward reality. Efforts to provide consistency in privacy laws are a necessary early step to facilitate the construction and maintenance of RHIOs and the National Health Information Network.

Health information exchange policy and evaluation

Concerns about the quality, safety, and cost of healthcare have driven the nation to increase its focus on this issue. A number of states are moving forward—in parallel with federal efforts—to develop and adopt policies for improving health and healthcare through health information technology and electronic health information exchange. Based on the eHealth Initiative’s experience providing technical assistance to more than 20 states, and its work related to its coalition of more than 250 state, regional and community-based health information exchange initiatives and organizations, the most difficult challenges facing these initiatives and organizations today is that related to assessing the value of services that emerge from the health information exchange to various stakeholders groups such as providers, payers, and employers, and converting those value assessments to business plans that promote and assure sustainability for these initiatives. The combination of increased federal and state focus and funding and the pace at which regional and community-based health information networks are developing, along with the identification of value and sustainability as some of the most difficult challenges experienced by these efforts, all point to the significant need for evaluation. The most critical evaluation questions focus on the impact of health information technology and health information exchange on quality, safety, efficiency, the value of such efforts for various stakeholders, and assessment of how grant programs can be designed to support positive impact, value, and a sustainable business model, so that efforts continue when the grant funds are fully expended.

Development of Regional Health Information Organizations (RHIOs): knowledge networks and collaboration

The development of Regional Health Information Organizations (RHIOs) has become an important priority for policymaking in the USA. These development efforts have focused primarily on data exchange. In this paper, we propose the use of a research approach, based on knowledge networks and collaboration, to develop an understanding of the processes associated with RHIO development. RHIOs need to be envisioned beyond the need to exchange electronic health information exchange and be seen as the catalyst for knowledge sharing of evidence-based medical practices. Sharing evidence-based medical and clinical practices allows for shared system improvement. Networks have been perceived as a foundation for forming inter-organisational collaborations. The term network implies a structure to relate social actors while collaboration is the process whereby social actors in the network take collective actions to achieve a common goal. RHIOs can serve as convener organisations that can act as a catalyst for bringing diverse stakeholders to work together toward a common purpose and a set of goals that benefit the community.

NHIN, RHIOs, and Public Health

Public health plays a critical role in forming the building blocks for community or regional health-information sharing, which is essential to the long-term viability of a Nationwide Health Information Network (NHIN) and the Regional Health Information Organizations (RHIOs). By contributing to its visions, policies, processes, standards, and needs/requirements, public health will close the loop within an NHIN and the RHIOs environment. In this article we illustrate public health's essential role in an NHIN and the RHIOs by examining the mutual benefits to healthcare and public health.

The Health Record Banking imperative: A conceptual model

No unified, functioning system currently exists for the exchange of comprehensive health-care information across the wide spectrum of health-care networks. Regional health information organizations (RHIOs) and a national health information network (NHIN) have been proposed as vital building blocks in providing such a system, but these face many challenges, including delineation and implementation of accepted standards for health-care data, accurate patient identification and record matching, and the definition of incentives for accelerated deployment of health information technology. In response to these challenges, we present in this paper an alternative option, the Health Record Banking (HRB) system. Emulating commercial banking, this approach uses health-record banks to serve the need for immediately accessible and secure data for diverse stakeholders. It provides a means for financial independence for these banks and a mechanism for fostering medical research. We conclude with 10 critical issues associated with the development and implementation of an HRB system, which require public discussion.

The Santa Barbara County Care Data Exchange: What Happened?

The Santa Barbara County Care Data Exchange was once one of the most ambitious and publicized U.S. health information exchange (HIE) efforts. Eight years after its inception, and several months after providing some data, the Santa Barbara Project shut down operations. Despite its developed HIE infrastructure, participants found no compelling value proposition in initial HIE services. Even with fewer technology delays and more community leadership, other regional health information organizations (RHIOs) may also stumble over HIE service-value propositions without some combination of grants, incentives, and mandates that develop initial RHIO infrastructure and services and ensure provision of unprofitable yet socially valuable services.

The State Of Regional Health Information Organizations: Current Activities And Financing

Electronic clinical data exchange promises substantial financial and societal benefits, but it is unclear whether and when it will become widespread. In early 2007 we surveyed 145 regional health information organizations (RHIOs), the U.S. entities working to establish data exchange. Nearly one in four was likely defunct. Only twenty efforts were of at least modest size and exchanging clinical data. Most early successes involved the exchange of test results. To support themselves, thirteen RHIOs received regular fees from participating organizations, and eight were heavily dependent on grants. Our findings raise concerns about the ability of the current approach to achieve widespread electronic clinical data exchange.

Retrospective: Lessons Learned From The Santa Barbara Project And Their Implications For Health Information Exchange

Despite its closure in December 2006, the Santa Barbara County Care Data Exchange helped focus national attention on the value of health information exchange (HIE). This in turn led to the federal government's plan to establish regional health information organizations (RHIOs). During its existence, the project pioneered innovative approaches, including certification of health information technology vendors, a community-wide governance model, and deployment of a peer-to-peer technical model now in wider use. RHIO efforts will benefit from the project's lessons about the need for an incremental development approach, rigorous implementation processes, early attention to privacy and liability concerns, and planning for a sustainable business model.

Regional Health Information Organizations: A Vehicle for Transforming Health Care Delivery?

Information technology (IT) has the potential to be a significant enabler in transforming the health care delivery system. New types of organizations are needed to guide the change. Regional Health Information Organizations (RHIOs) hold promise as agents for transformation. This essay discusses the results from a case study on how RHIOs are advancing IT adoption in the health care community. Results indicate that the RHIO model is early in its evolution. To be a catalyst of change, the RHIO must overcome privacy barriers, actively engage purchasers of care, and create compelling incentives for clinicians to adopt the RHIOs' services.

The Importance of Distributed Broadband Networks to Academic Biomedical Research and Education Programs

This article highlights the importance of distributed broadband networks as part of the core infrastructure necessary to deliver academic research and education programs. The authors review recent developments in the field and present the University of California, Davis, environment as a case study of a future virtual regional academic medical center. Achieving the potential benefits of distributed broadband networks through regional health information organizations will involve considerable collaboration between different academic groups and the development and implementation of standardized technological and business approaches. Broadband technologies offer a substantial opportunity to improve the way academic education and research programs are delivered.

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O3-DPACS Open-Source Image-Data Manager/Archiver and HDW2 Image-Data Display: An IHE-compliant project pushing the e-health integration in the world

After many years of study, development and experimentation of open PACS and Image workstation solutions including management of medical data and signals (DPACS project), the research and development at the University of Trieste have recently been directed towards Java-based, IHE compliant and multi-purpose servers and clients. In this paper an original Image-Data Manager/Archiver (O3-DPACS) and a universal Image-Data Display (HDW2) are described. O3-DPACS is also part of a new project called Open Three (O3) Consortium, promoting Open Source adoption in e-health at European and world-wide levels. This project aims to give a contribution to the development of e-health through the study of Healthcare Information Systems and the contemporary proposal of new concepts, designs and solutions for the management of health data in an integrated environment: hospitals, Regional Health Information Organizations and citizens (home-care, mobile-care and ambient assisted living).

Approaches to Patient Health Information Exchange and Their Impact on Emergency Medicine

Regional health information organizations and electronic health information exchange may have an important impact on the practice of emergency medicine in the United States. Regional health information organizations are local or regional information-sharing networks that enable electronic data interchange among stakeholders in a given geographic area. These stakeholders may include hospitals, skilled nursing facilities, clinics, private physicians' offices, pharmacies, laboratories, radiology facilities, health departments, payers, and possibly the patients themselves. Regional health information organizations are being formed across the country to improve the safety and efficiency of clinical care; improve public health efforts, biosurveillance, and disaster management response; and potentially create large databases of deidentified aggregate data for research. Because of the unique need for rapid access to information and the acuity of the clinical environment, few areas of the health care delivery system stand to change and benefit more from health information exchange than our nation's emergency departments. This article will explain the motivation for the development of regional health information organizations, identify some of the important issues in their formation, and discuss how their development might affect the practice of emergency medicine.

Keeping our Eye on The Ball: Managing The Evolution of Electronic Health Records

The AAFP’s leadership regarding Electronic Health Records (EHRs) has been impressive. As the Future of Family Medicine report underscored, EHRs include not only clinical information systems but also scheduling, billing and other functionalities, and these broader functionalities are critical for the fiscal viability of the New Model of Family Medicine. The AAFP initiative has created a market in small-office EHRs, resulting in development of common technical standards and better understanding of the costs of EHR adoption, greatly speeding the process. The Academy’s leadership has also led other professional organizations and the federal government to address the fundamental structure of health records, including the Continuity of Care Record (CCR), pay-for-performance measures, and EHR certification. ADFM believes, however, that these successes represent only a first step. As important as small-office EHRs are, they represent a by-station on the road towards the information systems we will need for primary care. If we allow the small-office EHR to represent the sole vision of family medicine, then family medicine will be forever confined to an office, largely unconnected to the other settings in which our patients receive care. We believe that family medicine must keep its eye on the goal—a patient-centered electronic health record which will allow the family physician to manage care across the spectrum of care, combining office with hospital, insurer and public health data to allow continuous improvement of access, costs and outcomes. To achieve this vision, we will need to confront substantial organizational, financial and intellectual challenges. These include: Interconnectivity. Many hospital systems have developed hybrid systems that are partly homegrown and partly commercial. Given the complexity of the tasks, limited number of vendors and huge investments, health systems are often conservative. Interconnectivity with outpatient EHRs often seems a low priority for hospital based systems; yet, in order to create the information system primary care needs, we must bridge this gap. The evolving certification process will help. Financing. In small offices, EHRs offer hope of improving cash flow through pay-for-performance and reduction of dictation and staffing costs. However, as a recent ADFM survey has shown, most family medicine units incur the costs of implementation without the benefits of the associated savings. Ease of Data Entry. Structured data entry facilitates chronic disease management. Direct entry by clinicians, however, is often cumbersome, making transition to EHRs challenging and often lowering productivity. Resolving this is a priority. Some EHRs work better than others, of course, and the ultimate solution may be technical—voice recognition technology that also enables coding and disease management prompts. Patient-entered data through personal health records and interfaces to immunization, laboratory, or radiology databases will also help. Underdeveloped Office Systems. Realizing the full potential of EHRs requires office system reengineering and customizations in software. Yet EHR conversion can prove so exhausting that clinical system redesign is not done immediately. Specifics will vary with site and EHR. Addressing Comorbidity. Family physicians bring to health care the potential to manage multiple chronic diseases simultaneously. Yet, the architecture of most available EHRs allow disease management 1 disease template at a time. A priority for family medicine must be facilitating management of multiple diseases at a single visit. RHIOs (Regional Health Information Organizations). The full potential of EHRs will be realized only when a patient’s health information becomes accessible to her family physician regardless of geography or insurer. Compatibility among systems will be slow to progress, competitive systems will be reluctant to share information, and regulation will complicate the process. Individually, each of these areas represents a substantial organizational, intellectual and financial challenge. Together, the list is daunting. As with any journey, however, the first steps are the most important—and we need to start by understanding what is important. Departments of family medicine have a major role to play. The market has produced large systems like Epic and others that are increasingly capable of addressing both the needs of complex medical centers and small office practices. Users’ groups for each of these systems and direct linkages with developers can drive system development. Departments also have many faculty who play leadership roles in their institutions’ informatics groups, as well as connections to broader Academic Health Center and University IS resources. How can we as a discipline organize this strategic resource? Finally, increasing numbers of family medicine researchers have substantial expertise in disease/population management or the management of particular clinical problems. How can the discipline leverage their expertise to manage the evolution of electronic health records?

Health Care IT Collaboration in Massachusetts: The Experience of Creating Regional Connectivity

The state of Massachusetts has significant early experience in planning for and implementing interoperability networks for exchange of clinical and financal data. Members of our evolving data-sharing organizations gained valuable experience that is of potential benefit to others regarding the governance, policies, and technologies underpinning regional health information organizations. We describe the history, roles, and evolution of organizations and their plans for and success with pilot projects.

A draft framework for measuring progress towards the development of a national health information infrastructure

BackgroundAmerican public policy makers recently established the goal of providing the majority of Americans with electronic health records by 2014. This will require a National Health Information Infrastructure (NHII) that is far more complete than the one that is currently in its formative stage of development. We describe a conceptual framework to help measure progress toward that goal.DiscussionThe NHII comprises a set of clusters, such as Regional Health Information Organizations (RHIOs), which, in turn, are composed of smaller clusters and nodes such as private physician practices, individual hospitals, and large academic medical centers. We assess progress in terms of the availability and use of information and communications technology and the resulting effectiveness of these implementations. These three attributes can be studied in a phased approach because the system must be available before it can be used, and it must be used to have an effect. As the NHII expands, it can become a tool for evaluating itself.SummaryThe NHII has the potential to transform health care in America – improving health care quality, reducing health care costs, preventing medical errors, improving administrative efficiencies, reducing paperwork, and increasing access to affordable health care. While the President has set an ambitious goal of assuring that most Americans have electronic health records within the next 10 years, a significant question remains "How will we know if we are making progress toward that goal?" Using the definitions for "nodes" and "clusters" developed in this article along with the resulting measurement framework, we believe that we can begin a discussion that will enable us to define and then begin making the kinds of measurements necessary to answer this important question.

Regions work to exchange health information

President Bush declared a year ago that he wants the government to pave the way for “an interoperable health information technology infrastructure to improve the quality and efficiency of health care.” Such an effort takes time—the Office of the National Coordinator for Health Information Technology is reportedly sorting through some 5000 pages of suggestions for the national health information network—and not all health systems and care providers want to wait for the government. Some of these health systems and care providers envisioned communitywide or regional real-time exchange of patient-specific clinical information years before Bush made his intention known. At least 100 first-generation regional health information organizations (RHIOs) are in development, according to the Bush administration’s leader in health information technology, David Brailer. In fact, the RHIO that Brailer and colleagues in southern California started in 1999 is expected to be fully usable in April or May 2005, said Mike Skinner, executive director of Santa Barbara County Care Data Exchange.