Mind to Market

Friday, June 01, 2007

RHIOs Call in Sick

Information Week's cover story this week, Diagnosis Critical, paints a pretty bleak picture of health IT in this country. At issue is the ability to exchange patient data between healthcare providers in a Regional Health Information Organization (RHIO). I mentioned a RHIO which I had personally experienced in a blog last January; the Integrated Physician Network (iPN) Avista. Although RHIOs have some advantages for providers and patients, the economics are not sufficiently compelling for hospitals to create them without grant funding.

The failure of a role model RHIO, the Santa Barbara County Care Data Exchange, at the end of 2006 highlights the problems facing RHIOs and the exchange of patient information. The problems ranged from too ambitious to lack of community support, but in the end the providers could not see the value in the network. SBCCDE spent eight years building their network, if they had been able to accurately predict the time and expense in setting up the system they may have been better able to set expectations. But had they possessed that information at the start would they have proceeded with the project in the first place?

Integrated healthcare systems, such as Kaiser Permanente and the UK's National Health Service, have strong economic incentive to streamline processes and reduce costs, motivating them to persevere even when struggling against daunting cultural and technical hurdles. But the loose federation of healthcare providers in the U.S. doesn't have those incentives; the costs of inefficiencies just get passed along to the consumers.

The American Health Information Community, an advisory group to the federal government, is expected to recommend that doctors using health IT systems receive higher reimbursement rates for treating Medicare patients. Although creating financial incentives to drive health IT is a powerful motivator, there are people who feel that nothing short of a government mandate will be necessary to drive adoption. I'm all in favor of holding out a carrot, but do we really think using the stick will speed the process?

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