HIMSS Keynote: Brailer Stresses Public Governance, Private-Sector Innovation for RHIOs


SAN DIEGO -- A forthcoming guidance and contract solicitation from the Office of the National Coordinator for Health Information Technology will help the many regional health information organizations (RHIOs) that are popping up nationwide to create best practices for governance, operation, and financial sustainability, according to a senior federal health official.

The request for proposal will be "written tightly" with "specific deliverables," similar to the parameters for a series of contracts awarded last fall, in hopes developing a state-level RHIO model, said national health-IT coordinator David Brailer, M.D. Brailer said that the plan is to help others replicate successful connectivity networks with "plug and play" strategies, though he did not divulge many specifics of the contract request.

"It's time for us to focus as a nation to support the maturation of RHIOs," Brailer said here Monday during an impassioned opening keynote address to open the 2006 Health Information and Management Systems Society (HIMSS) conference. "We're now in a marathon. The sprint has begun to end."

Publication of the solicitation likely will come within a month, and Brailer expects the model to be done by the end of 2006. Brailer says that the contract work will be the final piece necessary for communities to begin deploying RHIOs.

In the next three years, Brailer wants every state to have at least one RHIO, including an "overarching" organization to coordinate healthcare data movement statewide. There should be a minimum set of standards for RHIO operation and sufficient transparency in governance so that users have confidence in each network. And there must be a financially sustainable business case for each RHIO.

Brailer called a public governance process "an absolute must-have" for any RHIO. "If we fail to do this, there will be no credibility for a market-based solution."

He said that the federal government will not regulate RHIOs, repeating his oft-stated preference for private-sector innovation and industry-driven regulation. "In our role, the federal government will not build, own, and operate the nation's health information infrastructure," Brailer said. To Brailer, the government's role is to "prime the pump." However, he wants the forthcoming contract work to "bring more formality to what's out there."

A key question that RHIOs will have to address, according to Brailer, is that when the proposed National Health Information Network (NHIN) is complete, will regional networks continue to develop their own software, or will they subscribe to the national infrastructure?

Will there be a hybrid of regional networks connected to the NHIN or a national network with branches to the regional level? The latter is technically impractical, Brailer says. "I think we are heading toward that loose set of networks."

Brailer says he was interested in the idea of "brokerless" health information network even before Napster made peer-to-peer file sharing popular. However, privacy and security requirements make this type of network a challenge in healthcare. A more feasible alternative, according to Brailer, might be a "lightly brokered" network with a third party that locates data and decides who has valid reasons to access the information. He envisions the RHIO as the broker.
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