…they don’t, at least so says an HHS funded study by Avalere Health
While some states have progressed, the Avalere report highlights challenges in achieving national goals. None of the highlighted HIE projects — even those with deep political and physician support — have established a sustainable business or financial model. Some states are also struggling to gather providers and other commercial organizations’ agreement on technology standards and win over their long-term support.
At IFTF we (Jane Sarasohn Kahn and I) wrote a report on CHINs in 1994 which basically said we didn’t think they’d be much more than a sideshow—and it turned out we were over-optimistic! Not that much has changed. Some things have, but there are few incentives to promote inter-operability. Don’t believe me, Brailer said as much when I saw him talk two years ago.
The incentives that prevent interoperability can be (and ought to be) changed—if we want to use that Medicare carrot/stick. But that would mean Congress taking on a litany of providers, payers and vendors…
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There still won’t be a business model (not that I am against Medicare “helping” things along).
The only place I can see the integrated, ubiquitously-available medical record making sense is at the patient-management level, which today means payers and HMOs specifically. Hospitals developing or deploying their own systems limit them to their own physicians, and only those patients of those physicians who are seen in their facilities, and further, only those results produced in their facilities can be added to the record. These are being used as competitive tools to bind more tightly the physicians to the institutions and present a high-tech image to patients.
The only other RHIO-ish thing I can think of that might possibly work is to have the three or four biggest payers in each region spin-up a joint venture “Switzerland” subsidiary and make the IT available to any physician who has any patient covered by any of the insurers. The physicians would be free to keep the records of all their patients in the system even if they’re not insured by one of the partners in the system. This would probably mean that every physician could have cheap (or even free) access to a state of the art EMR/CDSS/PM system, and the insurers would have “fair” access to performance and outcomes data. This solves all manner of problems.
Medicare/Medicaid could do the same kind of thing — spin up a quasi-governmental corporation like SALLIEMAE to do IT, and then “incentivize” everyone to play nice with it.
As a stand-alone entity, I don’t see how a RHIO can be sustained. But I have a dream…
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