It’s that languid time of summer when even rebroadcasts of last year’s college football games are starting to look good.
I’m incapable of walking into a store without making a mental list of how they could perform better. I guess I’m just naturally curious. Every now and then I get a good idea; other times I’m just wasting air. I’ll let you be the judge of this one.
The value of a national network (EHRs to Rhios to NHIN) is the exchange of information. If the Rhio neither adds, changes, or deletes any information and simply passes it upstream, is there an argument to be made about whether the Rhio adds any value to the process? Can Rhios be eliminated without decreasing the value of the national network?
What do you think?
Pale Rhino Consulting 
Part of it is the walk before you run concept. Secondly, I was under the impression that a RHIO was expected to be able to operate in the absence of the national network. Partly because of store and forward for infrastructure outages, but also as the primary backup for the national network – albeit regional. The risk mitigation depends upon how they build out the comm infrastructure between the RHIOs and the NHIN. Extreme redundancy makes a stand-alone RHIO less important. Then if you peel it back one more layer, the failure of the power grid could also negate a link to the HNIN even if comm redundancy was optimal.
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I understand the concept of what you wrote, but the design does not address the question of where’s the value add if the Rhios just hand the data from the EHR to the NHIN. Has anyone seen a combined estimated cost for for all the Rhios? Is it fair to assume it’s near nine figures? Probably more than the cost of the NHIN? If so, that’s a lot of money to pay just to back up the thing you really need. Isn’t that like me saying I need a flashlight, but in case the batteries die I’m going to buy 100 smaller flashlights?
I know this is a somewhat specious argument, but isn’t this like over-planning for failure? Should the total cost of the backup exceed the cost of the primary? Wouldn’t it be cheaper to have two NHINs? Of course that’s silly, but I think that’s the entire point–isn’t it?
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Point taken. I chewed on it some more after I posted and reasoned that the vast majority of the data access would even be at the EHR level anyway, not regional. Loss of access to the NHIN on any given day would still impact a minor fraction of 1%. Your view on cost is dead on since it’s way cheaper to build out 2 mega SANs vs. 10 smaller ones, for example. The incremental cost per bit is far cheaper and you have fewer points of failure. I’m converted now, though I’m still cautious about data protection since I’ve seen data loss fall through 2 layers of protection and thankfully, level 3 (the last one) was recoverable.
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I think the main point is that we’re having trouble getting quality RHIO’s established. If creating something that’s much smaller in scale is having trouble, why do we think that we can somehow create a national one? To your point. If the RHIO is just passing data, then it is pretty useless.
I think it’s worth considering the opposite question. Is there a need for an NHIN if we have a bunch of RHIO? How many people regularly travel outside of their RHIO and need healthcare? Not very many. So are RHIO sufficient? Plus, once you connect all the RHIO you have a virtual NHIN anyway.
Scott,
In regards to your comment “it’s way cheaper to build out 2 mega SANs vs. 10 smaller ones.” This is true. Unfortunately, the real question is whether 2 SUPER MEGA SANs is cheaper than 10 mega SANs. Point being that I think an RHIO is larger enough that you already experience the cost savings of scale. In fact, back to my first point, the NHIN would be such a large “SAN” that it’s complexity makes it more expensive to create, manage and maintain in my calculation.
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