Will state HIEs replace current RHIOs?

Although it reads as if we were all playing together in some odd health IT island on Second Life, an interesting debate broke out online yesterday.

It started out at our online virtual trade show, which SearchHealthIT editorial staffers were attending from three different locations. During the show — which had speakers like Dr. John Halamka and U.S. Office of the National Coordinator for Health Information Technology interoperability czar Dr. Doug Fridsma — I ducked out to attend another online meeting that featured leaders from Oregon, Texas and New York health information exchanges (HIE).

Meanwhile, back at the SearchHealthIT trade show, WellSpan Health CTO William “Buddy” Gillespie, one of our speakers, remarked that he thought the HIE concept could replace the regional health information organization (RHIO) as we know it. An interesting idea, for sure. It prompted an email exchange among us SearchHealthIT’s newsgatherers, debating whether or not that rang true.

Our consensus? We didn’t know.

At the time, I happened to be sitting in on this other virtual meeting — sponsored by Symantec — with 15 other journalists and the three state HIE decision makers. At my home computer, monitoring my colleagues’ email and instant messaging the others, I pasted the HIE/RHIO question into the online meeting’s Q&A mechanism and put it to them.

Wow, they said, that is a great question. The representative from Oregon said she thought yes, state HIEs could possibly replace the RHIO concept — but only in some cases. An example might be in regions where “RHIO” could be defined as competing large hospital systems running, in effect, private RHIOs within their walls and not sharing with one another for competitive reasons.

The guy from Texas — and it’s unclear whether he had a cowboy hat on, because the online meeting didn’t support video — felt that RHIOs would always be needed, because state HIEs are underfunded, government typically is inefficient and the stimulus money will run out before they can build the needed infrastructure. If robust health information exchange ever comes to pass, it will require public-private cooperation to get it done, he felt.

The New York HIE leader said that if a strong local RHIO was in place already and running well, a state HIE probably wouldn’t add much value and therefore the RHIO wouldn’t get replaced. But in those locales where there is no RHIO — or one that isn’t doing a lot — the state HIE might add value for local patient care and could supplant it.

All of them agreed that the system of RHIOs and HIEs in the United States is an emerging market and no one really can know for certain where it’s headed. But health care providers should watch this trend closely as they help build out the nation’s health IT infrastructure.

Interesting ideas, and none of them exchanged face-to-face. Just another day at the (virtual) office.