The RHIO Answer

highlighter-yellowIt may be helpful as you read this to use your highlighter on the screen to accentuate the important parts or some white-out for the parts you don’t favor.

Do you ever kick an idea around, speaking about it, writing about it, until at some point you finally capture it in a way that makes sense to you?  That’s how I reason things through.  I write like I’m talking aloud and sometimes it lands in my lap.

That just happened to me as I was trying to get my arms around what it is about the concept of the RHIOs that has been bothering me.  Bear with me.  I was on LinkedIn emailing someone using the ‘send a message’ feature.  I was returning an email which she was returning which I had initiated.  The process works like this.  I get an email from LinkedIn telling me I have a message.  I go to LinkedInm read the message and send a reply via LinkedIn.  She receives an email indicating she has a message, goes to LinkedIn, and so forth and so on.

Do you see it?  In this scenario, what is the added value provided by LinkedIn?  Nothing.  It’s all hat and no cowboy.  LinkedIn serves simply as a pass through, contributing nothing.  I wrote in my message to her, “Send me your email address, I feel like I’m in my own RHIO.”

When is a RHIO not aRHIO?  When there’s no need for it.  Is there any functionality intended for the hundreds of RHIOs which couldn’t be dealt with at the N-HIN?  What do you think?


4 thoughts on “The RHIO Answer

  1. (Not a user of LinkedIn, but I would say the “value added service” is the buffer of anonymity. May or may not be of value to YOU at any given point in time, or even the only/best way of doing it, but that’s the benefit. Not all hat, there is a midget cowboy there.)

    What kind of “intelligent device” are you talking about?

    A PDA in the patient’s pocket? Or a cloud server ? Something in between? Where does the data actually live?

    And who controls access to the data ? I guess the patient always does in a global sense, but how finite is that control?

    One vision (very simplistically explained) might be a PDA-ish thing that the patient plugs into the Doctor’s USB port during the visit and examination. But if the info isn’t accessible when the doctor’s office needs something for billing the next day, or the patient calls in with a follow-up question, and all that history information is gone, then from the health care provider’s point of view, that’s an unsatisfactory, and probably unworkable, solution. (Personal stance: I’m in favor of doctors working more from actual records and notes, and less from memory.)

    Another vision of a comprehensive electronic health record that a “personal portable intelligent device” enables would be the (potential) ability of the patients to selectively control who sees what. From the patient’s point of view, that probably sounds close to ideal.

    But from the health care providers’ point of view, that sets up a situation where a patient can inadvertently … or intentionally … hide information that is highly relevant to the diagnosis or care of the patient. If the doctor can’t count on the fact that all known relevant info is being presented, then his legal and malpractice attorneys WILL say “you cannot rely upon the info in the patient’s carry-around health record as the basis of your diagnosis and care decisions, you need to acquire and your own copy in your own records.” Under that scenario, the patient’s personal health record is of almost no value to “the health care system,” it’s just a personal diary of sorts. And thus adds nothing to the national need to reduce duplication of records, scattered silos of unconnected info, or the need to re-order tests and imaging simply because the version of the patient record that the physician is looking at doesn’t include them.

    (I had more written but I’m not sure it was going anywhere terribly useful.)

    For these reasons, my instincts are that a personal health record wrapped in an intelligent device could be incompatible with the “needs” of the “health care system.” If it doesn’t allow access to all the information, at any time, to any h.c. provider or payer, then the benefit likely will not exceed the cost.

    (I said payer rather than insurance company, because I’m not sure that the underwriting side of insurance companies should ever be allowed to have systematic access to machine readable comprehensive health records.)

    So what do YOU mean when say “intelligence device” and postulate that RHIOs are all-hat, no-cowboy? Feel free to point me at previous writings you’ve done, I arrived here via a Google-alert and for better or worse have no history of where you’re coming from.



    • The post reads:

      Do you see it? In this scenario, what is the added value provided by LinkedIn? Nothing. It’s all hat and no cowboy. LinkedIn serves simply as a pass through, contributing nothing.

      As you can read, there is no mention of Rhios regarding the hat and the cowboy. That statement only refers to LinkedIn.

      Regarding your comments about the “device.” The brief phrase was meant rhetorically as a non-starter, a throw-away. Since my perspective on the Rhios is that they are a pass through and do not change the data, no device would be required.


  2. Hi Paul,

    As to the LinkedIn concept, my take is that you see it as merely a pass through. All hat and no cowboy.

    RHIO’s for that matter are also a pass through, they do NOT change the data..they may allow more users access to the data, by reason of their name and loosely implied definition.

    You do not require a device of any sort to belong to one. In fact RHIO’s are sort of like high priced country clubs. You gain membership through inflated cost. But golf is still golf.

    The sharing of intelligent information does not require a RHIO…what is their need?

    If the purpose is to tie up disparate offices in a regional health “Conglomerate”, then the RHIO has a structure, again, loosely defined.

    An intelligent device, such as a clinical health record, or health information exchange, is a better idea. It is Interoperability we are all seeking. Care across a patients care continuum.

    We want to be sure that Grandmother’s nursing home is acutely aware of the medications, tests and procedures that were done at the IM, PT, DO, and hospital. We want to be sure they do not d/c meds from the PBM, or the Nursing home, just because they are high dollar. We want to be assurred that everyone is equally aware of Grandma’s illnesses, and are all involved in the same “Plan”.

    RHIO’s do not accomplish this. Intelligent highways of health information does.
    Interoperability. It does not make sense to tie up health providers into one org, called a RHIO. It DOES however make sense to share information along a patients care continuum.

    We do not need RHIO’s to accomplish better outcomes. Just like we do not necessarily need LinkedIn to communicate.


  3. RHIOs that provide health information exchange to a region are typically serving in three different capacities:

    1. a convener of the healthcare stakeholders in a community, and the governance and collaboration associated with it
    2. a provider of health information exchange, which connects often isolated sources of clinical information for the benefit of patients so that a more comprehensive, longitudinal record is available for validation, discovery and processing
    3. a vehicle to assist in HIT adoption

    The intent of this is to improve the quality, safety, and efficiency of care for all stakeholders but with a primary focus on the patient. I would suggest that there is a pragmatic aspect to HIT adoption that is often ignored– physician groups, hospitals, health plans, nursing homes, etc are not always collaborating — in some cases communicating — for the benefit of the patient. This occurs for many reasons, some good and some not so good. RHIOs offering health information exchange bring the key players to the table (including consumer representation), have them agree not to use patient information as a competitive tool, contribute their clinical data collected in the normal course of their healthcare business, and embed this in their patient care decision making.

    Oftentimes the value of RHIOs is focused solely on the health information exchange component, which is critical, but only one component of what a RHIO delivers to its stakeholders. Providing the collaboration vehicle, convening the community and governing the organization as a collective function is as important as the HIE itself. Yet, if the information is not used in the course of patient care, the value proposition fades. As a result, a RHIO’s role as an HIT adoption, service-oriented organization seems equally important.

    At some point, in any model, the data must be shared and then clinically adopted into workflow. If a RHIO serves that role, great. If there is another effective vehicle that is providing results, let’s put energy behind it. Chances are it is different in each community and, like it or not, care still has a strong regional influence.

    By the way… I think the LinkedIn message piece is annoying, as well, at least after the initial contact. Once I make the connection, let me email using my preferred instrument and the same for the recipient. In the world of RHIOs, I would liken it to HIE being accessed through a portal versus pushing the information directly into your native clinical system (EHR, hospital information system).


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