The rocky road to RHIOs


These networks can provide useful clinical data and connect EHRs, but it's unclear who will pay for them.

For the past six months, James Spurlock, a solo family physician and part-time emergency physician in Woodbury, TN, has had access to a web-based, statewide health record that covers all of his Tenncare (Medicaid) patients, who form 40 percent of his rural practice. Provided for free by Shared Health, a subsidiary of Blue Cross and Blue Shield of Tennessee that contracts with Tenn-care, this "Community Connection" health record includes visit data (based on submitted claims), test results, ED information, and medication lists.

Spurlock says that the Community Connection "can save some time" by alerting him to tests and procedures that other physicians have already ordered or performed on his patients, so that he doesn't have to order them again. The community record also lets him know which patients are seeing other doctors of whom he's unaware. Among other things, that can help him catch patients who are "shopping" for controlled substances.

Having a complete drug list available for each patient is also useful, he says. "It helps me to find out what medications new patients are taking even before I get records from another physician. It also helps to see how frequently they're refilling their prescriptions. If they're not using their medications properly, I can pick up noncompliance."

Gracanin wishes her reference labs were also on HealthBridge and that she could order tests through the web portal. At least the latter wish may soon be fulfilled, says James Gravell, chairman-elect of HealthBridge and executive vice president of Mercy Health Partners, one of the participating healthcare systems.

Wesley V. Eastridge, a family physician in Gate City, VA, has similar hopes for a community-wide electronic network based in nearby Kingsport, TN. The nonprofit organization that's planning this network, known as CareSpark, has raised nearly $600,000 in seed money from local physician groups, hospitals, health plans, employers, community organizations, and the Foundation for eHealth Initiative, a private group that controls disbursement of some government grants. CareSpark's ambitious goal is to get most local doctors to adopt EHRs and to link their systems with a community portal that would also include hospitals, reference labs, and pharmacies.

Eastridge, who already has a homegrown EHR, thinks Care-Spark is a good idea. "The main value would be having more information available when I'm seeing a patient," he says. "The second thing would be improved communication between doctors and hospitals."

What is a RHIO and why should you care?

CareSpark and HealthBridge are very different examples of what is being called a "regional health information organization," or RHIO. Some observers define a RHIO as any electronic system for exchanging clinical data that involves at least two separately owned organizations. Under that definition, the Community Connection model of Shared Health isn't a RHIO. However, the claims, pharmacy, and lab data that feed Community Connection do provide doctors with a basic kind of electronic record that's similar to what true RHIOs offer. And this year, Shared Health plans to broaden the scope of Community Connection from Medicaid to patients who are privately insured.

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