RHIO Questions and Answers Kick Off National Health IT Week

WASHINGTON -- Regional health information organizations (RHIOs) have cropped up nationwide, due in no small part to government and foundation grants. But what happens when the seed money runs out? In other words, how do RHIOs achieve the elusive goal of financial sustainability, the phrase du jour in health-IT?

That was a burning question here Monday at the U.S. Agency for Healthcare Research and Quality's combined conference on IT and patient safety, which kicked off what is being called the first National Health IT Week. Answers, according to several conference presenters, include trust and collaboration among RHIO participants, transparency of information to build that trust, and a viable business model.

"Finding neutral ground is very important in this endeavor," said Thomas Unger, program manager of WNYHealtheNet (Buffalo, N.Y.), a consortium of three regional payors and four large health systems in western New York state. The system is fully funded by the seven members, who now save an average of 26 cents per transaction versus going through a commercial clearinghouse.

This model avoids per-click fees on vendors, which likely would be passed on to other users. "We did not want to layer in costs in the community," Unger said. All functions are outsourced, so WNYHealtheNet actually has no assets and no employees.

Since 2002, WNYHealtheNet has handled upwards of 50 million transactions from 20,000 users, representing 85 percent of the region's healthcare market. It is still unproven with clinical data, though the organization just won a $3.5 million state grant to create an online clinical data exchange, data repository, and electronic prescribing network.

Farther along the clinical path is the much-publicized Indiana Health Information Exchange (IHIE), which has been handling clinical data since October 2004. (See http://www.bio-itworld.com/newsletters/healthit/2004/10/12/20041012_10545?page=1.) Health-IT leaders in the Indianapolis area decided early on that hospitals and physician groups would pay for the ability to send and receive electronic messages from other healthcare entities.

"I think the clinical messaging is a strong place to start," said exchange president and chief executive J. Marc Overhage, M.D. It is relatively easy to set up, and financial gains are quantifiable. For example, IHIE has determined that an electronic "push" of data to hospitals can reduce the amount of time a nurse needs to reconcile a medication list from 17 minutes to just five.

A format emerging as a model for other RHIOs to follow is the Utah Health Information Network (UHIN), which effectively functions as a public utility, paid for by user subscription fees, as low as $100 a year for physicians. It has a federated structure, with information stored at participant sites rather than in a central database.

Utah law requires Medicaid providers to submit their claims through UHIN, and the network now receives some sort of claims from 90 percent of healthcare providers in the state. Physicians gain because Medicaid generally pays electronic claims in about two weeks.

"We're using our data. This isn't just a theoretical point," said David Sundwall, M.D., executive director, Utah Department of Health, who delivered a keynote address here Monday. "It's clear that it's valued by the healthcare community in Utah."

The network has not perfected electronic reporting of notifiable diseases from labs to public health officials, in part because large lab companies still have some proprietary standards, Sundwall said. This is OK, according to the longtime president of the American Clinical Laboratory Association, because he believes a RHIO should be an incremental project -- evolutionary rather than revolutionary.
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