Mr. HIStalk recently reported on the demise of the Santa Barbara RHIO that had been headed by Dr. David Brailer. You may recall that he previously served as the National Coordinator for Health Information Technology in the Department of Health and Human Services. I have posted a number of previous notes about RHIOs. I am pessimistic about the likelihood of success for these organizations that seek to integrate health information across a geographic region. In part, my pessimism is prompted by the fact that the participating health systems themselves are usually inadequately integrated. Below is an excerpt from the note:
[Submitted Comment] For all of the hype that the Santa Barbara RHIO has received over the years, it was recently unplugged! Funny how everything has changed so quickly - time was when David Brailer would tout this as his pet project. Can you say CHIN revisited?"
[Mr. HIStalk response]... [I]t's dead, having accomplished little except spending grant money and getting everyone worked up over Interoperability Strikes Back: Return of the CHINs. The takeaway: what killed it was privacy concerns and a lack of incentives for the two participating organizations to pay for its upkeep. Actually, what probably sealed its demise was the far broader CalRHIO initiative, which made this one obsolete before it ever got going. Unfortunately for the Santa Barbara group, others did it better with the benefit of hindsight.
Note to my younger readers: CHIN stands for Community Health Information Network. The concept had some traction in the 1990s. I think that all such entities quietly disappeared, as will RHIOs, but not without a number of vendors and consultants feeding at this trough for a few years.
Mr. HIStalk suggests that the fate of the Santa Barbara RHIO was sealed by the emergence of CalRHIO, which I had not personally been tracking. According to a recent report (see: CalRHIO reviews bids to build $100M health care data system for state), this organization is planning to build a $100 million healthcare IT network to serve California. On March 13, it was announced that CalRHIO had selected Medicity and Perot Systems to build their statewide network. As part of my background reading about CalRHIO, I came across a list of its Board of Directors. Below is the list, including its ex-officio representatives. culled from the CalRHIO web site.
Board of Directors
- Molly Coye, M.D., CEO, Health Technology Center (Interim Chair)
- Linda Ackerman, attorney, staff counsel, Privacyactivism.org
- Ronald Bangasser, M.D., practicing physician, Beaver Medical Group
- Eric Book, M.D., chief medical officer and sr. vice president, Blue Shield of California
- Don Crane, CEO, California Association of Physician Groups (CAPG)
- Duane Dauner, president, California Hospital Association
- Seth Fearey, vice president and COO, Joint Venture: Silicon Valley Network
- Patrick E. Fry, president and CEO, Sutter Health
- Lark Galloway-Gilliam, executive director, Community Health Councils, Inc.
- Jennie Chin Hansen, board member, AARP
- Ronald W. Jimenez, M.D., associate medical director, clinical informatics, Santa Clara Valley Health and Hospital System
- Barbara Johnston, executive director, California Telemedicine & eHealth Center (CTEC)
- Charles Kennedy, M.D., vice president, Clinical Informatics, WellPoint, Inc.
- Robert Klein, M.D., associate executive director, The Permanente Medical Group, Northern California
- Peter Lee, president and CEO, Pacific Business Group on Health
- Chris Ohman, president and CEO, California Association of Health Plans
- Tom Priselac, president and CEO, Cedars Sinai
- Jo Ellen Hylind Ross, president and CEO, Lumetra
- Tom Williams, executive director, Integrated Healthcare Association
- Mark Windisch, senior advisor, L.A. Care Health Plan
Ex-Officio Members
- Lesley Cummings, executive director, the Managed Risk Medical Insurance Board (MRMIB)
- Cindy Ehnes, director, California Department of Managed Health Care
- Jeff Flick, regional administrator, the Center for Medicare and Medicaid Services (CMS) Region IX
- Don Holmquest, CEO, CalRHIO
Here is the mission statement for CalRHIO copied from the organization's home page:
CalRHIO - is a collaborative effort to incrementally build the structure and capabilities necessary for a secure statewide health information exchange system that enables California’s health care providers and patients to access vital medical information at the time and place it is needed.
So what do we have here? First of all, its an organization whose mission is to "enable California’s health care providers and patients to access vital medical information at the time and place it is needed." The Board of Directors has 20 regular members and four ex-officio members. By my count, the group contains six physicians (boldface) but five of them are "suits" serving in an executive capacity with health systems and insurance companies. One of the total of 24 on the Board is very prominently labeled as a "practicing physician" to make the point and none are identified as nurses. On the patient advocacy side, one potentially in this category is labeled as a board member of AARP but I would also personally place this individual into the "suit" category.
Can you see where I am headed here? If this RHIO ever managed to go "live" on some sort of robust integrated system, the chances of which I think are quite slim, the further likelihood of if ever providing any value to the physicians and nurses of the state who may want to use it are even slimmer. I suspect, based on the composition of the Board, that the goals of CalRHIO are primarily to exchange healthcare financial information -- note the carefully selected references in the mission statement to "California healthcare providers" and to "vital medical information." No use of the word "clinical" here at all. At least with CHINs, one of the major avowed purposes was to share clinical information across a region.
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