Mr. Histalk picked up on an interesting nuance in a speech by David Brailer at the recent HIMSS meeting. Here is the link to the Brailer speech. Brailer is the national coordinator for Health Information Technology for the Department of Health and Human Services. Here is the link to the comment from HIStalk (scroll down) with a cut-and-paste from it below.
Does David Brailer really support the IT work of RHIOs? Some have speculated that he doesn't, preferring as a business-friendly guy to instead to turn the whole package over to a big-bucks vendor like IBM or Cisco and let RHIOs deal only with the politics and collaboration. An interesting quote that may reinforce that speculation, one I must have missed in his HIMSS speech: “I did not start out by believing the national solution will be a network of regional networks. Our goal with the national health information network is to allow those who do not want to participate in RHIOs to not have to do it." I'm not so sure that the work being done by various groups is operating under that same assumption.
If you believe that regional sharing of health data is important and that regional networks are an important next step, the question arises about how to build the network infrastructure. It seems to me that there are at least two possible approaches -- bottom up and top down. If you choose the former, it is highly likely that the regional components will never be sufficiently compatible to interoperate on a national basis. If you choose the latter (i.e., Cisco or IBM builds the infrastructure; regional RHIOs address the collaboration and politics), I still don't think that it would work. As I have stated in a previous note, the large health systems within a region are the primary stakeholders in any project to share clinical data on a regional or even national basis. I am hard pressed to identify any major incentives for them to share clinical data outside of the regional area from which they draw their patient populations.
Here a great article on the NHIN (national health information network) to be theoretically formed by the coalescence of the RHIOs. Below is the money quote; boldface emphasis mine.
The second element of the NHIN is interoperability, a concept that is cumbersome to fully capture and quantify but one that is synonymous with its organizational catalysts, RHIOs. Interoperability represents an organizational and technical infrastructure that allows for information to be readily and securely shared between a variety of health care stakeholders. The difficulty in assessing the benefits of interoperability is that the magnitude of improvement is dependent upon the level of participation by other stakeholders. The more organizations that participate, the greater value to all constituents. In addition, the types of benefits attributable to interoperability are less tangible and predictable, accruing variably to different types of stakeholders across a variety of health care processes. In the end, it looks like we would be getting a technical infrastructure that has the potential to do some good things, but it would be difficult to quantify those benefits today. The risk would primarily reside in the implementation of the technology and whether providers actually would use it.
The bottom line from this analysis is that the benefits of a RHIO/NHIN are highly dependent on the number of participants (the so-called network effect), that there are variable benefits by stakeholder, and that the estimated cost of such a project (total capital costs of $156 billion over five years and $48 billion in annual operating costs) will be staggering.