Feds look for common thread among medical info exchanges

With the pieces in place, officials say now is the time to get involved with state, regional organizations

We are seeing a convergence of multiple efforts across the country.'

'Scott Young, HHS director of health IT

Rick Steele

When Jan Root talks about the potential of regional health information exchanges, it doesn't take her long to get to the possibilities of the real dollar savings.

As assistant executive director of the Utah Health Information Network, one of the first regional health information organizations in the country, Root points to the success of the data exchange concept from any number of her organization's 1,500 members.

For instance, Desert Mutual Benefit Administrators, a nonprofit insurance and retirement planning provider, saves about $1 million in personnel costs a year using UHIN.

She talks about how Blue Cross Blue Shield, United Health Care and other large insurance companies have seen what they pay to process a claim fall to about 19 cents, while other transactions, such as those under the Health Insurance Portability and Accountability Act, are free.

'RHIOs should be about reducing costs of health care,' Root said. 'We can get rid of faxes and phone calls from providers to payers, or providers to providers. A medium-size office could reduce one or two full-time positions, and that is a big chunk of change.'

UHIN is a regional health information organization that lets members send secure messages to each other. But UHIN's approach is different from that of other RHIOs around the country. In fact, there is no common definition of a regional health information organization.

'There is some market confusion of what RHIOs will do,' said David Clark, director of integration and interoperability for the Healthcare Information and Management Systems Society, a not-for-profit industry association in Alexandria, Va. 'They come in all shapes and sizes. Some have technical infrastructures and some do not.'

Clark estimated there are about 300 of them across the country and said at least 28 counties are looking into developing information exchanges, while other RHIOs will focus on governing smaller exchanges.

Reference point

The diversity of organizations is why the federal government is starting to play a larger role. David Brailer, national coordinator for health IT in the Health and Human Services Department, recently said his office likely will not mandate what it means to be a RHIO. But it would like to set certification standards and create an objective reference point for RHIOs to follow.

'We can't say a RHIO is this or that,' he said. 'It's a term that doesn't mean anything in the sense that it's self-described. With certification, it's whatever meets this criteria. It's clean and it's done. It's the same thing with RHIOs.'

Brailer's office is trying to settle on a common description of a regional information exchange. His office hired the American Health Information management association of Chicago to develop best practices from nine state RHIOs and work with a nationwide group of experts to come to agreement on them. Under the $490,000 contract, AHIMA si to finish the project by August, said Kelly Cronin, director for the Office of Programs and Coordination in ONC.

This is the office's first foray into RHIOs, and many experts believe it's coming at the perfect time. In fact, Brailer first coined the term RHIO in a speech in July 2004, Cronin said.

'The federal government is getting involved at the right time,' said Dr. Edward Ewen, director of clinical informatics for Christiana Care Health System in Wilmington, Del., a statewide information exchange. 'The role they are playing is to continue to spur interest and growth in the private sector. This is uncharted territory for this country.'

This isn't the first attempt by the health care industry to develop information exchanges. In the late 1980s and early 1990s, some state and local governments and private-sector organizations tried to form Community Health Information Networks (CHINs) to act as information exchanges. But except for a handful, including Utah's, most failed by the mid-1990s, experts said.

'CHINs lacked a bona fide purpose for why they wanted to exist,' said Jeff Rose, founder and chief executive officer of Health Alliant Inc. of Piedmont, Calif., a nonprofit organization that helps communities develop RHIOs. 'CHINs connected a lot of technology but didn't enable anyone to do anything. RHIOs are focused on business issues.'

Ewen added that the technology to support the information sharing was far less mature than it is now, and physicians and patients were less comfortable with doing business electronically 10 to 12 years ago than they are now.

The federal government actually has been involved in RHIOs for a number of years, funding pilot programs through HHS' Agency for Healthcare Research and Quality, said Scott Young, the agency's director for health IT.

With 122 programs in 41 states, AHRQ provided $50 million for health IT projects, including $6 million a year for five years for five regional pilots.

Multiple efforts

AHRQ also launched a resource Web portal in January that features technical project support assistance and lessons learned from those who developed federally funded projects.

'We are seeing a convergence of multiple efforts across the country,' Young said. 'RHIOs are finding money from us, from state and local governments, and from the private sector. They are looking for a sustainable business structure.'

AHRQ also has funded the Health Information Security and Privacy Collaborative, which is looking at 40 state issues involving data exchange, Young said.

'The collaborative is looking at how security and privacy issues work around Medicaid and how they interplay with health information exchange,' he said. 'We don't want to see all 50 states figure this out on their own.'

But Utah's Root said the feds are focusing too narrowly.

'The government is working too fast and should step back and, instead of just looking at clinical exchanges, look at administrative exchanges as well,' she said. 'Setting up and maintaining these networks are not cheap so they should be used for as many things as possible.'

Cronin said the benefits of mobile health information lie in both clinical and administrative areas. But with a clinical focus, the immediate benefits to society are more clear, she said.

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