Regional Health Information Organization - Current Status

Current Status

Of the more than 190 RHIOs in various stages of development (2009), a 2009 survey found that 57 RHIOs actively exchange data used by healthcare stakeholders. RHIO initiatives exist at two levels, larger (statewide) and smaller (local and rural).

Compared to local RHIOs, state-level initiatives, because of the larger number of stakeholders and patient base, and consequent financial strength, have a greater likelihood of being able to utilize national-level expertise both in health IT and policy-making. Most operational RHIO efforts tend to be larger efforts, though the risk of political battles and consequent failure is also amplified if several large stakeholders choose not to cooperate with each other.

Compared to state-level RHIOs, stakeholders tend to be more heterogeneous with respect to line of business, use of technology and size. Rural RHIOs have a subscriber base of less than 100,000. The presence of numerous, smaller organizations with relatively limited IT budgets translates to numerous challenges due to the diseconomies of small scale. There is limited access to skilled technology professions, and health IT vendors pay less attention to small customers. Many stakeholders continue to deploy legacy software from long-defunct vendors and some may not deploy IT at all. In addition, stakeholders may be less IT-savvy, and even availability of high-speed Internet connectivity may not be assured. A significant sustainability challenge for smaller RHIOs involves funding. Some support models (e.g., used by Northwest, Louisville KY) are based on shared, subscription-based use of commercial health information software, and the shared use of scarce resources such as information technology professionals, who are unaffordable for smaller organizations acting individually.

Irrespective of size, certain challenges remain, such as interoperability standards, as well as consistent standards with respect to privacy, security and appropriate use of the data. Currently, privacy/security issues vary across states, and federal efforts to ensure uniformity are desirable.

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