Nonprofits accept the e-health records challenge

More than 20 regional health information organizations (RHIOs) are exchanging health care information, less than a year after government officials said such collaborative networks would help advance reliance on information technology throughout the nation?s medical institutions.

More than 100 RHIOs have been formed, but most are still in the formative stages, according to a draft report by the eHealth Initiative, a Washington, D.C., nonprofit organization that is promoting the transition from paper-based medical records to online data.

The RHIOs generally are forming nonprofit organizations composed of community institutions, such as hospitals, physicians, government agencies, insurers, laboratories, employers and consumers. Once organized, they must develop a governance structure. Then they generally begin to weigh how they can facilitate data exchange and how they will be funded.

Government officials have been encouraging these initiatives but ruled out a major federal role in funding them. The Health and Human Services Department has promised to spend $139 million over five years on direct assistance to a handful of pilot RHIOs and support for other RHIO activities.

?We will not achieve our goals by spending mostly taxpayer dollars on this,? said David J. Brailer, national coordinator for health information technology, at the Connecting Communities for Better Health conference in Washington, D.C., in May.

He said progress may be made without a top-down program directed by the federal government, adding that ?this grassroots movement is moving much faster than the federal government can move.?

However, some speakers at the meeting asserted that federal leadership is critical.

John Glaser, president of the eHealth Initiative and chief information officer of Partners HealthCare Systems Inc. in Boston, called the federal government ?the principal driver and the principal mover? behind the push for advanced healthcare IT, adding that ?the true epicenter is the executive branch of the federal government.?

Brailer said the grassroots movement alone will not be enough. He said a national model is needed to harmonize and integrate the local exchanges. National interoperability standards would allow the RHIOs to exchange data with one another. Such a data exchange network is one of the goals of his office.

But because the RHIOs are getting under way before such standards are in place, he said interoperability may emerge as a hybrid of local, regional and national systems for some years to come. ?It?s going to grow organically? at the federal, state and local levels, he said, adding that ?the American way is that it?s going to be messy.?