Disc 2 IT healthcare Admin

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Widespread adoption of the Electronic Health Record (EHR) has demonstrated how health information technology (HIT) can improve patient outcomes on an organizational level. However, the larger goal of the Health Information Technology for Economic and Clinical Health Act (HITECH) is to implement Regional Health Information Organizations (RHIOs) and the Nationwide Health Information Network (NHIN). Stakeholders interested in seeing this come to fruition include, but are not limited to, providers, healthcare organizations, public health interests, technology companies, researchers, insurance companies, politicians, governments, and patients (Ramirez, 2016). As with the adoption of the EHR, there are technical, administrative, and financial hurdles to implementing RHIOs and the NHIN. The most significant technical limitation has been the lack of interoperability. According to Glandon et al. (2020), interoperability is the “exchange of information between computers across industry networks with little intervention on the users’ behalf (p. 214).” Although many, but not all, hospitals use integrated systems such as Cerner and EPIC, these systems vary in their data format and vocabulary (Glandon et al., 2020). These variances inhibit data exchange; therefore, data storage must be standardized, and language must be translated (Glandon et al., 2020).  

To aid in progress, the Centers for Medicare and Medicaid Services (CMS) upgraded the EHR Incentive Program to the Promoting Interoperability Program (PIP), requiring the use of Certified EHR Technology (CERHT) (Glandon et al., 2020). Through the PIP, CMS offers financial incentives for using CERHT, thus promoting interoperability for RHIOs and the NHIN. In addition to incentives, CMS penalizes organizations for data breaches (Glandon et al., 2020). The HITECH Act requires that all data breaches affecting 500 or more people are reported to The U.S. Department of Health and Human Services (HHS) office for civil rights for further investigation (Glandon et al., 2020). The average cost of a data breach is about $148 per record, which can add up to millions of dollars (Glandon et al., 2020). Data breaches resulting from negligence suffer more significant financial penalties than unintentional ones. 

In addition to financial incentives and penalties imposed by CMS, there are designated groups dedicated to achieving RHIOs and the NHIN. One such group is the Health Information Technology Advisory Committee (HITAC), which reports to the National Coordinator for Health Information Technology. HITAC recommends policies and standards, suggests implementation plans, and identifies criteria for certification all related to advancing HIT (Glandon et al., 2020). Another essential group is the Cybersecurity and Infrastructure Security Agency (CISA), responsible for securing federal networks and infrastructure (Glandon et al., 2020). 

To progress toward RHIOs and the NIHN, all stakeholders must address barriers in both the private and public sectors. Stakeholders must push for widely adopted technologies and related standards, the alignment of payment systems to promote value-based care, standardized security requirements to ensure trust, and a shift in culture to align business practices and policies (Ramirez, 2016). Doing so will support interoperability throughout a person's entire continuum of care.  

Overcoming barriers related to the success of RHIOs and the NHIN can be accomplished by improving the current HIT to allow for not only the exchange of information but also access to on-demand information. HIT systems should be searchable to enable quick access to relevant information from a person's health history. For example, current systems may allow access to health data but require users to read significant amounts of irrelevant information. There could be a considerable improvement in function if the user could type “transfusions” into a search bar and see a person's entire transfusion history. Better yet, the search could be customizable and allow for data to be organized by date and location. In addition, instead of information exchanged in the form of a summary, integrating data would be more useful (Ramirez, 2016). Searchability and data integration would benefit all stakeholders as it would improve the ease of use and decrease the time required to obtain desired information. 

Another way to facilitate overcoming barriers includes increasing people's involvement in their medical journey. People involved in their medical care and medical decisions have a better overall understanding of their health. They are more reliable sources of information regarding health history and are more willing to contribute as a member of their care team (Ramirez, 2016). In addition, allowing patients to see their projected health trajectory will help to motivate them to work towards health-related goals (Ramirez, 2016). 

Lastly, barriers can be overcome by not only designing HIT systems that are interoperable but also adaptable for improved user experience and to meet the needs of different organizations (Ramirez, 2016). As technology and medicine advance, these systems must be learning health systems that can accommodate changes to maintain their relevance in the future. Therefore, the investment in RHIOs and the NHIN will genuinely be an investment into the future of healthcare. 

References 

Glandon, G., Slovensky, D., & Smaltz, D. (2020). Information technology for healthcare managers (9th ed.). AUPHA/HAP Book. 

Ramirez, E. (2016). Connected health care: A roadmap for interoperable health information and technology. Nova Science Publishers, Inc. 

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In this post we are going to better understand Regional Healthcare Information Organizations (RHIO) and how sharing information with the Nationwide Health Information Network (NHIN) has fallen short since it was proposed in the Health Information Technology for Economic and Clinical Health (HITECT) Act.

Reginal Healthcare Information Organizations is a group of organizations for a designated area that bring together healthcare providers of that geographic region. The RHIO gathers health-related information from hospitals, clinics, physician offices, government agencies and payers to a shared network for improved quality of care and patient outcomes (Rosencrance, 2019).

Financial

Costs to implement EHR systems in small and rural hospitals and their providers is more than many facilities can afford. Once connected, networking with the Regional Health Information Organizations (RHIO) posed more difficulty as these the demand falls to stakeholders of the local region. These stakeholders are larger healthcare systems that create portals of shared information, connecting hospitals, physicians and clinics. RHIOs have been formed in larger metropolitan areas but gathering the necessary resources to join many smaller forces over broader areas is difficult and outweighs the cost. While RHIOs are government funded, the funding is still insufficient to maintain this independent group to cover such a broad area.

 

Technical

Regional Health Information Organizations are faced with the challenge of collaborating data from many different information systems. Electronic health records or EHRs are used with the individual providers to collect information which has to further be integrated into the regional system. There are many EHR systems, but two hold 50% of the ambulatory market share (The 10 most common inpatient EHR…, 2022).

 

Administrative

A functional Regional Health Information Organization consists of many skilled individuals well versed in healthcare informatics. This field was not developed at the time the HITECT Act was initiated. Since 2009, careers in healthcare information systems have grown. As of 2018, health information technology jobs were projected to grow 23% (Health information technology schools, 2022). This delay in the development of this career field further stalled formation of RHIOs throughout the country.

 

Recommendations

1. Establishing a RHIO will require government funding and may need more than what is slotted for a given area (Yaraghi, 2014). The organization will need to procure funds to initial and continue software support for the collection and processing of health information by requesting more from local legislature and taking all tax credits available by the IRS for such entities.

2. Widen the coverage region. By merging and sharing resources with a broader geographic space, funding can be fed from additional areas, increasing the budget of the potential RHIO.

3. Increase data sharing ability between various EHR systems to improve communication with RHIO. It is important not to dismiss or discredit smaller EHR vendors that can provide more affordable options to smaller providers but to find ways to collaborate. By encouraging only few larger companies, there is a risk of monopoly formation among the EHR giants. 

 

 

References

Health information technology schools. (2022). MTS.  Health Information Technology Degree Programs (medicaltechnologyschools.com)

Rosencrance, L. (2019 May). Regional health information organization (RHIO). TechTarget.  What is Regional Health Information Organization (RHIO) ? - Definition from WhatIs.com (techtarget.com)

The 10 most common inpatient EHR systems by 2021 market share. (2022). Definitive Healthcare.  The 10 Most Common Inpatient EHR Systems by 2021 Market Share (definitivehc.com)

Yaraghi, N. (2014 March 18). How to cut healthcare costs: Regional health information organizations. Brookings.  How to Cut Healthcare Costs: Regional Health Information Organizations (brookings.edu)