Defining a task is the first, and sometimes hardest, step on the road to accomplishing it. So it's no surprise that after months of working to create best practices for regional health information organizations (RHIOs), an industry body devoted to the task found it needed to change focus.
"It sort of moved from best practices to development and guiding principles," says Eileen Murray, vice president and executive director of the American Health Information Management Association's (AHIMA) Foundation of Research and Education (FORE), Chicago. "We pretty quickly found out when we started doing interviews that true best practices aren't really there yet. They haven't been doing this long enough.
"I think one of our primary findings was there isn't necessarily any one best way and that's OK, that, very legitimately, different states will come at this in different ways in different sequences. At the start of the project, we were thinking we could do a decision tree or a nice little map, and found out we couldn't — but we also found that's actually OK, that, at this stage, it would probably be foolhardy to try to force anyone into a pattern that might not be the right one for everyone."
State-level RHIO executives have already learned — more likely have had their educated estimates confirmed — that governance and technology architectures that work for a small state like Maine won't for a large state like California, for example. But they have also learned that the AHIMA project has helped streamline the creation of a network, and that some lessons can be shared more quickly now.
"The technology isn't the hard part," says Dr. J. Marc Overhage, CEO of the Indiana Health Information Exchange in Indianapolis (IHIE), alluding to governance issues. But among the technological obstacles facing the IHIE, Overhage mentions he would like a "magic wand" to bring about stronger user authentication and more standardized interfaces.
Overhage and others say technology, such as better user interfaces, will help RHIO backers convince stakeholders of the value in the concept. That concept is that as the baby boom generation — which has become accustomed to doing so much business online — demands more healthcare services, it will drive the building of a network of electronic health information.
From both clinical and financial perspectives, two RHIO directors say the Zeitgeist is right for pushing RHIOs forward. Referring to the recent study by the Institute of Medicine (IOM) which claims medication errors hurt at least 1.5 million patients in the United States annually, California RHIO Project Director Ann Donovan says the baseline necessity of providing better records to all caregivers, and ultimately their patients, is paramount.
"No matter who you're talking to, they want to know why we're doing it, and it's fragmentation of care," Donovan says. "What are the hazards? On the one hand, you don't want to scare consumers and you don't want to blame anybody, but you have to get the point across that care is fragmented and there are risks in errors."
Devore Culver, CEO of Maine's HealthInfoNet RHIO in Manchester, says finding a way to reduce the cost of errors (the IOM report estimated each error adds $8,750 to an affected hospital stay) is a lesson that small states might teach larger states because they will likely reach the breaking point first.
Culver says small states, such as Maine and Rhode Island, will probably have to deal with the possibly catastrophic rising costs of healthcare much faster than larger states, because their tax bases have far less cushion. The resulting pressure on these states' budgets is forcing quick and creative thinking from the entire spectrum of stakeholders, Culver says, including government, the business community, and healthcare providers across the board, and a workable RHIO might go far in helping that effort.
"It's spurring some real creativity to figure out how to do better because they know they can't keep raising taxes," Culver says. "It's a really interesting dynamic that I think small states will get to faster than large states."
Greg Goth is a contributing writer based in Oakville, Conn.