San Diego County has become the latest community to launch an effort to share patient information across disparate health care providers. Over a hundred so-called RHIOs (regional health information organizations) have sprung up in recent years, encouraged by the federal government.
RHIOs are expected to give health providers more complete information about patients, resulting in more appropriate and less redundant care, but efforts are hampered by murkiness about how data will be stored, maintained and protected and by who will shoulder the associated costs.
San Diego’s RHIO would encompass 20 hospitals; 7,000 physicians; 2,700 health and human resources professionals; 370 pharmacies; all health plans; private labs; the Department of Public Health’s Immunization Registry; as well as community clinics. In the proposed system, every health care provider would own and maintain its own data about patients, and Sun Microsystems would provide a framework that would pool current patient information from multiple providers without setting up a separate repository to store it.
“The data to make a single patient view that may come from a collaboration of 12 different sites,” said Wayne Owens, vice president, Healthcare Integration Platforms, Sun Microsystems, Inc.
This so-called federated model is the least expensive and sidesteps issues about data ownership, said Stephen Carson, chief medical officer of the San Diego County Medical Society Foundation, the non-profit group that is shepherding the RHIO. Providers can continue to use whatever technology they’ve already put in place “We’re not asking any physicians or labs to do anything other than give the time needed to plug into the network,” he said.
The most remarkable resource for the San Diego RHIO is that the entire health care community seems to be on board, said Scott Tiazkun, research manager at consultancy IDC, who recently completed a report on how RHIOs can be organized.
The real test of the RHIO’s success will be whether health care providers will actually access available information and find it useful. Most physicians do not use electronic health records. Although San Diego clinicians would still be able look at patient information collected by other providers through a secure Web-based system, there is no guarantee they will do so. If they don’t, other efforts to promote health IT might stagnate.
On the other hand, said Tiazkun, “the project could drive providers toward technology, and so grow the market for the vendors.” Carson said that doctors using paper records might be able to use the RHIO as “a practice EMR” and be able to experience the advantages of such systems firsthand.
The project will launch in phases, starting with a simple directory that clinicians can use to identify nearby pharmacists and specialists. But Carson envisions that within three years San Diego patients won’t need to fill out clipboards, receptionists won’t have to keep track of copayments, and clinicians can see results of previous lab tests when the information becomes relevant to a patient’s care.
Sun Microsystems is simply providing tools to integrate and display information from other clinical systems; it will not be providing EMR systems itself or deciding what kinds of medical information should be collected and shared. Sun Microsystems will be using technology from its acquisition of SeeBeyond to provide interfaces between different kinds of technology. However, some institutions have found that eliminating interfaces is a better strategy.
In an interview in May, Bill Lewkowski, CIO of MetroHealth said that interfaces don’t always work as well as they should and can require additional updates. “Every time SeeBeyond updates, we have to migrate to a new platform, and that’s painful and costly,” he said.
Though neither Sun nor San Diego are releasing exact pricing data, the project seems relatively inexpensive, with hospitals paying perhaps $100,000 each. San Diego health providers were very concerned that the RHIO could be self-sustaining, said Carson. His foundation will put up the funds to get the RHIO infrastructure in place, but health care providers and payers will then split maintenance fees. Owens estimated that the necessary hardware for the project would cost around $50,000 because it would work from hardware clinicians already have. Sun will host any necessary data and design interfaces necessary for different systems to communicate.
RHIOs with federated organization are often considered the most advanced. Another mode of organization is the co-op model, in which one organization houses data. This eliminates some difficulties in matching up records for the same patient from different institutions and can streamline technology costs. Hybrids organizations combining elements of both the co-op and federated models also exist.
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