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Across The RHIO Planned
HOLLAND — There is a very telling disconnect between the federal government and the nation’s health care community — telling because it illustrates the frustrated aspirations of forming a nationwide, interconnected electronic health information system: They can’t get their terms straight.
The government talks about EHRs, or electronic health records. To most of the health care community, they’re EMRs, or electronic medical records. That may seem like a trivial difference, but the inability of different organizations to come together and “speak the same language” is the crux of the delay in forming this nationwide health data exchange. Anyone who has ever tried to play a Betamax tape in a VHS player, or run a diesel engine on gasoline, knows the importance of uniform standards.
The health care community in Holland is not about to wait around for the government to set those standards. A coalition of doctors, hospital officials and other health care professionals have come together to lay the groundwork for the area’s first regional health information organization, or RHIO.
A subcommittee of the Principal Health Physician Hospital Organization recently issued a request for information and has received four responses from health care information technology providers. Principal Health is a partnership between Holland Hospital and Lakeshore Physicians’ Organization, an association of 170 doctors in the community.
Over the course of the next several months, the group hopes to review the technology, raise funds and begin implementing the system. If all goes well, Holland Hospital and the doctors, pharmacists and other health providers in the Lakeshore community will have shared access of patients’ medical records by the end of the year.
According to the members of the task force developing the RHIO, Holland is in a unique position to implement the system.
“You’ve got a physician base in the community that already recognizes the value of electronic medical records — and in many cases has already invested — a hospital that has invested, a manageable-size medical community, a single-hospital system. It really does have all the makings of a great place to move forward with this,” said Tim Breed, public relations officer with Holland Hospital.
“The teamwork already takes place,” he said. “This is just yet another form of teamwork. Right now equipment is shared and facilities are shared and results are shared. This just takes it another step in that team approach around the patient’s care.”
Terry Steele, vice president and CFO of Holland Hospital, agreed, saying that his organization has had an electronic medical record system for more than a decade. Over 80 percent of the independent practitioners and physicians’ groups in the community have either implemented their own EMRs or are in the process of doing so.
However, Steele said that the Holland medical community’s predisposition toward using electronic medical records is not a clear-cut advantage for implementing the RHIO. Although the practitioners may be more comfortable with the use of technology, they may be hesitant to continue spending money to implement further incremental advances.
Task-force member Dale Dykema, a gynecologist and the medical director of Principal Health, who admitted to spending a sizeable sum on implementing an EMR system, agreed.
“There’s a cost to build the bridge. And when a doctor has spent 30 grand on his EMR and you tell him, ‘Now you have to build a bridge for $8,000 more,’ eventually they say, ‘What am I going to gain from that?’”
A lot, according to Steele.
“The incremental benefit to connect that system to everybody else — who benefits from that is a fundamental question,” he said. “We certainly think the patient does, in terms of providers having better information about them. So when you show up as a patient in my emergency room, I know what prescriptions were given to you this morning so that we don’t inadvertently create a drug interaction. Those kinds of things are extremely beneficial and don’t exist today.”
The value of the RHIO is in sharing patients’ data. The ability for all of a patient’s records to be stored electronically in a central repository is certainly advantageous to various doctors’ abilities to provide efficient care. It could also lead to a reduction in duplication of services. For example, a doctor wouldn’t be likely to order a new MRI on a patient who had just had one, if he could simply call up the results of that test on his computer. That means reduced costs for insurers who pay for those tests.
“So the payer benefits and the patient benefits,” said Steele. “But how do we justify that in terms of the huge amount of money that’s already been invested?”
The task force plans to solicit funds from insurance companies and members of the local business community in order to cover the initial costs of licensing the software and setting up the RHIO infrastructure. Priority Health has already provided a grant to the organization to foster the development of the RHIO. Other organizations that see a potential cost savings inherent in the system may follow Priority’s lead.
Once it’s in place, the RHIO will be supported financially by the practitioners who use it.
“So that way, all the folks who are connected to this and claiming that space actually contribute to maintaining this thing long-term,” said Steele. “We’re not asking for anyone to get a free ride.”
For now, the task force is reviewing the information provided by the IT vendors, in order to make an initial determination about the scope, capabilities and cost of the system. This step is critical and should be studied carefully, task-force members said, as the future of the initiative will hinge upon choosing the right infrastructure. And while they plan to deliberate for some time, the task force is swift compared to some of its counterparts. Dykema mentioned a Rhode Island community that had been working on its RHIO for five years and has made less progress than the Holland team has in a year.
Much of the team’s efficiency comes from Holland’s position as a single-hospital city. That allows the RHIO planners to be more nimble in their decision-making than they could be in a multi-hospital city such as Grand Rapids. That said, the task force expects the RHIO to spread to Grand Rapids in the future.
“We really see this growing bigger than ourselves,” said Steele. “We’d like to start this in Holland with this (group), but we’re really open to having this morph into something much broader to include all of Ottawa County, Kent, Muskegon — to really service all of West Michigan and beyond, potentially,” he said.
That’s what the federal government would like to see. The Department of Health and Human Services lists interconnectivity as No. 3 among its top four priorities — after the promotion and initial implementation of, as it calls them, EHRs. Once those are in place, the office hopes that more regional collaborative efforts like Holland’s will spring up. At that point, the federal government will get involved.
“These local RHIOs must be able to use a common set of standards so they can communicate with one another,” read a report from the department. “Interconnecting each RHIO will require an infrastructure, known as a National Health Information Network (NHIN), to facilitate interoperability among RHIOs. This will allow medical information to travel anywhere with patients, thus revolutionizing the industry by making information more consumer-centric.”
It’s not clear how long it may be before the NHIN comes to be. In the meantime, health care communities around Michigan are keeping an eye on Holland, hoping to learn from its experience.