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A journey to RHIO

November 1, 2006
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Regional health information organizations are starting to gear providers up for electronic health records—and nursing homes are invited

As electronic health records (EHRs) and integrated clinical information systems become commonplace, more healthcare provider organizations are beginning to come together to create the next step in healthcare information technology—regional health information organizations, or RHIOs. They offer the promise of improved patient care and enhanced provider organization efficiency. What's more, the federal government is promoting the concept of RHIOs as a key element in the ultimate drive towards a National Health Information Network (NHIN).

Where is the place for nursing homes in this new interconnected world? To date, only a handful of RHIOs are actually up and running and sharing clinical data, so the horizon is still a bit distant for this concept to apply to nursing homes. But within the next year, according to numerous surveys, dozens of RHIOs may be up and sharing data in real time. And, though only a very small number of long-term care executives say they are actively involved in RHIO development, that number, too, could leap ahead fairly quickly in the next couple of years.

For physicians with patients who are nursing home residents, the potential for better and smoother hospital admission and discharge processes seems likely because of RHIO-based data availability, while nursing homes themselves could benefit from regionally, and eventually nationally, shared clinical data to improve coordination with hospitals and overall patient care.

What's going on with RHIOs right now? A small number of nursing home executives are actively involved in some level of RHIO-related planning or activity. One is Gary Kelso, president and chairman, Mission Health Care Services, a system of four nursing homes, based in Huntsville, Utah. As president of the Utah Health Care Association (UHCA) and a member of the Health Information Technology Committee (HIT) for the American Health Care Association (AHCA), Kelso has naturally become involved in working with other long-term care executives, as well as executives from all sectors of healthcare, to bring his own organization and his state and national associations into collaborative initiatives. Describing him-self as “something of a geek,” Kelso says it's clear that technology cooperation will be essential to overcoming those staffing, cost-inflation, and reimbursement crises in which long-term care is perpetually enmeshed.

“We've got to do things faster, smarter, cheaper,” he says. “I wanted to get involved in a process, so I got involved with the HIT committee. Before that I had formed a committee with the Utah association, working with the state department of health. We wanted to make sure that long-term care was not a ‘stepchild’ as RHIOs were developed. So I met with our local RHIO, explored what they're doing, and asked how we could become involved.”

The statewide RHIO, called the Utah Health Information Network (http://www.uhin.com), has been live since 1994 (it started out as a community health information network, or CHIN, back in the 1990s, when CHINs were popular). It already connects all the state's hospitals, 95% of its physicians, all its labs and psychiatric hospitals, and long-term care for claims purposes, notes Jan Root, PhD, UHIN's director. The next step, and one in which Kelso and other UHCA member-organization executives will be involved, is to create a statewide clinical network under the RHIO's sponsorship that will begin exchanging clinical data among providers. The software that Kelso and his colleagues at Mission Health Services are codeveloping with a vendor, the Salt Lake City–based BlueStep, Inc., will provide a platform for nursing homes to share data with acute-care and other providers.

At the same time, UHIN is working “very quickly” with [the Salt Lake City–based] Intermountain Healthcare and Utah Department of Health to create full-fledged statewide provider clinical data exchange, Root says. “We don't want to be left out in the cold; we want to have the ability to be linked in with either e-prescribing or e-medical records. For example, with this software, if a resident moves from one building to another, part of the file can immediately be transferred to whoever needs it.”

The RHIO is starting out modestly with a transorganizational messaging system (i.e., focusing on messages that often need to be documented on paper by hand) for clinicians, Root says. “Right now, we have just three sites—one clinic, one hospital, and one health plan,” all exchanging electronic messages around clinical information. Root's organization hopes to move beyond this initial pilot this autumn and, she says, nursing homes are welcome to participate along with other providers. Sometime next year Root hopes to convert this “early-adopter” project into a statewide clinical messaging system that will pay its way through some sort of per-message fee system.

In fact, across the United States, a wide variety of business and operational models are emerging among the RHIOs being developed. In Virginia, for instance, the Richmond-based MedVirginia, operating as a for-profit entity but with primary sponsorship from the Marriottsville-based Bon Secours Health System, Inc., is already processing more than one million messages a month, and already has more than 370,000 unique patients in its database, according to MedVirginia CEO Michael Matthews. “And we just see the data becoming richer as time goes on and we get additional data suppliers into the system. Our model is a community utility,” he adds, and says he welcomes participation by all types of pro-viders in the state, including long-term care.