Welcome to RHIO

What’s a RHIO you ask, and what does it have to do with simplifying health care?  RHIO stands for Regional Health Information Organization, and has been defined as “A nongovernmental organization charged with overseeing business and legal issues involved in the exchange of interoperable electronic health information among patients and providers within defined regions..”

Alright, what’s interoperable mean? “The ability of one system to send, receive and use data from another system”

So a RHIO in concept  facilitates seamless electronic transactions and flow of information between the three P’s (patients, providers and purchasers). Thus in theory a RHIO would move us well along the way towards simplification.

Do RHIOs exist anywhere besides Area 51, hidden under the Roswelll flying saucers? They do indeed exist, but are in the stages of infancy in many parts of the country.

Being they are still in the developmental stages, definitions connected with RHIOs are certainly subject to change. There is currently not a standard or regulation defining regions that RHIOs are to operate within. Furthermore, as a voluntary effort stimulated by public policy and funding, there is not a mandate that they must exist. Much of federal discussion regarding regional boundaries has used Medicare regions as a starting point.

The e-Health Initiative RHIO Governance Project recommends that "the RHIO Entity be organized as a [State] nonprofit public benefit corporation. We further recommend that the RHIO Entity seek recognition from the Internal Revenue Service as a tax exempt organization described in Section 501(c)(3) of the Internal Revenue Code."

Holt Anderson, of the North Carolina Healthcare Information and Communications Alliance (NCHICA) defines and expands upon RHIOs as follows: "Regional Healthcare Information Organizations (RHIO)-A collaborative, consumer-centric organization focused on facilitating the coordination of existing and proposed e-health initiatives within a region, state, or other designated local area. RHIOs provide leadership, oversight, fiduciary responsibility and governance for the development, implementation, and application of secure health information exchange among healthcare industry stakeholders within the region. Components of a RHIO may include:-Wide representation of health providers, payers, state and local government, public health, clearinghouses, vendors, researchers, and other interested organizations;-Defined purpose and objectives related to the facilitation, promotion and implementation of a local health information infrastructure;-A governance structure that facilitates the implementation of project-specific activities aimed at advancing the local health information infrastructure; and-Coordination with other RHIOs to leverage opportunities, experiences and lessons learned."

There are three primary resource organizations beyond the Office of the National Coordinator for Health Information Technology (ONCHIT) that are providing funding, guidelines and administrative resources towards RHIO development:

• eHealth Initiative: the Foundation for e-Health Initiative "provides seed funding and support to multi-stakeholder collaboratives within communities (both geographic and non-geographic) who are using electronic health information exchanges (HIE) and other information technology tools to drive improvements in healthcare quality, safety, and efficiency." Through their program Connecting Communities for Better Health (CCBH), nine different entities across the country have been awarded grants for RHIO development.
• AHRQ- the federal Agency for Healthcare Research and Quality is providing guidance and limited grants through the Transforming Healthcare Quality Through Information Technology (THQIT) program, which "is aimed at improving health care quality and patient safety by promoting the development, adoption, and diffusion of health IT in a variety of important health care settings. This initiative will include a special focus on small and rural hospitals. " AHRQ has also funded the National Health Information Technology Resource Center (NHITRC)- which serves as a repository for Best Practices, provides Technical Assistance for Grantees, and Provide focus for collaboration. 
• WEDI Regional SNIP Affiliates (RSAs): the Workgroup for Electronic Data Interchange will be convening a RHIO Policy Advisory Group (PAG) to further discuss and develop recommendations for the National Coordinator for Health Information Technology (NCHIT), and has established the Strategic National Implementation Process (SNIP), "dedicated to improving healthcare through Electronic Commerce." Through an application process, Regional SNIP Affiliates (RSAs) have been named that ere receiving WEDI support and resources.

Public policy is big on RHIOs. The Department of Health and Human Service runs the Office of the National Coordinator for Health Information Technology (ONC), which lists their Goals of Strategic Framework in this regard at http://www.hhs.gov/healthit/goals.html

There are many organizations across the country providing funding and resources for specific initiatives as well. For example, The Massachusetts e-Health Collaborative, received major funding from Blue Cross Blue Shield of Massachusetts.

However, funding is the major obstacle to further development of most RHIO initiatives. An article appeared earlier this month (Nov. 12^th) in the AMA’s newlsletter AMNews: “RHIOs hit financial stumbling blocks on path to national network”  The article states “Unless regional health information organizations tap into additional funding sources, establishing a national health information exchange will be more difficult than initially predicted….. The problem, experts say, is too much reliance on federal and state money and not enough fundraising and support building on the local level, including tapping hospital systems and physicians for financial support.” 

If you want to stay tuned to what’s going on in RHIO land from the viewpoint of public policy, you can register for the free Health-IT Listserv at https://list.nih.gov/archives/health-it.html