As noted in HIS-Talk, Former Meriter Hospital CIO Peter Strombom has written an interesting article on Wisconsin’s progress towards a regional health information exchange (RHIO). Peter’s history and thoughts are very pragmatic and, IMO, on target; I thought I would share some quotations.
The motivation behind Peter’s article is that, like many areas of the US, Wisconsin has been talking about building a RHIO (or two) for a long time. The current challenge is architecting the system and ultimately paying for it. The state has issued an RFP asking for help designing the architecture. Costs for the total deployment are estimated at $1.2B and are, presumably, to be funded by the providers.
Peter makes some great points about:
- The fact that we’ve been at this “regional interoperability game” for a long time.
- RHIOs are the latest name for an old idea
- Peer-to-peer communication (rather than centralized “control”) has a better chance of success
- Good discussion of political v. economic v. quality of care motivations for interoperability
- Providers must be using electronic records before they can be exchanged, well, electronically
- On-going work to firm up standards will help with interoperability
Two counter points I would make to Peter’s thoughts:
- I do not think that the banking analogy Peter uses is a good one. The banking world has (effectively) centralized control over the SWIFT and related networks. A better analogy would be peer-to-peer file sharing networks — heck, if we can share MP3s in an ad-hoc-yet-organized-way, surely we can share healthcare records.
- IMO, the CCHIT is not the total driver for peer-to-peer interoperability. HL7 (among others) has been working on this problem for a long time and, again IMO, CCHIT is effectively profiling existing standards rather than creating new standards.
Selected quotations from Peter’s article:
[In November 2005 Wisconsin’s Governor] called for “a statewide eHealth infrastructure […]. [P]resident Bush’s State of the Union Address [in January 2004] stated that By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care.”
The statements were both politically appropriate at the time, but as of June, 2008, little has been achieved in Wisconsin.
We have been at this for a long time. The CHINs (community health information networks) of the mid-1990s were an idea that had merit but was not adequately supported by the technology of the day. The RHIOs (regional health information organizations) of later times were also a great attempt at interoperability but suffered from lack of community acceptance and viable business plans to sustain them. It is telling that only a handful of RHIOs continue in business from the several hundred that were founded on initial seed money only to fail when those funds became exhausted. The poor support from the healthcare providers and the payer community, and the absence of inspirational insight into the opportunity being presented to us by the technology, contributed to the lack of success of what I will call the second generation of this approach at interoperability.
Presumably, the healthcare provider and payer will bear the cost of this process. […] Importantly, to be viable, the plan further assumes that all healthcare providers in the State of Wisconsin will maintain patient records electronically. This is not the current or the foreseeable situation, as many small hospitals and physician practices do not have the available funding to achieve this goal with only their own resources.
Application (systems) vendors in healthcare are working together under the auspices of the Certification Commission for Healthcare Information Technology (CCHIT) to develop standards for interoperability. By working together it is planned that their output will become accepted as was the HL7 interface standard. A peer-to-peer network with communications between healthcare providers using software from the same or different software vendors and based on the CCHIT standards could follow a model based on the Banking system model.
This peer-to-peer network lends itself to progressive growth and expansion, as warranted as additional providers implement electronic medical records systems. Importantly, a sustainable business plan at the operations level is not needed to finance the exchange of key clinical information in a time of need.
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