Needed: A Compelling, Sustainable Business Model for RHIO's

In his 2004 State of the Union Address, President Bush proclaimed that we’ll have an electronic health record for most Americans within 10 years. Soon after, the Office of the National Coordinator for Health Information Technology was established and Dr. David Brailer was appointed as its first director. On October 6th, the Feds announced the first set of grants to help formulate consensus around standards and harmonization (, compliance certification (, and privacy and security ( for RHIOs; the so-called Regional Health Information Organizations that will serve as a foundation for an eventual National Health Information Network. The idea; Interconnect hospitals, clinics, labs, imaging centers, health plans and others in the healthcare ecosystem to enable the secure exchange of medical information within a region, or across the nation, to improve the safety and quality of patient care.

If this all sounds familiar, it’s because it is. Back in the 80’s and early 90’s, progressive healthcare leaders applied for grants and joined together to form CHIN’s, Community Health Information Networks. Back then, the technology needed was considerably more complex and expensive than the contemporary solutions available today (Internet, web services, xml). But the reason CHIN’s never took off in a big way had little to do with the available technology at the time. CHIN’s didn’t take off in a meaningful way because when the grant money dried up, there just wasn’t a business model to sustain them.

Who benefits from the fluid exchange of health information? Is it in the best interest of hospitals and clinics to share their confidential and sometimes proprietary data? And more importantly, who should pay? Patients? Providers? Health plans? Government?

One company here in the Pacific Northwest has not only come up with some very good technology to enable RHIOs, but also a clinician-centric business model to support them. It calls for clinicians to pay about $100 a month to share health information. Hospitals pay more. So far, area clinicians are actually lining up for the service saying they’ll receive at least that much value from being able to freely exchange information with local hospitals and their fellow medical providers.

If history offers a lesson, it’s that the business model to sustain a regional or national health information network is as important, if not more important, than the technology that makes it possible.

What do you think? With all the buzz about RHIO’s and NHIN, is enough attention being paid to the sustainable business models that will support them? Who should pay, and what’s the return on investment? We welcome your thoughts.

Bill Crounse, MD, Global Healthcare Industry Manager, Microsoft Healthcare and Life Sciences