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Issues for Community and Region-wide Health Information Organizations to Address in the National Context

Regional health information exchanges (RHIOs), also called health information exchanges (HIEs) come in all types and sizes involving some or all of the stakeholders in a region including health systems, physicians, other providers, public health, researchers, academic medicine, health plans, and consumers. A significant number are community multi-stakeholder RHIOs that perform a shared community function enabling physicians to inquire into or retrieve stored data or receive electronic messages in the ambulatory and inpatient settings that come from multiple sources. Some of these RHIOs are regional in that they serve multiple communities often across state lines. Yet, for every community or regionally-based RHIO, there are multiple other variations of RHIOs or HIEs, e.g. a hospital centric RHIO for participating physicians, a health plan sponsored RHIO making EMRs with ePrescribing capabilities available to physician practices, a multi-hospital exchange of data within emergency rooms, a public health sponsored RHIO that uses shared electronic data to monitor health and disease trends. Many states are starting statewide RHIOs or oversight bodies in an effort to accelerate data exchange across the state.

The naturally occurring “community” or geographic area for a RHIO is the referral region among the providers where the vast majority of electronic transactions occur. Following the 80/20 rule, many of the early RHIOs have grown to reflect the immediate patient information needs of health providers and physicians who share patients and do many cross-referrals.

The challenge at the national level is linking the many RHIOs to a national structure based on standards in which data is exchanged between RHIOs and is exchanged with national and regional data providers and users such as national labs, state health departments, academic researchers, and providers serving mobile consumers. Building a national network of RHIOs calls for federal and state policies, guidelines, standards, and incentives that encourage the development of RHIOs, ensure interoperability across communities and regions, and address consumer and provider concerns around privacy and security.

At the community and regional levels the solution to the exchange of health information can not be found by one hospital, one hospital network, one physician network, one laboratory, one public health agency, or one health plan. All of the major healthcare providers have to see the issue from a community perspective, lay aside their competitive instincts, and come together to solve the problem. Issues to address include:

• Who is essential to have in the health information exchange network to be viable?
• What is the community vision for the exchange of data that inspires participation?
• What information needs to be exchanged and by whom?
• What is the status of participating organizations – mission, volume of activity, IT capabilities, future plans, financial resources, etc?
• What features and functions will best assure the timely access to patient information, promote patient safety, enhance quality healthcare, and improve efficiency?
• What is the role of the RHIO compared to that of the participating entities?
• What process can be put in place from the beginning to address consumer concerns about privacy and security?
• What is the transition plan for building the capacity of an entire community to become electronic?
• What does a financially sustainable business model look like?
• Assuming limited federal and state financial support over the long-term, what are viable local funding sources?
• What is the business case for funders?
• What are the operating agreements between the entities and how is the RHIO governed?