The Regional Health Information Organization ( RHIO , pronounced rio ), also called the Health Information Exchange Organization , is a multistakeholder organization that created to facilitate the exchange of health information (HIE) - the transfer of electronic health information throughout the organization - among stakeholders of the region's health system. The main objective is to improve the safety, quality, and efficiency of health care and access to health care through the application of efficient health information technology. RHIO is also intended to support the secondary use of clinical data for research as well as assessment and quality improvement of institutions/providers. RHIO stakeholders include smaller clinics, hospitals, medical communities, large employers and payers.
RHIO is intended to be the key to the proposed US National Health Information Network (NHIN).
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The US health care system is highly complex and fragmented, with the use of multiple information technology systems and vendors that combine different standards. Unlike other developed countries, health care accounts for a disproportionate percentage of US GDP, and there are concerns about the economic viability of Medicare. Although these expenditures are significant, there is evidence of inefficiency, waste and medical errors, with a 2001 estimate by the Institute of Medicine between 44,000-98,000 annual deaths due to medical errors. While many possible causes for this situation exist, much of the waste (eg, duplication of laboratory tests) and medical errors (eg, adverse drug reactions) can be traced to the inability of healthcare providers (who are not the primary provider of patients) to access existing patient medical information at just the right time when needed: better and more general health information technology everywhere may be part of the overall solution.
In 2004 President W. George Bush issued Executive Order 13335 for the national development and implementation of a health information technology infrastructure that can be operated to improve the quality and efficiency of health care with the aim that most Americans will have an EHR by 2014. In July 2004 the Department Health and Human Services United States released their vision of how the American health system can be rebuilt over the next decade. The aspect of federal efforts is the establishment of the Office of the National Coordinator for Health Information Technology. One of the roles of ONC is to facilitate RHIO development.
The planning stage of RHIO formation involves
- identification of shared vision/motivation
- create a government structure
- identifies technology and network infrastructure for data integration
- sets standards for data sharing, data protection, and business practices to ensure patient protection during data exchange
- defines education and business strategies to ensure sustainability of efforts.
Finally, the RHIO should implement the proposed strategy.
Maps Regional Health Information Organization
Architecture type
Two broad architectural types, centralized and federation , in accordance with the data warehouse and the combined database system model of data integration. In centralized configuration (for example, the Santa Cruz Community and the Michigan UP Network), all providers send their data to the RHIO repository on a regular basis (daily). In the federation model, RHIO acts as a location search service, the data remains in its original location, and the RHIO has only a "pointer" for that information.
The pros and cons of each architecture follow from the approach.
- Centralized
- For Centralized design, once data is centered and restructured into a uniform data model, it is easier to query and analyze. However, since movement and restructuring are generally complex batch processes involving well-known "extracting, transforming, loading" steps, centralized data may be a bit outdated if the (challenging logistics) target of daily updates is not achieved. Also, there may be concerns between each RHIO participant coming from the raw data that they submit "control" and "ownership" after the data is copied to the central site. In addition, the creation of a central repository requires close cooperation to determine what data will be centered and how the structure will be structured.
- Federation
- In a composite system, RHIO software only stores information about the location where patient data is available. This is usually more politically feasible than a centralized system. However, designing protocols that can be used by RHIO to perform queries (heterogeneous storage) from individual provider data stores is technically challenging. The software on each site must ensure authentication of electronic requests to ensure that they are legitimate and authorized, and no standards can be used for this purpose currently. The combined settings require greater network bandwidth than a centralized approach, as requests by central RHIO software users can be assigned to various provider systems.
Centralized and combined approaches are not mutually exclusive, and hybrid setup can be used. In a proposed hybrid model, health record trust or bank health record data, all data for each patient will remain in one repository as in a centralized model, but patients can choose which data banks to use for their records.
Current status
In 2009, 193 initiatives (including RHIO) in the United States worked on the exchange of health information, and 57 of them actively exchanging data used by health stakeholders. The RHIO Initiative is at two levels, larger (statewide) and smaller (local and rural).
Compared with the local RHIO, state-level initiatives, as the number of stakeholders and the larger patient base, and the consequent financial strength, are more likely to utilize national-level expertise in both IT health and policy-making. Much of the operational RHIO effort tends to be a greater effort, although the risk of political battles and consequent failures is also strengthened if some of the major stakeholders choose not to cooperate with each other.
Compared with state-level RHIOs, stakeholders tend to be more heterogeneous with respect to business lines, technology use and size. The rural RHIO has a customer base of less than 100,000. The presence of many smaller organizations with relatively limited IT budgets translates to many challenges due to dis-economies of small scale. There is limited access to skilled technological professions, and health IT vendors pay little attention to small customers. Many stakeholders continue to use legacy software from long-dead vendors and some may not deploy IT at all. In addition, stakeholders may lack IT, and even the availability of high-speed Internet connectivity may not be guaranteed. A significant sustainability challenge for smaller RHIOs involves funding. Some support models (eg, used by Northwest, Louisville KY) are based on shared use, subscription-based commercial health information software, and the shared use of scarce resources such as information technology professionals, which are not reachable by smaller organizations that act individually.
Regardless of size, certain challenges persist, such as interoperability standards, as well as consistent standards related to privacy, security, and appropriate data usage. Currently, privacy/security issues vary across states, and federal efforts to ensure uniformity is desirable.
Example
INPC and IHIE
Indiana Network for Patient Care (INPC) - originally the Patient Nursing and Research Network (INPRC) - operated since 1994, linking five major hospital systems in larger Indianapolis. All INPC participants now submit registration notes, all laboratory tests, text reports, medical history, and all UB92 notes (diagnosis, length of stay, and procedure code) for hospital admissions and emergency room visits to separate electronic medical records records on the server INPC center uses the combined data store model. The message exchange standard used is HL7. The computer system standardizes all clinical data when the data arrives at INPC safes, laboratories, radiology, and other test results are mapped to a series of common LOINC test codes with standard unit sizes, and patients with multiple medical record numbers are linked.
Implementation has been simplified because each participating institution uses the same data model and dictionary containing code, name (and other attributes) for tests, medicines, coded answers, etc. Data for each participating patient seen in one of the 11 areas. emergency room can be presented as one of the virtual medical records. Stakeholders in this RHIO include: large and regional hospital systems, regional and national, state, federal, and private payroll referral laboratories, claims service pharmaceutical reparation management, major physician practice organizations, individual providers, state governments Department of Health), major academic research institutions, and others.
The state-wide Indiana Health Information Exchange (IHIE), which uses the same medical information technology expertise/IT team as INPC, combines clinical data in combination with administrative data (claims) to support the delivery of electronic test reports to doctors offices using fax, printer, and e-mail, as well as the Clinical Quality Service, which provides "report cards" (and incentives) on quality measures established for physicians, practice groups, employers, and payers. The IHIE is a rare example of independent health information exchange (not dependent on government grants). Satisfaction of stakeholders with RHIO seems to be high.
CalRHIO
CalRHIO is an example of RHIO failure due to political/order battles; it was shutdown January 8, 2010. After heavy competition with California e-Health Collaborative (CAeHC) for appointment as HEW entity in the entire state of California, both organizations were rejected by the state government in December 2009; major stakeholders such as Medicity Inc. and Kaiser Permanente then follow and withdraw financial support. The reason for the failure of CalRHIO has been attributed to the limited business model depends on the appointment of state-entity.
Healthcurrent
Healthcurrent is RHIO for the state of Arizona, formerly known as AZHeC. Healthcurrent hosts the physical health and behavioral health/crisis portal for health information exchange throughout Arizona. Current health care link providers to standard HIE-based platforms and store available data repositories to be shared with properly accredited care providers in the community. Arizona is an opt-out country for health data flowing into HIE countries.
Another example
In some states (eg, Kansas), alternatives to consortium-based state-level RHIOs are under consideration, namely the direct involvement of state governments in creating RHIO infrastructure. This approach builds on the strengths of state governments as the main employers and buyers of health services (eg, University of Alabama in Birmingham, is Alabama's largest company). Similarly, TennCare in Tennessee has its roots in dealing with a population of low-income countries and consequently more state driven. Utah's efforts are based on the country's previous efforts to process health claims.
Recent federal efforts (for example, in the Veterans Administration) aim to create a federal employee-based electronic healthcare registry system, which may be considered a national RHIO.
See also
- Chesapeake Regional Information System for Our Patients (CRISP) - RHIO serves Maryland District of Columbia
- HealthBridge - RHIO for the greater Cincinnati area (Ohio, Kentucky, & Indiana)
- Informatics Corporation of America - RHIO vendor
- PeaceHealth - Medical Group in Alaska, Oregon, & amp; Washington
References
External links
- National Coordinating Office for Health Information Technology
- AHRQ National Resource Center for Health Information Technology
RHIO site
- Hixny - Albany area and New York North
- Rochester RHIO - Rochester, New York
- Indiana Health Information Exchange
- Medical Information Network - Northern Voice (MIN-NS) - Mount Vernon, Washington
- BronxRHIO - Brox, New York
- CORHIO - Colorado
- Keystone Exchange Health Information (KeyHIE) - Pennsylvania
- Chesapeake Region Information System for Our Patients (CRISP) - Maryland District of Columbia
- Midsouth Health Alliance - Memphis-area, Tennessee
- HealthLink New York - Hudson Valley, Catskills, and Southern Tier, New York
- HEALTHeLINK: New York New Clinical Information Exchange - Buffalo, New York
Source of the article : Wikipedia
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