OK, the title is a take off on the Police song, but the subject has got a little more influence lately. A sometime THCB correspondent had these thoughts:

The December 11 edition of Health Affairs contains a very important article on “The State of Regional Health Information Organizations.”  At first glance, the article seems to pile on to the prevailing wisdom that RHIOs are a bad idea, because, of course, RHIOs are failing.

A more careful read, though, differentiates the issue of whether fully-functioning RHIOs (or clinical health information exchanges, more broadly) could provide value to a community and its (healthcare) stakeholders and the issue of whether the current model for funding RHIOs is sustainable – two very different issues.

The study takes no issue with the notion of the value of RHIOs: “Electronic clinical data exchange promises substantial financial and societal benefits…”

However, a sentence in the piece’s “Discussion” section really cuts
to the heart of the latter issue: “Whether RHIOs represent small
businesses that need viable business models, which requires the ability
to generate profits as well as value for participants, or public goods
that require funding is an important unresolved issue.”

Small businesses – in healthcare and otherwise – are among the most
risky of ventures and frequently fail.  It seems – surprise, surprise –
that RHIOs are no different: “Our results, in this context, suggest
that young RHIOs face substantial challenges, and it is not clear
whether even more mature RHIOs have a path to profitability.”

According to the article, the RHIOs that are “making it” are
generally focused on the very narrow task of “exchanging results of
diagnostic tests,” something for which some hospitals are willing to
pay but which falls well short of the scope of functionality and data
necessary to achieve most of the broader value of health information
exchange. 

A recent iHealthbeat story
reflects a similar dissonance between the “business case” for
individual providers to adopt EMRs and their benefit to the overall
healthcare system and patients. To quote the article, “Despite mounting
evidence that IT can help boost patient safety, many hospitals have
been reluctant to invest in technology…Only about 11% of
hospitals…reported having a fully implemented EHR system. This
reluctance is likely tied to financial, cultural and workflow barriers.”