University of Maryland's Robert H. Smith School of Business Creates New Framework for Networks Sharing EHRs

COLLEGE PARK, Md., March 8, 2011 /PRNewswire-USNewswire/ -- The Center for Health Information and Decision Systems (CHIDS) at the University of Maryland's Robert H. Smith School of Business has developed a new framework to help states and Washington, D.C., create self-sustaining and effective networks for the exchange of electronic health records. The center assessed the DC Regional Health Information Organization (DC RHIO), Washington's primary health information exchange (HIE).  The DC RHIO is managed by the District of Columbia Primary Care Association (DCPCA) and funded by the city government.  The center rated the DC RHIO among the top 20 percent in the nation as a fully operational exchange and provided recommendations to make the organization sustainable through operating revenue.

With new federal policy, all health organizations - doctors, hospitals, laboratories, Medicaid organizations, etc. - will eventually have to shift to electronic health records to utilize, exchange, and share the information. Full adoption is still years away and more than $18 billion is being provided to help incentivize the process.

"Much of the country has a long way to go to getting electronic health records implemented and able to share health information seamlessly," said P. Kenyon Crowley, associate director of CHIDS. "This work is vital - the development of effective and sustainable HIEs enables better quality of care. With shared patient health information, clinicians can better manage and coordinate care, which improves patient safety, reduces redundancy and spurs quality and efficiency."

The CHIDS HIE Evaluation Framework - co-authored by Ritu Agarwal, professor and Dean's Chair of Information Systems, and director of CHIDS; Sunil Mithas, associate professor; and Crowley - offers a methodology for assessing any RHIO across the nation. HIEs are evaluated on five key performance components: the value creation and sustainability of its business model; organizational structure and decision-making processes; technology; community engagement; and trust in the system.

"HIEs are complex organizational forms that engage many stakeholders, sometimes with conflicting goals.  The framework is designed such that it can address the multiple dimensions along which an HIE needs to exhibit superior performance," said Agarwal.  "As more HIEs become operational, the tool can be used to compare and benchmark performance."

The CHIDS HIE Evaluation Framework and associated recommendations are based on the information and documents provided by key stakeholders of the DC RHIO, an environmental scan of HIE efforts across the nation, best practices published in the literature, and benchmarking with leading HIEs.

Nationwide, there are approximately 200 HIE initiatives, but only 18 have revenues and cash flow from operations that exceed expenses. In order for the DC RHIO to achieve this level of sustainability, CHIDS recommends the organization construct a hybrid revenue model based on subscriptions (that include a set of pre-determined services) and fees for additional services.

The CHIDS assessment reveals that the DC RHIO has made progress in most of the dimensions of the HIE Assessment Model and has reached operational status (transmitting data that is being used by healthcare stakeholders), but much work remains to be done in order to reach sustainability.

Launched in 2007, the DC RHIO was recently named the state health information exchange for the District of Columbia. It has Microsoft's Amalga Unified Intelligence System in place, connecting six community health centers and two hospitals with two additional health centers and two more hospitals in the process of adopting real-time access to shared electronic health records.   The DC RHIO is also working closely with the DC Department of Health Care Finance and Department of Health to enable improved health data management for the District's Medicaid population and the District as a whole.

"The DC RHIO has come a long way in just a few short years, and we have good understanding of where we are today, and now a good roadmap for the future," said Donna Ramos-Johnson, chief of technology operations at the DC Primary Care Association, the parent organization of the DC RHIO. "This study confirmed some of the issues we already knew, provided valuable insights, and lent a great deal of credibility to our current initiatives."

Crowley and Ramos-Johnson announced the findings at the HIMSS 2011 Annual Conference and Exhibition in Orlando.

About the District of Columbia Primary Care Association

DCPCA is a leader in the health care community as a nonprofit, health action and advocacy organization improving health care and health coverage for low-income, uninsured, and medically vulnerable people in the District of Columbia. The mission of DCPCA is to facilitate the development and sustainability of an effective, integrated health care system in the District that guarantees access to primary care and eliminates inequity in health outcomes.  DCPCA enhances and leverages resources to expand, strengthen, and improve primary health care services for District residents.  More information is available at

About the Center for Health Information and Decision Systems

CHIDS is an academic research center with collaboration from industry and government affiliates, and is designed to research, analyze, and recommend solutions to challenges surrounding the introduction and integration of information and decision technologies into the health care system. CHIDS offers the benefit of a world-class research staff and renowned scholars in technology implementation, adoption, assimilation, decision sciences and information technology, and health services. CHIDS serves as a focal point for thought leadership around the topic of health information and decision systems.  More information is available at

About the University of Maryland's Robert H. Smith School of Business

The Robert H. Smith School of Business is an internationally recognized leader in management education and research. One of 12 colleges and schools at the University of Maryland, College Park, the Smith School offers undergraduate, full-time and part-time MBA, executive MBA, executive MS, PhD and executive education programs, as well as outreach services to the corporate community. The school offers its degree, custom and certification programs in learning locations in North America and Asia. More information is available at

CONTACT: Carrie Handwerker, +1-301-405-5833, [email protected]