Qual-IT - February 2005 | Archived

Recent national policy reports have cited the need for regional coordination of various IT activities, and several statewide and community efforts have already been launched.  Since the RHIO is a new concept, there is no standard definition or single model at this time, but a framework for appropriate functions and organizational models is beginning to emerge. 

The development of such a framework is a major focus for current United Hospital Fund efforts that will work with partners to evaluate and recommend approaches to RHIO formation in the New York metropolitan area, taking into account emerging federal and state policies and similar initiatives in other parts of the state. 

The U.S. Department of Health and Human Services (HHS) has promoted state and regional coordination of health care IT systems for several years.  Growing concerns, in the late 1990s, about bioterrorism and disease surveillance prompted the Centers for Disease Control and Prevention to develop specifications for the exchange and linkage of key data between health care providers and state and local health departments.  Building on these efforts, and recognizing the need for broader standards-based data exchange, HHS advanced the concept of a National Health Information Network to provide direction for and stimulate health information network development across the country.  RHIOs are viewed as the essential building blocks that will enable this national network to be established. 

As HHS explained in its July 2004 report, The Decade of Health Information Technology: Framework for Strategic Action,

The development, implementation and application of secure health information exchange across care settings require a local leadership, oversight, fiduciary responsibility, and governance.  These regional health information organizations... are critical to health information exchange that reflects the health care priorities of a local area as well as the legitimacy and trustworthiness of this activity to clinicians and consumers.

While the definition of a RHIO is still preliminary, there are several community-level efforts that are widely viewed as prototypes for this concept.  Several models were profiled for a group of 50 New York health care leaders who recently gathered at the Fund for the first meeting of the New York State Health Information Technology Policy Summit Initiative.  Participants from Massachusetts, Indiana, and Tennessee reviewed their pioneering experiences developing organizational and technical models for regional health information exchange, and facilitated discussions on the principles of and priorities for IT in New York. Summit participants also reported on a large number of regional efforts that are already beginning to emerge in New York. (A Fund grant is assisting the eHealth Initiative and Foundation [eHI] to conduct two summit meetings in New York and prepare a background report describing the current national, state, and local environment relating to IT adoption and the exchange of information across systems, including up-to-date descriptions of these and other models around the country.) 

As described in the background report for the summit, state and regional IT activities have recently been spurred by federal grant funds, principally under two programs:

·        Connecting Communities for Better Health (CCBH) provides funding and technical support to raise awareness and demonstrate the value of health information exchange at the community level, highlight the technical, financial, legal, and other challenges associated with these exchanges and provide funding support, tools, and technical assistance to address them, and establish a communications network as a means to facilitate information sharing among communities and stakeholders.  The program is funded by the Health Resources and Services Administration (HRSA) and administered under contract with eHI.  Proposals were solicited through a request for capabilities (RFC) application process; 134 applications were submitted, and ultimately nine communities were approved for funding totaling more than $2 million in 2004;

·        The Agency for Healthcare Research and Quality (AHRQ) recently awarded $139 million in grants to states, communities, and health care organizations to support health information systems integration and linkages; five states were awarded grants to form state and regional IT networks.  These grantees will receive a total of $25 million over five years under this program.  AHRQ also funded a large number of community-level planning and implementation activities through this program.

Clearly there is widespread interest in regional coordination efforts to support health care IT, but are these communities and organizations prepared to tackle the major issues?  In fact, most are in the early stages, and major challenges lie ahead.  In an article that will be published in the Journal of the American Medical Informatics Association, eHI's lead reviewers for the CCBH program found that many applicants did not have well-developed technical or business models, rank-and-file clinicians were generally not involved in the planning process in its early stages, and proposed activities were often too comprehensive and ambitious, rather than incremental and focused on short-term "wins."  Overall, however, the nine programs funded under CCBH, and the many programs funded by AHRQ, withstood a rigorous policy, technical, and operational review process, and represent very promising models for regional IT coordination.

You can read more about the New York State Health Information Technology Policy Summit Initiative, and the CCBH and AHRQ programs, on the eHI web site, at www.ehealthinitiative.org

In the first issue of this Qual-IT newsletter, we briefly described the Fund's key health care IT activities.  One of the first priorities is to promote regional coordination that will support health care IT adoption and use, including the steps that must be taken to support the formation of one or more RHIOs in the New York metropolitan area.  As stated in HHS' strategic framework report, health information exchange activities need to be organized at the local level and build on their unique health care market and population needs. 

The Fund's initial focus will be on identifying and fostering coordination across existing and short-term planned activities that are sponsored by New York City-area health care organizations.  Through this process, we will be able to identify common obstacles and solutions, and determine what additional projects and activities should be mobilized on an incremental basis.

In addition, we will determine the key features and decision points of the RHIO planning process, including:

·        Organizing focus – Will models driving health care IT adoption and use be primarily consumer- or provider-centered?

·        Function – Should the RHIO be primarily a convener and trusted source of information, the architect of local health information networks, or a provider of services and applications for use by subscribing members?

·        Governance and organizational structure – Who are the key stakeholders requiring some ownership of the process, and what is the most suitable type of corporate structure for the RHIO?

·        Business model – How are the RHIO and its activities funded, initially and on a sustained basis?

·        Technical architecture – What are the most important features of the technical architecture needed to support health information exchange, and how will that structure be built and maintained?

·        Legal issues – What types of agreements are needed to facilitate health information exchange while protecting public interests?

CCBH Resource Center, accessed at www.ehealthinitiative.org, provides a wealth of information regarding state and community IT initiatives; it is maintained and will be continuously updated by eHI.

Overhage JM, L Evans, J Marchibroda.  Communities' readiness for health information exchange: The national landscape in 2004.  Journal of the American Medical Informatics Association. 2004; 0:16801 (November 2004 preprint; finalized manuscript to appear in March/April issue).  Available online (fee for nonsubscribers) at www.jamia.org/cgi/reprint/M1680v1

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