Vol. 18 •Issue 2
• Page 55
Onward — and Upward
Modern pioneers are using health information exchanges to share clinical information with providers at the point of care.
By Christina Beach Thielst, FACHE
During our nation's ex-pansion into the Western frontier, wagon train leaders sometimes cried "Onward, ho!" to herd settlers forward. Today's vast, uncharted region is information technology, not the Wild West—yet the same expression still applies.
Health information exchanges, sometimes known as regional health information organizations, have been building in momentum for years, and like the settlers before them, they're blazing paths toward a better future.
A RHIO can be described as a network of stakeholders within a defined region who are committed to improving the quality, safety, access and efficiency of health care through health information technology.1 In the case of imaging and radiation oncology, these stakeholders can be a collaborative of all imaging and radiation oncology providers in a region and those who need access to this information for patient care and treatment. It also can be a community-wide collaborative of all stakeholder groups who adopt a shared vision and common goals to establish systems for the electronic exchange of imaging data.
Today's visionaries see the potential of using RHIOs—of which no two are alike—to improve safety, quality, efficiency and access. They continue to move these collaborative efforts forward nationally and internationally as each one finds its way past the myriad challenges and barriers to success.
Even as some imaging professionals are only beginning to learn about RHIOs, the health care community is witnessing its first wave of shakeouts. Some early expeditions, like the Santa Barbara County Care Data Exchange in California, didn't make it for several reasons. But we've learned from their travails. Other pioneers have adapted, become self-sufficient and made slow-but-steady progress toward building a national health information infrastructure.
Where from here?
If there's truly no RHIO-in-a-box, it's my opinion that there can't really be a RHIO 2.0. The next generation of RHIOs will address the question "How will we implement this?" rather than "Can we do this?" They will more quickly focus on developing a shared vision and common goals among stakeholders and will explore the benefits of linkages with other networks. Through the latter, some RHIOs may even decide to join forces and encompass greater geographical regions to maximize efficiencies of scale and expand resources.
Newer RHIOs also will focus more quickly on smaller-scope efforts to capitalize on early successes and the benefits derived from continual and definitive progress. For example, physician engagement is an important, yet difficult, challenge that sometimes becomes a barrier. Involving physicians in a new initiative is hard enough, but when projects slow repeatedly and show little progress—and when competing interests begin to shift physician attention—the risk of disengagement becomes significant. As a result, RHIOs will begin to focus on doing one or two things well, such as exchanging picture archiving and communication systems (PACS) images or electronic prescribing, rather than doing everything poorly, creating tremendous opportunities for the imaging disciplines.
Imaging, rad onc opportunities
Technology has long been associated with imaging and the professionals who work with it daily. Imaging technology has continued to develop and expand beyond what could have been believed 20 years ago, and with the latest PACS there seems to be a natural fit and tremendous potential for community-wide health information exchange and RHIOs. Consider the benefits of a family physician being able to view all images of a patient from his home office in the middle of the night, or remotely on a laptop while making rounds. Also, consider the benefits to the patient and her physician if the radiologist can immediately see images or call up previous films whenever the family physician calls to discuss findings. This flexibility increases efficiency for physicians and potentially the timeliness of patient follow-up care and treatment.
More providers of radiology and imaging services are introducing PACS because they're beginning to regard it as a cost of doing business rather than just another capital expense requiring a return-on-investment analysis. Several factors explain this change in perception:
Physicians with access to digital images prefer the PACS mode of access and demand it from other providers.
Significant improvements result from staff efficiency and the elimination of costs associated with managing tangible films and the need to locate, copy and transport them between health care providers.
Patients are happier because they no longer need to pick up films for appointments and risk rescheduling a visit because their films weren't available.
The need for support staff to assume more difficult-to-recruit technical roles is reduced.
Getting started
Ultimately, those involved in the imaging disciplines are in an ideal position to join frontiersmen as they continue to implement electronic health information exchanges. To find out what community efforts exist in your area, visit the Health Information Management Systems Society State Dashboard at www.himss.org/StateDashboard or the eHealth Initiative Foundation's Collaborative Communities at http://www.ccbh.ehealthinitiative.org/communities/states.aspx. Learn as much as you can about the organization's leadership and governance structure, and determine whether stakeholders enjoy a shared vision and common goals. Ensure also that those involved are accountable to the community as a whole, and not to their individual interests.
Perhaps you'll find that no one in your community has begun to discuss the implementation of electronic health information exchanges. In that case, you'll be able to facilitate the dialogue needed to drive forward the collaborative process—and become the newest pioneer.
Reference
1. The Healthcare Information and Management Systems Society RHIO Guidebook Task Force. (2007). Guide to Establishing a RHIO, p. 1.
Christina Beach Thielst, FACHE, is the chief operating officer at Santa Paula Hospital, a Campus of Ventura County Medical Center, and editor of the Guide to Establishing a Regional Health Information Organization, published by The Healthcare Information and Management Systems Society. She also maintains http://www.thielst.typepad.com, a blog that addresses health information technology and RHIOs.
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