JAMIA: Is doing away with RHIOs good for NwHIN?
An article published in the Journal of the American Medical Informatics Association on Jan. 21, questioned whether the federal government’s shift away from regional health information organizations (RHIOs) in favor of information exchange is best for the Nationwide Health Information Network (NwHIN).
Leslie Lenert, MD, MS, department of medicine, University of Utah in Salt Lake City, and colleagues wrote, “In the midst of a US $30 billion investment in the NwHIN and EHRs systems, a significant change in the architecture of the NwHIN is taking place.”
Prior to 2010, Lenert wrote, the focus of information exchange in the NwHIN was the RHIO but since 2010, the Office of the National Coordinator for Health IT (ONC) has been “sponsoring policies that promote an internet-like architecture that encourages point-to-point information exchange and private health information exchange networks. The net effect of these activities is to undercut the limited business model for RHIOs, decreasing the likelihood of their success, while making the NwHIN dependent on nascent technologies for community level functions such as record locator services.”
Lenert cited as an example of a "public good" implemented within many RHIOs the potential capability to quickly and automatically locate and retrieve most relevant EHRs for a patient, which “was a critical design feature of early RHIOs.”
He said RHIOs serve other functions in communities that may be difficult to duplicate at a state or national level, such as serving as a forum for developing consensus-based data use and reciprocal support agreements (DURSAs) among healthcare data across entities within a region. "DURSAs contain the policies related to use and re-use of data for research purposes, system access, security, patient access and consent. DURSA agreements play an important role in the dynamic security of data exchange, specifying security levels, logging and tracking of transactions, and responses to findings of malicious software."
Lenert said that changes in the policies of the ONC put RHIOs at risk since the HITECH Act did not provide direct funding of RHIOs and the ONC did not renew funding from its congressional appropriations to support existing RHIOs. He called for an open debate in the development of “scientific consensus before irrevocable commitment to one model or another for the NwHIN is made.”
Leslie Lenert, MD, MS, department of medicine, University of Utah in Salt Lake City, and colleagues wrote, “In the midst of a US $30 billion investment in the NwHIN and EHRs systems, a significant change in the architecture of the NwHIN is taking place.”
Prior to 2010, Lenert wrote, the focus of information exchange in the NwHIN was the RHIO but since 2010, the Office of the National Coordinator for Health IT (ONC) has been “sponsoring policies that promote an internet-like architecture that encourages point-to-point information exchange and private health information exchange networks. The net effect of these activities is to undercut the limited business model for RHIOs, decreasing the likelihood of their success, while making the NwHIN dependent on nascent technologies for community level functions such as record locator services.”
Lenert cited as an example of a "public good" implemented within many RHIOs the potential capability to quickly and automatically locate and retrieve most relevant EHRs for a patient, which “was a critical design feature of early RHIOs.”
He said RHIOs serve other functions in communities that may be difficult to duplicate at a state or national level, such as serving as a forum for developing consensus-based data use and reciprocal support agreements (DURSAs) among healthcare data across entities within a region. "DURSAs contain the policies related to use and re-use of data for research purposes, system access, security, patient access and consent. DURSA agreements play an important role in the dynamic security of data exchange, specifying security levels, logging and tracking of transactions, and responses to findings of malicious software."
Lenert said that changes in the policies of the ONC put RHIOs at risk since the HITECH Act did not provide direct funding of RHIOs and the ONC did not renew funding from its congressional appropriations to support existing RHIOs. He called for an open debate in the development of “scientific consensus before irrevocable commitment to one model or another for the NwHIN is made.”
Beth Walsh,
Editor
Editor Beth earned a bachelor’s degree in journalism and master’s in health communication. She has worked in hospital, academic and publishing settings over the past 20 years. Beth joined TriMed in 2005, as editor of CMIO and Clinical Innovation + Technology. When not covering all things related to health IT, she spends time with her husband and three children.