Thursday, January 31, 2008

Health Information Infrastructures: RHIOs

Recently much has been written about regional health information exchange and RHIOs. Adler-Milstein et al. (The State of Regional Health Information Organizations: Current Activities and Financing, Health Affairs, published online: 11 December 2007 at examine whether "the current US. market-oriented approach - offering small grants and waiting to see which RHIOs flourish - will work." Evidence suggests that this approach will not work. These authors surveyed 145 RHIOs in early 2007, and found that of these only 32 were functioning to facilitate data exchange across independent entities on January 1, 2007, and only 20 were medium to large size organizations. Analyses report per centages (n=20) of this sample processing data from hospitals. ambulatory services, labs, imaging centers, payers, public health services, pharmacies and pharmacy benefit management organizations. Categories of data include test results, inpatient data, medication history, outpatient data, and public health. Support for RHIOs studied (n=20) included time or in-kind resources, one-time financial contributions, grants, and recurring fees. Results reported are very misleading due to use of percentages and the inadequate sample size. This study objective is a very important one but methodological weaknesses of the research design obscure results that might have been drawn from qualitative case analysis of the RHIOs. The reader learns nothing about HOW these organizations work, but it seems clear from the large number of failed or stalled efforts that the policy model for development of RHIOs yields only small scale, unsustainable and fragmented initiatives.

The reasons for this evident failure are many, including reliance on market dynamics with a "bottom-up" approach, for-profit definition of sustainability, and lack of attention to public sector information infrastructures required as a foundation for the success of information exchange. Issues related to privacy impede concept development while lack of regional or national consensus on standards and interoperability prevent the process of "scaling up." (See also Walker et al., The Value of Health Care Information Exchange and Interoperability, Health Affairs, 19 January 2005, at )

Financial services networks offer another model useful as a reference for development of a national and international health information systems satisfying criteria of individual privacy and confidentiality. Viewpoint papers published by Electronic Data Systems (EDS at show IT infrastructure developments in other industry sectors - especially finance and communications - that might be very instructive for the health care industry. See for example:
Converged Communications Network for Financial Services (2007) available at
Governance – The Key to Unlocking the Challenges of SOA (Service-Oriented Architecture) (2007) available at
Virtualization: The EDS Perspective (2007)

Gartner has developed a conceptual framework for research on application infrastructure: the "Magic Quadrant" (2007) available at

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