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December 19, 2005 The
Promise of RHIOs Few dispute the potential benefits RHIOs can provide to patients, practice-based providers, and hospitals. Now there are emerging technologies that can overcome barriers to RHIO implementation and speed the delivery of these benefits to stakeholders in the healthcare continuum. A provider within a group practice enters the exam room and introduces himself to an older adult patient experiencing recent weight loss and fatigue. It’s the patient’s first visit with the provider—yet, as the provider accesses the medical record, he sees test results and a diagnosis of hypothyroidism from a prior visit the patient had with an endocrinology consultant in an outpatient clinic. He clicks deeper into the electronic medical record (EMR) and learns the endocrinologist ordered blood tests from a private lab to monitor the effects of a hormone therapy treatment plan for the patient. The endocrinologist also suggested guidelines to make hormone therapy dosage adjustments after reviewing the blood test results. With the information in hand, the provider discusses the lab results with the patient. He appropriately relates the patient’s complaints to suboptimal hormone therapy and increases the replacement dosage amounts. The above scenario is fictitious, but it shows how regional health information organizations (RHIOs) can benefit patients, providers, and hospitals. In the ideal RHIO setting, competing healthcare providers would share patient medical information as a collective unit—with all stakeholders benefiting from this more comprehensive approach to providing healthcare. Patients will appreciate providers who have a full grasp of their medical histories—whether or not they’ve seen a particular doctor in the past. Patients will feel more comfortable about their providers and the treatments they recommend. In addition, patients will appreciate that providers are less likely to order duplicates of costly tests they may have received at another facility. Minimizing the patient’s out-of-pocket expenses is obviously critical in today’s era of rising healthcare costs. Ultimately, RHIOs promise that patients will be more satisfied and engaged with their providers. Also, hospital and practice-based providers will see better outcomes with patients. With shared access to a patient’s medical information, RHIOs enable hospital- and practice-based providers to see a more longitudinal view of a patient’s medical history. This means providers are more likely to spot the warning signs of conditions such as diabetes and heart disease that can be treated and managed before they become chronic and debilitating. Additionally, this richer view of past diagnoses, treatments, lab tests, and other medical information helps ensure that providers are not prescribing medications that may cause harmful interactions. Hospitals can also earn better patient satisfaction ratings and positive perceptions from participating in an organization that seeks to improve the health and well-being of its respective communities. Barriers
to RHIO Benefits Healthcare experts note that competition between hospital- and practice-based providers remains the single-most significant barrier to the formation of RHIOs on a broad scale. In some areas, large and successful healthcare organizations see no reason to link their operations and patient databases with less successful, and possibly financially challenged, providers whom they’ve long regarded as competitors for the same patient populations. At the same time, hospital- and practice-based providers are concerned about the start-up costs for technology that would enable the formation of RHIOs and the sharing of patient data and information across a network of disparate hospitals, provider practices, outpatient facilities, labs, and other entities in the healthcare continuum. Many of these healthcare organizations have already invested heavily in creating their own centralized databases of patient data and information. They have overcome internal challenges, such as the tug-of-war between the information technology department and clinical staff, as they have developed EMR systems to improve the efficiency and quality of care. These organizations have spent time, money, and energy to properly link and interface disparate clinical systems to give their providers a single point of access to patient information. Given these experiences, many would-be RHIO participants question the cost and value of taking part in the development of an infrastructure that would require wrangling with competitors over the ownership of patient data. In addition, these more technologically advanced healthcare providers tend to view their own efforts to develop an EMR system as a competitive advantage as they seek to recruit providers and nurses to work at their facilities. In short, they regard themselves as best in class because they ensure their care providers use the most up-to-date and advanced systems for delivering care to patients. Meanwhile, hospital- and practice-based providers that have made fewer strides toward developing integrated patient care systems view the prospect of RHIOs as a costly endeavor that’s even larger and more complicated than their own fledgling efforts to incorporate technology in their patient care processes. To them, RHIOs appear to be a sound—but virtually unreachable—concept. Competing providers also raise concerns about the privacy and security of patient data in RHIO settings given the HIPAA standards for protecting patient privacy. Furthermore, some providers question how patient information would flow between providers in RHIO settings: How would participants establish unique and secure patient identifiers? Who would take charge of establishing interoperability standards for shared patient data? Technology
Addresses RHIO Barriers In fact, there is at least one example of a successful RHIO delivering the promised benefits of improved patient outcomes, more efficient, and thorough caregiving by taking advantage of new approaches to managing patient data and information. Four years ago, Clalit Health Services in Israel, one of the world’s largest HMOs, began developing a network of shared patient data within its own system of 14 hospitals. The effort, which has since evolved to cover both Clalit and other independent providers, has resulted in a successful, national-scale network of autonomous healthcare organizations whose providers access the same medical information on patients, regardless of where the patient was treated. The key to the Clalit success follows advances in data-sharing technology that is starting to generate awareness and interest in the United States. In short, the technology does not require a single, centralized repository of patient information. Instead, it allows hospital- and practice-based providers to maintain and use the clinical and EMR systems they have implemented or developed to view real-time patient information that’s been gathered by any provider in the Clalit network and in several partnering medical centers. This emerging approach to data sharing, which is based on Microsoft’s latest technologies, relies on the Internet and servers that glean patient information from individual patient databases within the network. It reformats and integrates the data to enable users to view the patient information through their own front-end interfaces. In this setting, participating providers can use their own clinical information systems, no matter the vendor, to access and view patient data in the formats they prefer. Healthcare experts believe this type of data sharing can enable the implementation and ramp up of RHIOs in the United States and help overcome the barriers that, to date, have thwarted the delivery of benefits RHIOs can provide. Here are three examples: • Data ownership and cost concerns fade. The new approach to data sharing does not require massive exercises and expenditures for data mapping and integration of disparate clinical information systems to allow them to communicate with each other. Indeed, the cost of creating such integrated interfaces are often the single, largest expense any healthcare provider will incur as it seeks to link patient information between providers and facilities within its enterprise network. New advances in data sharing enable each participating provider in a RHIO to maintain its own proprietary database, while sharing only the relevant portions of patient information other providers need to make informed decisions about patient care. At the same time, as RHIO participants determine they need access to greater volumes of individual patient information, the data-sharing technology allows greater flexibility to expand capacity without triggering large, additional integration and data-mapping expenses. • Ramp up time is reduced. In the Clalit example, each participating provider retains the use of its own EMR or other clinical system. The data-sharing technology simply integrates the delivery of patient information from the RHIO into the workflow of the users of these front-end systems in a format users are accustomed to viewing on a daily basis—whether they use workstations or handheld devices. Such flexibility minimizes the training needed for hospital- and practice-based providers to participate in a RHIO, enabling a much faster implementation of these networks. At the network in Israel, for example, it takes only two to four months to add each new organization that opts into the network and enable it to begin sharing patient information with existing providers. • Agreement on data standards among providers is easier to achieve. The new Web-based data-sharing technologies enable RHIO participants to establish flexible standards and formats for how patient data would flow between them. Because the technology does not require extensive data mapping and integration or a central repository, RHIO participants need only to reach agreement on the type of patient data their providers require to deliver appropriate care without haggling over specific formats. For example, RHIO participants may agree that providers need to know the type and dosage of a drug administered under a treatment plan and whether there was any adverse reaction. But the providers would not necessarily need to view specifics on the site of an IV or the lot number for a drug to provide care to a patient. Healthcare experts acknowledge that greater awareness of new data-sharing technologies will need to occur before executive teams at hospitals and health system networks take a greater interest in participating in RHIOs. Perhaps more important, though, is that new data-sharing technologies can more quickly bring about the benefits that RHIOs promise for all participants—better patient outcomes and greater satisfaction among patients, hospitals, and practice-based providers. —
Peter van der Grinten is general manager, U.S. & Canada, for
dbMotion Inc., a provider of Web-based data sharing technology that
helps healthcare organizations improve provider workflows with minimal
disruption.
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