Your Local RHIO/HIE Could Be a Meaningful Partner

Your local RHIO or HIE should be much more than a check box on your Meaningful Use requirements list, they stand to play an important role in delivering the vision of Meaningful Use. Too often RHIOs are discussed as nothing more than repositories of clinical data, but by working with them as a partner they can help organizations and providers address half the Meaningful Use requirements.

I know many of you are probably a little skeptical at this point. Sure, there may be a few areas where they could help, but half sounds a bit unrealistic. While there are no guaranties that every RHIO can deliver on everything, the possibilities are there. All health care organizations are facing tight budgets and huge costs to meet Meaningful Use. As the CIO of a community hospital I don’t have the staff, the time, or the budget to do everything in house so help is always welcome. The Rochester RHIO has been working with hospitals, providers, insurers, local employers, and community health agencies in a nine county region of Western New York State since 2005 and is poised to make an impact on our Meaningful Use efforts.

First let me address how any RHIO can play a role.  The table below gives an overview of some of the Meaningful Use requirements and how a RHIO can help.

Requirement	Hospital(H) or Eligible Provider (EP)	RHIO / HIE Role
Generate and transmit permissible prescriptions electronically.	EP	Provide access to ePrescribing through a RHIO based application.
Maintain active medication list.	H & EP	Through linkages with ePrescribing and insurance companies RHIOs can provide medication histories.
Maintain active medication allergy list.	H & EP	This can be done either as clinical data or through medication history.
Incorporate clinical lab Test results into EHR as structured data.	H & EP	Particularly for EPs a RHIO can act as a single interface for electronic delivery of lab tests.
Check insurance eligibility electronically.	H & EP	Many RHIOs are tied into payers and are able to provide this information.
Provide patients with electronic access to their health information.	H & EP	Since most or all of this data would be available in the RHIO, the patient can be given access through a PHR or PHR gateway provided by the RHIO.
Provide patients with an electronic copy of their discharge instructions and procedures at time of discharge.	H	These could be sent to the RHIO and made available via a RHIO provided PHR or PHR gateway.
Provide patients with timely access to their health information within 96 hours of it being available.	EP	Since most or all of this data would be available in the RHIO, the patient can be given access through a PHR or PHR gateway provided by the RHIO.
Provide clinical summaries for patients of each office visit.	EP	These could be sent to the RHIO and made available via a RHIO provided PHR or PHR gateway.
Capability to exchange key clinical information among providers of care and patient authorized entities electronically.	H & EP	This is the classic use case for a RHIO / HIE.
Perform medication reconciliation at relevant encounters and each transition of care.	H & EP	Since patients don’t always have this information written down and could forget important details the medication history could be obtained from the RHIO portal and reviewed with the patient.
Provide summary of care record for each transition of care and referral.	H & EP	These could be sent to the RHIO and made available via a RHIO portal.

At this point I hope you’re less skeptical, but probably still having your doubts about how realistic it is to actually do some of this.  Five years ago I was too, but much of this is already happening or being worked on in Rochester.  Here are some specifics from the Rochester RHIO:

• ePrescribing – the RHIO offers a bi-directional ePrescribing application to community physicians, allowing them to electronically send prescriptions to local pharmacies. http://www.grrhio.org/providers/ePrescribing.aspx
• Active Medication List – the three largest insurance providers in the area are sending the Rochester RHIO medication history for their members. http://www.grrhio.org/about/~/media/DataMaster0410.ashx
• Incorporate Clinical Lab Results – not only does the Rochester RHIO collect clinical lab results from most labs in the area, but they can electronically deliver the results from all participating labs to a provider’s EMR through a single interface. http://www.grrhio.org/providers/services.aspx#eResults
• Exchange key clinical information – through its web portal as well as interfaces to provider EMRs the Rochester RHIO provides access to medical transcriptions, radiology reports, and radiology images.  http://www.grrhio.org/providers/fastfacts.aspx
• Check insurance eligibility – through their connections to local payers the Rochester RHIO is able to provide participating organizations access to insurance eligibility. http://www.grrhio.org/providers/fastfacts.aspx
• Provide patients with electronic access – through a PHR gateway that is currently under development the Rochester RHIO plans to allow patients to direct the information stored in the RHIO to publically available PHRs such as Google Health or Microsoft HealthVault. http://www.grrhio.org/patients/phrs.aspx

So how did all this happen? Through collaboration and partnerships among the RHIO and the community stakeholders. Five years ago I was a skeptic who saw the promise of the RHIO as a pipe dream. Today I see the RHIO as a valuable partner. I’m not proposing that the RHIO is the only way to accomplish these things, but they certainly do hold some great possibilities.

If you’ve read this far and you’re still a skeptic then you better get busy, because you’ve got a lot of work to do and you’re probably going to need to find some help.