Quality of Care and Patient Safety: RHIOs Aim to Transform Quality of Care and Patient Safety


May / June 2006

Quality of Care and Patient Safety

RHIO-member CEOs assess real-time patient information at Sheba Medical Center in Tel Aviv, the largest medical facility in Israel, with 1,700 beds.
Courtesy of dbMotion

RHIOs Aim to Transform Quality of Care and Patient Safety

In today’s fast-paced healthcare environment, a provider’s quick diagnosis and suggested treatment makes the difference in whether a patient has a positive or negative outcome. The consequences of a provider making a critically “incorrect” decision based on partial information range from ineffective treatment mildly affecting the patient and prolonging the care cycle to the extreme of a critical situation and potential loss of life.

Medical errors are often the result of providers lacking the benefit of a full medical history for the patients they treat. Particularly in emergency room settings, diagnosis and treatment decisions sometimes are based on partial, and often unreliable and inaccurate, information provided by the patient and his or her family.

That is one reason why a growing number of healthcare organizations are expressing a greater interest in the formation of regional health information organizations (RHIOs). The Health Information and Management Systems Society (HIMSS) defines a RHIO as “a multi-stakeholder organization that enables the exchange and use of health information, in a secure manner, for the purpose of promoting the improvement of health quality, safety, and efficiency.”

Such organizations provide universal access to patient data across a disparate network of organizations — hospitals, clinics, pharmacies, etc. — in a given geographic region. Providers can view a patient’s full medical history in real-time and quickly apply this first-hand knowledge to their diagnoses and treatment decisions, thus reducing the risk of adverse reactions or duplicate tests or procedures.

It is self-evident that this level of access to the most up-to-date patient information will drastically change the quality of care and patient safety landscape.

A Real-World Example
To better understand how a RHIO can impact the current care environment, consider this real-world example:

A patient in his late 50s arrives at the emergency room (ER) with a full-blown case of pneumonia and sepsis. The patient recounts his past medical history — he had chemotherapy for colon cancer 5 years ago — and consequent follow-up showed no evidence of tumor recurrence.

In the ER, an imaging work-up and chest x-ray reveals an abnormal finding at the apex of the left lung. The differential diagnosis includes a metastatic lesion versus an old scar from a past pulmonary infection. This diagnosis defines the patient as an intensive care unit (ICU) candidate to provide curative, versus palliative, treatment. However, all ICU beds are occupied and a new admission means transferring another patient to the floor. The resulting dilemma: the ER physician’s clinical judgment has potential consequences for another patient in the ICU and, if the lesion is metastatic, the intent to provide curative treatment could possibly shift to palliative, therefore not justifying ICU admission.

The diagnosis and treatment of this same patient would be different in a RHIO setting. The physician quickly accesses the ER’s electronic health record system (EHR), which integrates all information from neighboring hospitals, outpatient facilities, and primary care community clinics. He then drills down to all previous imaging studies and sees a 3-year-old radiographic finding and CT reports from an ambulatory setting that conclude the lesion is benign, probably an old tuberculosis scar. This information removes the possibility of a metastatic lesion and enables the admitting physician to make an informed clinical judgment, in real-time, for the patient’s proper — potentially life-saving — course of treatment. Real-time access to past medical information helps avoid inappropriate or unnecessary steps throughout the continuum of care, thus saving the patient time and exposure to potentially risky procedures, and the provider and payer organization respective costs.

Different Technology Approaches
Proponents assert that these types of benefits will grow exponentially as more organizations climb aboard the RHIO bandwagon. Currently, there are about 100 RHIOs in various stages of development across the country. In some other countries, such as Israel, RHIOs are more fully formed and operational.

To provide the necessary level of data access to providers, RHIOs tap into the individual patient data repositories that typically exist in each organization or enterprise network. Traditionally, a centralized or decentralized data-sharing approach is used.

With the centralized approach, participating providers and IT vendors determine the format of patient data that resides in a regional repository and who can access this data. Once that is decided, interfaces are developed that enable the disparate clinical systems to transfer records to the regional repository where they must be managed, merged, and maintained by the RHIO.

By contrast, the decentralized approach relies on the latest data-sharing technologies that enable RHIO participants to view patient data across the organization without building a centralized repository. Advocates of the decentralized approach note that the strategy enables would-be RHIOs to bypass many of the data ownership conflicts that have stymied the development of these organizations.

Wealth of Benefits
Even in the early stages of development and adoption, healthcare organizations report that RHIOs have already helped them improve patient outcomes and safety, as well as reduce the costs of care for both patients and payers. For example, the large-scale RHIO formed by the Clalit, Rambam, and Sheba healthcare organizations in Israel (see sidebar) reports reduced duplication of tests and improved patient outcomes as a result of greater access to patient information.

Participants in this and other RHIOs, as well as RHIO proponents, say access to patient data has also reduced the risk of medical errors and harmful drug interactions because providers have a complete understanding of a patient’s medication history. Further, some data-sharing vendors offer providers the ability to enhance preventive care by allowing them to segment specific patient information — say, all 50-year-old males within a given geographic region who have not had a colonoscopy — and provide alerts to providers. Some RHIO participants are also using this technology to track possible vitamin deficiencies in infants and signs of abuse among young children.

These benefits are only the tip of the iceberg. RHIOs and their advocates believe that these organizations will become the care delivery model of the future, and as they do, providers will continue to realize new ways to improve the quality of patient care and the safety and well-being of their patients.

Peter van der Grinten serves as general manager, U.S. and Canada, for dbMotion Inc., a provider of Web-based data-sharing technology that helps healthcare organizations improve provider workflows with minimal disruption. He may be contacted at Peter.vanderGrinten@dbMotion.com.

Lessons Learned from a Successful RHIO

  • Recognize that the technical model must conform to the political realities of the collaboration. Each organization was concerned about maintaining its own data, as opposed to transferring it to a centralized repository. Likewise, each wanted to retain its own security requirements. To accommodate these requirements, the Clalit/Rambam/Sheba RHIO implemented a decentralized, or federated, RHIO model.
  • Remain sensitive to the financial pressures affecting each participating organization. The solution must provide cost-effective value and be agile enough for rapid expansion.
  • Utilize technology that accommodates the diverse levels of technical sophistication each organization might exhibit. Some organizations relied upon high levels of automation, contributing detailed specifications and data elements.

    Others provided only scanned PDF files. The RHIO platform must make the full range of patient information available to all its member organizations, regardless of the sophistication of their technical infrastructure.

  • Focus on practicality. With disparate partners, it is impossible for a RHIO to meet each partner’s specific needs. The Clalit/Rambam/Sheba RHIO’s stakeholders recognized that their top common priority was the effective delivery of integrated medical information and used a solution that creatively leveraged the existing standards and interfaces already in place.