A Medical Device Daily

Some pursuits are replete with a particular kind of lesson, and the same holds for the pursuit of the regional health information organization (RHIO), currently the best hope for cobbling together an information technology (IT) infrastructure for the exchange of electronic health records (EHRs). One of the more conspicuous elements in the RHIO story is suggestive of a traditional economic dilemma, that of the spill-over benefit (Medical Device Daily, Aug. 2, 2007).

But there are those who think that a more ground-up approach to RHIO development would trim costs and keep the incentives in line with costs.

According to a recent article in Modern Healthcare, a group that put its resources into the development of an IT backbone for EHRs in Portland, Oregon, has suspended operations after plowing more than half a million dollars toward the effort. As matters currently stand, there is no guarantee that the group, the Oregon Community Health Information Network (OCHIN; Portland), which put 18 months into a system that would serve the metro Portland population of about 1.2 million, will be able to revive the program.

OCHIN put a stop to the effort on May 15 after hearing from a consultant who proposed a funding commitment of about $3.4 million for each of five years. While the RHIO's anticipated savings were much greater - about $17 million a year by some estimates - the healthplans and the hospitals working in the area would be stuck with essentially the entire tab, and they were not at all certain how long it would take to recoup their investments.

On the question of whether this RHIO has drawn its last breath, Andy Davidson, president/CEO of the Oregon Association of Hospitals and Health Systems (Lake Oswego, Oregon) was quoted as saying "the honest answer is, I really don't know."

Richard Gibson, senior VP and the chief information officer at Legacy Health Systems (Portland), a five-hospital provider system in the Portland area, said the best description of the current status of the project is "not moving forward," but added that "it could be resuscitated" if the planners "would come back and redesign it or come back with other funding and business plans."

Gibson added that the organization's supporters "spent a lot of money and a lot of time," and that 18 months of extra hours and substantial monies were poured into the OCHIN, "so it was not cast away in an indifferent act."

Others who have attempted to put together RHIOs have a few observations that might pertain to the Oregon experience. One of these has to do with basic human motivation, alternately known as incentives. David Lansky, senior director of health programs at the Markle Foundation (New York), said that it is not yet clear "if the incentives exist for healthcare organizations to share information."

John Regula, who was the chair of the now-expired Northeastern Pennsylvania Regional Health Information Organization (NEPA), said that healthcare data exchange organizations have to think in terms of the business cases that providers and other funders will need in order to rationalize their continued financial support.

"It's a noble idea to say 'put the patient first,' but what you have to have are business plans with the provider community" in mind, Regula said, adding that the top-down nature of the NEPA effort was doomed in part because each of the potential participants "is already managing an incredible list of internal priorities." He recommended that future efforts be built around the notion that "people will find commonality where a business plan or a business need exists."