President's Page

President's Page
July 2005

Regional Health Information Organization—
Coordinating your Electronic Medical Records

by Leslie H. Secrest, MD
2005 DCMS President

Most physicians never have heard of a RHIO, and, as I did, may speculate that it is a prehistoric cousin of the modern-day rhino. This will change in the next year or so, when all physicians will know what a RHIO is, and how it has affected their practice and contributed to the access and interoperability of electronic medical records. A Regional Health Information Organization, or RHIO, is the first step in allowing electronic medical records interoperability or data to be accessed over a wide range of medical facilities and providers. The RHIO will be the coordinating body that sets standards and establishes a system to connect an electronic medical record to hospitals, physician offices, and other medical facilities (laboratories, radiology departments, and pharmacies). Such a system will allow the treating physician, when properly authorized, to access a patient’s medical data even though the data originated in another facility, physician office, or laboratory.

Digital technology has made it possible to instantaneously have all of a patient’s medical data available at the time a patient is being treated, while also improving health care and decreasing duplication and the opportunity for errors. After President Bush created a National Health Information Network, he formed the Office of the National Coordinator for Health Information Technology. He appointed David Brailer, MD, as National Health Information Technology coordinator within the Health and Human Services Department to organize and lead the program. The first phase is to establish Regional Health Information Organizations to provide connectivity among electronic medical systems within a region. Congressman Pete Sessions and DCMS member John Gill, MD, began the initiative to develop a RHIO in the Dallas area. They asked the Texas Healthcare Task Force to bring together representatives from the business community, hospital community, physician community, and information technology community to learn of the efforts of others in Texas and the nation, and to discuss how Dallas could create a RHIO.

Initial meetings revealed the importance of being able to electronically connect all the emergency departments in the city so each could have access to data created at other facilities. Such a system could eliminate duplication and improve the continuum of care—immediately, patient safety and quality of care would improve.

Although expensive, technology allows such interoperability. The large hospital systems in Dallas are moving to interoperable electronic health records and are willing to expend the resources to implement a system, despite the well-publicized failed attempts by other institutions. Other attempts have been successful; for example, Veterans Administration Medical Center in Dallas has had a successful electronic medical record system for a number of years. Some larger medical groups have implemented electronic medical record systems using the latest in mobile and hand-held technology. A few solo practitioners are technology pioneers and already have implemented EMRs.

Successful adoption of the interoperable electronic health record will depend on physicians and their office staffs using the technology. It is estimated that 80 percent of physician care is provided by physicians in practices with four or fewer people. This implies that the ability to finance the purchase, implementation, training, and maintenance of an electronic health record system would be beyond the reach of most small practices, so to do so, physician incentives must be developed to finance, implement, and use EMRs.

The Center for Information Technology Leadership, chartered in 2002 by Boston-based, nonprofit Partners HealthCare System as a research organization established to help guide the healthcare community in making more informed strategic IT investment decisions, has estimated the annual value of electronic healthcare information exchange and interoperability at $78 billion nationally and at $1.2 billion in the Dallas area. Because 80 percent of the saved dollars will benefit third-party payers and large employers, the financing to acquire, implement, maintain, and utilize such a system must come from the annual savings.

Other challenges for a RHIO will be determining its governance, determining whether to use centralized or decentralized data storage, and ensuring the validity of patient identification. Patient identification is critical because most patients have several medical record identifiers if they have been in different facilities or if they have the same name as another patient. The system must correlate the correct data with the correct patient. The opportunity for quality improvement is immense as physicians gain the skills to use data that reflects practice patterns. For physicians who are paranoid or just suspicious, privacy will have to be maintained at the same level or better than what exists with a paper system.

A June 6th article in American Medical News outlines a bill in the House of Representatives that will provide $50 million in initial funding for 20 demonstration projects and will provide exceptions to federal laws that would allow hospitals to provide electronic record systems to physicians. The article noted that a national interoperable information exchange system for electronic health information has strong political backing, citing that Sen Hilary Clinton and Newt Gingrich appeared on the same platform to support the project. This is an interesting project that may quickly change how medicine is practiced and will bring new challenges and new errors.

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