Institute For The Future

The continuing challenges of RHIOs and EHRs

In August, I wrote about the demise of the Regional Health Information Organization (RHIO) in Santa Barbara. In January, the California HealthCare Foundation (CHCF) published a discouraging report about these collaborative health information technology (IT) offerings. Interviews with several prominent thought leaders in the area included comments like this one from Charles Kennedy of WellPoint: “The problem with RHIOs is no one has figured out how to specifically connect them to the existing business model of health care. So they’re kind of this entity that’s hanging out there that doesn’t really have a role in what we would call the value chain.”

 

The author of the report noted that, "despite President Bush's 2004 plan to ensure that most Americans have interoperable electronic health records by 2014, 'the vast majority of practicing physicians, those who practice alone or in small groups, are no closer to using HIT now than they were three years ago.'" (Wow! I didn't know President Bush had a plan for anything I might be in favor of.)

 

Another CHCF report issued at the same time--The State of Health Information Technology in California--revealed that in California, the larger the medical practice, the more likely it is to have an EHR system. About 79% of Kaiser Permanente physicians reported using EHRs, followed by 57% of patients in large practices of ten or more physicians. Fewer small/medium practices (25%) and solo practitioners (13%) use EHRs.

The major barrier for EHR adoption by medical groups was cost (59%), followed by the difficulty and expense of implementation (42%), uncertainty about how to select the right product (31%), and resistance to changes in practice style (30%). Among long term care facilities, the lack of integration with other systems was the most commonly cited barrier to HIT adoption.

 

A third CHCF report examines a possible solution to some of these obstacles. Open Source EHR Systems for Ambulatory Care: A Market Assessment

looks at free and open source software (FOSS) and whether FOSS systems are suitable for widespread adoption and effective use as EHRs in physician offices. The report provides detailed assessments of a number of FOSS EHR systems and describes both the advantages and limitations to the software. The FOSS approach offers advantages such as lower acquisition and maintenance costs, greater opportunity for customization and enhancement, decreased barriers to interoperability, and less vulnerability to vendor failure or product termination. Limitations cited include a general lack of decision-support capabilities, greater reliance on free text relative to coded clinical data, and less support for electronic prescribing and lab-test ordering, although this varies by specific system.

It seems obvious (to me) that interconnected, interoperable EHR systems would benefit health care providers and patients alike, making health care safer (due to a likely reduction in errors) and more efficient. But how can obstacles like implementation costs and concerns about privacy be overcome?