By Cindy Atoji

May 27, 2008 | Despite their struggles to find a solid business model, RHIOs and HIEs are becoming strong markets for health IT. Recently, InterSystems, a Cambridge, Mass.-based integration platform supplier, has had success selling its HealthShare product as the backbone for RHIOs in central Florida, Rhode Island, and New York. HealthShare leverages InterSystem’s Ensemble, an integration tool suite, and CACHE, a database. Paul Grabscheid, VP of strategic planning, spoke with Digital HealthCare & Productivity about the move to connectivity among health care providers and the challenges it poses.

DHP: What are the major challenges health care providers must overcome as they try to move to a more connected environment?

Grabscheid: Many health care organizations offering a variety of medical programs take a “best of breed” approach when implementing software. This often results in a loosely coupled network of administrative, financial, clinical, and logistical applications, each one using different technologies, databases, hardware platforms, and operating systems. As the systems get more imbedded in organization, it gets harder to take them out—it’s too expensive and time consuming to make a change.

One of the things we see people focusing on today is that rather than ripping out and replacing systems, they’re focusing more on building connectivity between systems. Organizations want to put together an integrated system that will support a variety of solutions for electronic medical records, data warehouses, physician portals, executive dashboards, regulatory compliance, and more. That’s why maintaining flexibility is key. From a technology standpoint, you want to have service orientated architecture (SOA) and think about the functions that the system provides and how, in some modular way, you can make talk to each other.

DHP: Do you have advice for managing these kinds of projects?

Grabscheid: You can’t view these just as technology projects. If you don’t get clinician involvement and buy-in early in the process, you’re going to fail. We’re often prone to look at integration as a technology problem and build things which are technically elegant, but not very useful or usable for the population.

DHP: What is the potential ROI for connecting and integrating systems?

Grabscheid: The ROI comes in a couple of buckets. The most measurable ROI comes from making information more available and eliminating duplicate tests. That’s the easiest saving to quantify: If you had access to all your recent lab tests, you wouldn’t have to order tests again. Second is avoiding adverse events. If I can connect to your information and understand you’re allergic to penicillin, I can avoid giving you something you shouldn’t have. And in some cases when communities start getting connected, they’re distributing information they were already distributing, but now doing it in a more efficient way. So they’re taking lab results that used to go out by fax and doing it at lower price electronically. But it’s hard to cost-justify a lot of these community or regional projects.

DHP: How are health care providers addressing patient concerns about privacy and security as more clinicians and administrators gain access to their EHRs?

Grabscheid: This is a theme I see all the time: people are concerned about security and privacy. One of the challenges that comes from connecting things together is making sure connections aren’t abused and you’re not creating an environment where the weakest link exposes everyone to misuse of information. You have to be attentive, maybe even paranoid about those issues.

Then you also get into specific issues, such as, how do I get consent form patient, and what’s the nature of that consent.  People have different ideas—medical and legal—about what kinds of rules make sense for granting consent and disclosure of info. And when you have a bunch of people thinking about a problem, they can come up with a complicated solution. You need something that fits on one side of a sheet of paper on clipboard that the receptionist can hand to you when you walk into the doctor’s office. We try to tell people, “keep the clipboard test in mind.”

DHP: A lot has been written about the difficulties of sustainability when it comes to RHIOs in the U.S. What’s your perspective on the future of RHIOs?

Grabscheid: The idea of connecting together at the regional level is vital, but I’m not convinced we’ve figured out how to do it from an economic and organizational perspective. My guess is, five years from now, none of us will know what those four letters, RHIO, stood for—things will have morphed again.  But it is inevitable that health care gets connected at the regional level.

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