Why RHIOs shouldn't exist

Without a doubt, there are a number of good reasons why RHIOs/HIEs should exist.  Certainly, it can improve overall patient care if all of the providers a patient is likely to see have the same information. And sharing that information can save money if it avoids the need for duplicative tests or keeps patients from getting sicker than needed.

However, RHIO efforts keep getting swamped by legal issues (how do you handle the myriad of data sharing issues under HIPAA?), cost issues (the darned things are expensive!) and problems with the "coopetition" needed to get the job done? And how long can this model last if most efforts are paid for by grants? (see story below)  Of course, the RHIO movement itself is in its infancy, but these are serious questions nonetheless.

Given these concerns, maybe it's time to take a contrarian position, and look at why RHIOs shouldn't exist. Maybe these aren't dealbreakers, but they aren't trivial problems either.

First, and perhaps most damning, the current model requires a level of trust among competitors that may simply be unrealistic. Opening up your network, on any level, is not a project for the faint-hearted. Sure, if you're a RHIO fan you can probably trot out examples of communities in which this has been overcome, but I'm betting that there's twice as many where lack of trust is stalling or even destroying connectivity efforts.

Another concern, of course, is cost.  As an armchair IT observer, it's easy for me to say "you guys should just spend the money," but even I find it hard to justify the expense in my mind when there's so many other innovations (telemedicine for example) for which the ROI is much better demonstrated.

Still another issue is market readiness. Maybe RHIOs should exist, but other factors (widespread adoption of EMRs within health systems, most notably) should be in place universally before providers even consider a broader data exchange.

And what about potential flaws in the model itself?  From my standpoint, some form of medical data banking--by a trusted intermediary rather than providers--seems to solve many problems that straight-ahead data exchanges can. That's one example of an alternate approach, and I'm sure there are others, which bypasses the existing data networking scheme entirely. What about Web-based PHRs, for example?  Once they become more robust, they may solve many of the problems the more-expensive RHIOs want to address.

Hey, with my patient/consumer hat on, I certainly like the idea of data following me. I love the idea of my providers cooperating. But at the moment, I simply can't see how this kind of data sharing can work in the near future.

I know I'll probably get annoyed letters from RHIO backers for writing this, and that's OK, but it's probably beside the point. All I'm trying to say here is that before we fixate on RHIOs as the answer to patient data sharing, we should probably make sure we treat RHIOs and HIEs with all due skepticism. After, as you all know, once a network is in place it's hard to unring the bell.--Anne

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