This is the third time the researchers have looked at this topic with similar results.
"The goal is to quickly build a technical infrastructure but states, RHIOs and any other organizations they partner with really have their work cut out for them," says Adler-Milstein.
According to the report, funding for RHIOs may be part of the problem. Substantial start-up money comes from the public sector, but eventually RHIOs are expected to find stakeholders willing to pay for the value they create and to become self-sustaining. This encourages RHIOs to "focus on a narrow set of transactions with clear value to providers (such as exchange of test results) as opposed to a broader data exchange that might offer more substantial benefits," the report says.
Among the 75 operational RHIOs, 25 were financially viable (able to cover operating expenses with revenues from the hospitals and physician groups that participate in the RHIO). About 40% of the operational RHIOs that said they weren't financially viable reported that they expected to become financially viable in the future. Of the 13 RHIOs that could support meaningful use, six were financially viable.
Despite the drawbacks, Adler-Milstein says that with the right tools in place states may find that a RHIO still offers a good starting point for building out their HIE because RHIOs already have the infrastructure in place to share information. The challenge, she says, is to create a sustainable business model for RHIOs where there hasn't been one before. That means states must put in place policies and incentives that encourage RHIOs to expand their services and the range of HIE that they support.
Adler-Milstein says "we need to strengthen the use cases for HIE. We've been pushing the technology first when we really should emphasize the comprehensive patient information that is available at the point of care. That's what will really drive the success of RHIOs."