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Built for the Long Haul?

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Quality Health Network passed a critical juncture in its young life earlier this year. The network, a regional health information organization based in Grand Junction, CO, wanted to move to a subscription-based fee structure. Having a fee structure in place would ensure a steady stream of revenue and help sustain the clinical data exchange, which began in 2005, says Dick Thompson, QHN’s executive director.

Luckily for Thompson, the local independent physician association—one of the founding members of QHN—endorsed the fee-based plan, agreeing to pay monthly dues for access to clinical data generated through 22 local data feeds. “The vote—which was 93 percent in favor—was a watershed,” recalls Thompson. “If doctors agree that QHN has value, how can anyone else refute it?”

The IPA’s endorsement meant that QHN might actually fulfill what remains an elusive vision throughout many parts of the country. Data exchanges are meant to be the cornerstone of a nationwide acceptance of clinical IT. When local physicians, hospitals, labs and health plans begin to exchange clinical data, they can improve patient outcomes and reduce healthcare costs. At least that’s the mantra of RHIO advocates. Data exchanges are widely visible in the industry these days. “There are 100 or more RHIOs funded by state and local governments,” observes Mike Tressler, chief operating officer at Healthia Consulting based in Minneapolis. “And there are many more less formal projects that are gliding under the radar.”

Just how many of these data exchanges will be left standing long-term remains uncertain, however. Many observers are beginning to question the longevity of RHIOs, while others are even questioning the assumption that initially spawned the efforts—that there is inherent financial waste in healthcare that clinical IT can wring out. On the bright side, many industry observers say that technology is no longer the main barrier to data sharing. Both commercial vendors and hospital systems have overcome some key hurdles, such as a master patient index and data security provisions. The key to RHIO survival, experts say, is a workable business model, one in which smallness trumps grandiose vision every time.

Fight for survival

When a longstanding, high-profile RHIO in Santa Barbara ceased operations at the end of 2006, many observers began wondering who would be next. The data exchange was associated with David Brailer, MD, the former national coordinator for healthcare IT who helped start the exchange more than a decade ago. “Santa Barbara raised everyone’s eyebrows,” says Tressler. “There was an irrational exuberance early on that RHIOs were going to make it, so it was sobering to realize we have to get practical and make these things work.”

According to Tressler, only a “small percentage” of RHIOs will become self-sustaining. Like many other observers, Tressler points to shaky finances as RHIOs’ likely undoing. After all, grant and government funding is in limited supply—that’s one reason Thompson was elated over the IPA vote. Initially QHN was funded by $2.75 million in contributions from its members, including Rocky Mountain Health Plan, two local hospitals, Hilltop Health Resources and the IPA. At first, QHN charged nothing for its services, which include access to a host of clinical data sets such as labs, radiology results and transcribed notes, in addition to services such as e-prescribing. “We had to prove the concept worked” before charging for the services, Thompson explains. He dubs the data feed “information heroin.” “Once we get the healthcare community hooked, they will never let us go,” he says.

Thompson’s plan worked, and now more than 75 percent of the community’s physicians receive information through QHN, with that number set to grow to 90 percent by mid-year. The physicians, however, did not endorse the fee plan without their own economic incentives. The at-risk IPA is devoting a portion of its insurance set-aside to physicians for participating in QHN, explains Thompson. He’s glad to have survived what he calls the catch-22 of RHIO formation. “You need to get folks who have data to contribute in large enough volume to achieve a tipping point so providers will connect,” he says. “At the same time, if not enough physicians are connecting, the sources won’t provide data.”

Can they save money?

Some observers are beginning to question one of the strongest working assumptions of data-sharing proponents: that it will reduce costs. “People say what big savings we’ll get in the healthcare community from interoperability of data. They say that we can avoid medication errors, provide better care, and avoid future costs like lawsuits,” says Alan Abramson, chief information officer at Minneapolis-based HealthPartners, an integrated delivery network that includes two hospitals and a health plan. “That’s wonderful, but I’m in the IT business, and no one monetizes future savings, cuts a check and says go buy clinical IT. There’s no ‘magic number’ where you start exchanging clinical data and IT costs go down. They go up.”

Although it has not organized a formal RHIO, HealthPartners is participating in two local data-sharing efforts. Assembling the technology to enable the two projects was not that difficult, Abramson says. “The technology barrier was among the easiest,” he says. In one project, local hospitals are using patient portal technology (with patient consent) as a way to access one another’s records. The hospital systems’ core information systems are from the same vendor, Epic Systems, which supports a personal health record for patients. Joining HealthPartners in the effort is Allina Health System and Fairview Health Services.

HealthPartners’ second project is driven by three local health plans, which recently completed a pilot of consolidating medication information. “Some people think that payers should participate in RHIOs mainly to pay, but payers have data that can benefit the providers,” he says. In the Minneapolis effort, the payers can provide a list of medications that were prescribed and filled, plus the most recent medication. It may not sound like much, but it can give providers a jump start on medication reconciliation efforts when a patient moves within the local healthcare setting, Abramson says.

Even though market competitors are involved in the data exchanges, the participants have steered clear of establishing a formal RHIO, Abramson observes. “It is not necessary to construct a big overarching bureaucracy for something being done by business trading partners,” he says. For Tressler, the HealthPartners’ projects have a better chance at longevity than do many more ambitious data exchanges. “They are not trying to build an EMR,” he says. “They are trying to exchange basic information. It has a better shot than grandiose initiatives that want to build an EMR across a community. That might be 20 years down the road.”

When it comes to data sharing, less may well be more.

Gary Baldwin is technology editor of HealthLeaders magazine. He can be reached at gbaldwin@healthleadersmedia.com