I have posted a number of previous notes about RHIOs. If you review these notes, you will discover that I have never been enthusiastic about RHIOs and their business models because I never thought that they offered sufficient incentives for hospitals to participate. John Moore, who blogs over at Chilmark Research, distinguishes between RHIOs and HIEs and predicts in a recent note, accurately in my opinion, why the latter organizations will have a greater chance of success (Why HIEs Succeed and RHIOs Languish). Below is an excerpt from his note with boldface emphasis mine:
Back at the beginning of the year, I did a Top Ten Predictions post where one of the predictions was the continued struggles of Regional Health Information Organizations (RHIOs) and the steady rise of Health Information Exchanges (HIEs). Since much of the ballyhooed National Health Information Network (NHIN) is built upon the premise of RHIOs and their success, the NHIN is basically dead in the water. Sure, NHIN supported by RHIOs is a great and grand vision, but that is about it - a great and grand vision created by policy folks in government (and their academic counterparts) that has little basis in reality. That divorce from reality stems from a lack of a true, justifiable business case. There is simply no compelling business reason for the vast majority of health industry stakeholders to invest in RHIOs. (Note: those that have invested in RHIOs are most often doing it for political reasons, not business ones.) This is not the case for HIEs. These networks are created by entities, typically large hospitals, that do have a compelling business reason (one reason: encourages referrals to their hospital) to share health information within a network of business partners (their provider network). This is quite similar to a supply chain network within the manufacturing sector....For hospitals its about delivering value to smaller practices, most often giving a physician a window into the HIE host’s EMR to facilitate care and insure referrals.
I agree with John's comments and conclusions. The primary goal of hospital executives is to increase their admission rates and they have very little interest in making clinical information more portable for patients. Although clinical belongs to the patients for whom it is generated, hospitals generally view it as proprietary to them. The consequences of the broad sharing of patient clinical information is to enable healthcare consumers to shop around among competing hospitals.
As John points out in his perceptive observations, the executives of a large hospital are very willing to reach out to their business partners such as those community physicians who refer patients to their facility. The assistance to such partners often takes the form of technical and financial support for physician office EMRs that are linked to the hospital EMR and can then provide continuity between the care delivered in physician offices with the care delivered during hospital admissions. The business case for such IT support is self-evident.
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