What is a RHIO?  What is an HIE? (Overview of EHR's, PHR's, and NHIN)

 

Introduction

 

A RHIO is a Regional Health Information Organization.  It performs technology services to the healthcare community and includes Health Information Exchange and Electronic Health Records. 

 

RHIO's try to serve geographic regions.  Regions have different views of how healthcare should look based upon local preferences, culture, and the local economy.

 

A RHIO functions as a convener and organizer of other entities. Participants include doctors and hospitals, social service agencies, government and municipalities, and people who are consumers of healthcare.  The differentiator and the common denominator that sets RHIO's apart from other organizations focused on healthcare is the use of technology.  

   

A RHIO plays a number of roles among its many participants. 

As described further below, some of the roles a RHIO can play include:

 

Repository of Clinical Information

Advisement

Convener

Product and Service Evaluator

Reseller of EHR and PHR

Help Desk and Technical Support

Data Center for the Private Practices of the Region

Consumer and Provider Advocate

Trainer

 

Relationship to HIE

 

RHIO's and HIE's are related organizations.  HIE's are Health Information Exchanges.  They move or store health data for their participants.  A RHIO can exist separately, be combined with an HIE, or even have multiple HIE's serving them.  SunCoast RHIO falls into the third model.  This is further explained below for those who wish to know more.  RHIO's perform on a much broader scale than HIE's and are people and organization oriented.  HIE's are computer and process oriented. 

 

Historically, people have thought of Health Information Exchanges or HIE's as computer centers that keep track of health information.  This term used to be interchangeable with the name RHIO.   HIE's do exactly what the name implies, they exchange clinical data about health care with other organizations or people.  Sometimes this includes financial data as well including claims and benefits and other financial information.

 

When we speak of clinical data, we generally mean the following broad categories:  Demographic s - who you are, where you live, what sex you are, and when you were born.  Referral Data - what doctors have you've seen and why and what they have to say about you; History Data - what illness did you and do you have a diagnosis for, where and what was your treatment, how long ago was the diagnosis, was it correct, what tests did you take and what were the results, what are your allergies;  Labs, pharmacy, and XRay's - what is your current blood profile, what drugs were you and are you on, and what radiography tests have you taken including computer images of those tests.

 

Three other acronyms will be briefly discussed in this section: The Electronic Health Record or the EHR; The Personal Health Record or the PHR; and the National Health Information Network or the NHIN. The first two are products and the last is an organization and a planned infrastructure for the nation.

   

Brief History and Overview of RHIO's in Florida and other States

  In Florida, there are approximately five RHIO's in the different regions.  Each is unique in its own way yet all strive towards the same goal, enabling Health Information Exchange. 

RHIOS's, previously called CHINS or Community Health Information Networks, have been in existence for many years.  Their history was unique to their served community.  Some succeeded and some failed.  Some were managed completely by the state or local government, others evolved in a total free market system, and a third class was somewhere in the middle.

 

Of those that didn't last, many studies were done to understand why.  There were many findings but the ones that stood out in many cases were the following: The effort did not have sustainable business model;  the effort was overly grant dependent;  the organization was run for a narrow purpose that did not address the overall health needs of the community they served;  The effort or organization was run by technology focused individuals who were not conversant with the health care community of doctors, nurses, Labs, radiography centers, pharmacies, health departments, consumers, and administrators;  the organizations' management did not fully understand the needs of their community leadership and misunderstood the need to have the active involvement and support of those leaders in their efforts.  (The recent rise of the job of the Chief Information Officer or CIO of major hospitals was a major catalyst to the change in acceptance.  These individuals are business and healthcare focused and understood the technology as an enabler to attain community health rather than an end product itself.)

    

The SunCoast RHIO

 

The SunCoast RHIO utilizes the clearing house approach to Health Information Exchange.   We offer products which include Electronic Health Records or EHR's, Personal Health Records or PHR's, multiple HIE systems and HIE's in other states.

 

We have a strong consumer as well as a free market business friendly customer base.  We are differentiated by our support of multiple HIE solutions encompassing existing systems, and physician private practice systems, and clinics.  Our coverage area in Southwest Florida covers many different cultures and because of our approach to supporting multiple solutions.  Our RHIO is not dependent on the HIE's around it.  They can succeed or fail without affecting the sustainability of the RHIO.

   

Being neutral and embracing the overlap of the free market and the social aspects of healthcare delivery helps us to define regional standards and contribute to the national efforts in standards definition, and allows us to seek investment through foundations and venture capital while, at the same time, embracing grass roots efforts.  As a "Trusted Broker", of services, SunCoast RHIO can also help our hospital and clinic participants in the areas of Disaster Recovery and Business Continuity as well as helping the government with information dissemination, consumer and provider education, and research.

 

The SunCoast RHIO also acts as consultant and advisor to many parties.  SunCoast RHIO is well equipped to deal with government contracts and is registered in all required grant databases such as grants.gov, CCR, and eCommons.  

 

As a community members, we work with others to promote Economic Development through affiliations with organizations in the region as well as in the rural areas.  In many cases, healthcare is the initial reason to install a network into an area thereby establishing an infrastructure that can be used to springboard other industries and jobs. 

 

We also work with educators and educational institutions at all levels to help foster apprenticeships, educational credits toward degrees, and to perform research.

   

Electronic Health Records, (EHR)

 

EHR's are primarily outgrowths of Hospital information systems.  Over the years, hospitals developed and purchased technology in order to make billing and collections more streamlined.  As Laboratory and Radiography systems emerged, it became clear that all parties profited by having an integrated system.  Hospitals kept patient records in paper format called the medical record.  These paper charts still exist today and became the common denominator for automation.  Finally, clinics and private practice doctors who needed to keep accurate records and have interfaces with the various hospital systems (usually by having privileges to practice there) and by having a need to see lab and Xray results, drove the automation process of the medical record from paper to computer more quickly.  This was added to by the need to know the findings of other doctors and providers, to  view and make referrals, and the need to automate the paper records in their own offices and clinics as well.

 

Some technology vendors saw the need to have private doctors records interfaced with billing systems and hospitals systems as well, and created products that were aimed at the doctor's office, the hospital or both.  Notable vendors such as Allscripts and Sage emerged.  Over time, the hospital vendors and the doctor office vendors began to merge products as well.  As the field progressed, new functions were added including the ability to perform Computerized Physician Order Entry or CPOE, the ability to see results of tests, physician and nurse documentation, medication reconciliation, clinical decision support, and performance measurement.  Today, products that perform these functions or a subset of them make up what are known as the Electronic Health Record Market.

 

As electronic evolution progressed, it became evident that these products should have some common computer basis so that interoperability and exchange of the data could someday occur.  A number of organizations were formed to help guide this effort.  Two notable organizations are the CCHIT and the HL7 working group.

 

Personal Health Records

 

PHR's are in the infant stage.  They are software products much like EHR's but, where EHR's are primarily for provider use, PHR's are consumer controlled and managed.  An EHR has doctor notes and other confidential information that has legal impact to the provider.  A PHR can include many of the same items however, at this time, is not a record that carries liability.  It is the patients record of what is wrong or right with their health.  It is a history of medications including over the counter remedies the person may take, it has demographic information and most likely insurance and next of kin or proxy information. 

 

There are many applications of PHR that could end up being standard information.  The consumer may choose to put information of those they care for on the PHR, emergency numbers, doctors, (ICE  or "in case of emergency" contacts, (this can also be placed in the cell phone along with the RHIO phone number which has other information)), wills - final and living, Healthcare directives and DNR's, and even financial records such as trusts, insurance, and custody agreements or where such documents could be found including bank address or safe deposit box.  Using a broader definition of good health, some individuals have placed telephone, checking account, or utility company records and phone numbers in PHR's and have notified these companies that they are the primary contacts for managing a person's affairs such as often happens with those with dementia, children, or those who are assigned guardians.  Executor designation can also be used.

 

Doctor consults, doctor emails, and appointment scheduling as well as lab results are sometimes used as are prescriptions, drug interactions, alerts, allergies, and when and where a prescription may be ready for pick up.

 

PHR's are pretty much an open area for development today and are primarily consumer driven.  There are many vendors in this emerging market.  Two of the biggest are Relay Health and Microsoft HealthVault.

  

The National Health Information Network (NHIN)

 

This will be the Nation's health network of networks.  It does not exist today as a single working entity but work is currently being done in the areas of defining what it will be and how the data will be exchanged over many different systems and networks.

 

One way to visualize the vision is to view the NHIN as the overall umbrella healthcare network of the country.  The NHIN is fed by state level networks which are in turn fed by regional organizations such as the RHIO's and HIE's or the particular state HIE.  In SunCoast's case, it is hoped that our RHIO will act as the clearing house for the various HIE efforts in our defined region.  Hospitals may be their own HIE's.

 

One view is that it will act much like the Federal Reserve Banking Network of central banks that supports our financial system.  Lessons from this model can help define how the NHIN may work in limited ways.  For example, the "Fed" controls inflation and other economic states of the economy with tools such as interest rates and money supply.  The future NHIN will need a focused purpose as well as tools to help optimize Healthcare delivery, healthcare costs, healthcare availability, and access for the consumer.