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September Edit Memo: The Bottom Line

September 1, 2007
by aguerra
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While patient safety may be the goal, RHIO success depends on the dollars making sense.

A few years ago, when I moved to HCI after covering financial services IT for most of my career, some friends and family questioned the decision. "How could the things you've learned watching CIOs on Wall Street help you understand the challenges faced by CIOs in hospitals?" they asked. "Aren't you starting all over?"

Well, at the time and ever since, I've said that many issues faced by CIOs are consistent across industries (notice the existence of CIO magazine and others like it). Breaking down data silos, integration issues, dealing with vendors, RFPs, SLAs, standards and C-suite politics follow CIOs as they move from one industry to another.

But CIO-level issues aren't the only ones that seem to translate across the two industries—well-intentioned ventures launched with tenuous business plans seem to do so as well. Let me explain.

About five years ago, the big buzz in financial services was called "T+1 (trade date plus one)”—the goal of settling a trade the day after it was made, rather than taking the customary three days (T+3). While there were critics, Wall Street had been doing just fine in its T+3 world.

However, T+1 advocates lobbied their position, creating the Global Straight Through Processing Association (GSTPA)— an industry organization devoted to making T+1 a reality. Initial funding for the GSTPA was in the millions, coming from its original members—a veritable who's who of Wall Street powerhouses. One major services provider, now called Omgeo, was invited to participate in the GSTPA, but due to a lack of agreement on intellectual property issues, declined, choosing instead to operate as a competitor to GSTPA. So the stage was set—a for-profit in this corner, a not-for-profit in that. Wondering who won?

Right. After millions invested, the GSTPA never got off the ground. Some say the failure was due to internal structure and governance issues in the entity itself. But I say it was a good concept chasing a business plan it could never catch. You see, T+1 would have been nice: settling trades faster means they have to be electronic, and electronic trades have fewer errors. But nice isn't enough. T+3 may not have been perfect, but for most it was good enough. CIOs in the industry had far too much on their plates—and packed into their budgets—to reshuffle everything for a "nice to have."

As the stories started coming in from HCI writers for our RHIOs Special Report, I found myself thinking more and more of the GSTPA and the parallels between it and defunct RHIOs—mainly, a "nice" concept in search of a business plan.

But you'll also see in our report that RHIOs are not doomed to failure. In fact, some are doing quite well. Those that are making it seem to have something in common—they are all addressing concrete administrative issues for their members by lowering costs, resulting in a sustainable flow of revenue that can fund operations. RHIOs that become complacent feeding off grant money are drinking at a well which could dry up at any time.

Patient safety is the ultimate goal of any RHIO, and it's a noble and worthwhile goal. But market forces can be callous. And expecting a number of competitors to work together towards a common goal is setting down a difficult road. Of course, let's not forget about the HIPAA privacy issues that need to be addressed in any inter-institutional patient data exchange (see protected health information).

The mission of our Special Report lined up perfectly with HCI's mission as a whole—to provide best practices based on real world examples from those in the field finding success, so you, their peers, can avoid starting an IT journey from scratch. Perhaps if the directors of GSTPA had more such information, they might have actually opened for business.

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