RHIOs fail to thrive, new study finds

By Nancy Feris

A new study finds that despite the widespread interest in regional health information exchanges in recent years, only 20 RHIOs in the United States are fully functional and a dozen are self-sustaining.

Calling RHIOs’ survival in their current form “tenuous at best,” the study questions many of the prevailing assumptions about how a nationwide health information network will emerge.

Policy-makers at the Health and Human Services Department and in the health information technology community expect RHIOS to serve as the building blocks of a national system. But many face an uncertain future, the study’s authors report.

The study, The State of Regional Health Information Organizations: Current Activities and Financing, appeared today in an online edition of the journal Health Affairs.

The authors, led by Harvard University graduate student Julia Adler-Milstein, identified 145 RHIOs nationwide that were getting under way in recent years. Of them, only 20 were functioning at even a modest scale, and only 15 were doing so for a broad set of patients as of Jan. 1, according to the article.

Nearly one-quarter of the RHIOs known to exist in mid-2006 were defunct by early 2007, it states. Our results suggest that at most 12 of [the 20 functioning] RHIOs are self-sustaining, since eight continue to receive moderate or substantial grant funding, it adds.

These findings suggest that nationwide electronic clinical data exchange will be much harder than what many people have envisioned, Adler-Milstein said in a statement released by Health Affairs. The expectation has been that we will have RHIOs throughout the country that bring together all the providers in their region and engage in comprehensive data exchange. In reality, we’re seeing few established RHIOs and those that are established only have a small number of participating groups exchanging a narrow set of data.

According to the article, it is not clear whether even more mature RHIOs have a clear path to becoming financially sustainable. Most of those RHIOs deliver results of laboratory and radiology tests to doctors, and the article says this is the where the return on investment is most achievable.

If we want RHIOs to attain the vision of comprehensive health information exchange, we need to increase our investments in them, Adler-Milstein said. Otherwise, many of these RHIOs will be unable to sustain themselves under the current market-oriented approach.
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