A dose of RHIOlity: the toughest RHIO integration challenges are not technology-based

Health Management Technology,  Dec, 2005  by John Smaling

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Remember how difficult it was to roll out enterprisewide orders and results, or group efforts to maximize adoption rates once CPOE went live? Who can forget the pain and suffering involved in bringing an e-MAR live? In their own ways, these were all Herculean efforts that transcended pure systems implementation and, ultimately, revealed themselves as lessons in human behavior and, in some cases, cat herding. Now, multiply those experiences by 10, sprinkle in a root canal and behold multiple attempts to launch regional healthcare information organizations, or RHIOs.

RHIOs are the feel-good story of the year that, collectively, are going to transform healthcare (no, we mean it this time). RHIOs represent the initiative wherein physicians, healthcare systems, payers and business at large are going to harmoniously play in the same sandbox, light scented candles and set aside individual interests for the collective good.

It's easy to fall prey to a feel-good story. In spite of what the major players may think, there is definitely a herd mentality in healthcare. No one likes a bandwagon-jumping contest better than healthcare stakeholders. Even the most sterile imaginations should have no trouble envisioning hundreds of relatively simultaneous RHIO efforts pulling away from port on their maiden voyages.

A current inventory reports that on Sept. 10, 2005, roughly 150 individual RHIO-related initiatives were under way across 41 states. Sadly, a disproportionate number of these will not achieve long-term viability. Some that appeared in a blaze will vanish as quickly as they arrived.

This is most unfortunate, because the regionalization of healthcare information exchange is a terrific way to ultimately feed a national electronic health initiative. In the age of HL7, XML, LDAP, pervasive broadband presence and the real maturation of Web services, the technology needed to "wire" a RHIO is well within our grasp. But technology is not going to be the determining factor in bringing the RHIO concept to reality. We are: People are. RHIOs that strike an appropriate balance of incentives, trust, messaging and sense of community are those that hold the greatest promise for success.

A myriad of considerations must be managed and balanced in the care and feeding of a RHIO. Most have nothing to do with the technical aspects of systems integration, but all have a great deal to do with integrating the minds and interests of RHIO participants.

Retain an Effective Champion

Look at any successful organization; at its helm is an effective leader who can be described with words like strong, intelligent, decisive and determined. Those who serve as champions of RHIOs must possess all of these qualities--and more, and in very large measure, because of the dynamics of the stakeholder groups involved. RHIOs are comprised of highly diverse participating members who often have competing interests. The stereotypes behind these competing interests are widely known:

* providers are practicing irresponsible, costly healthcare;

* payers are overcharging businesses and paying too little to providers;

* businesses are charging employees too much for too little benefit.

Inherent in the stereotypes is an innate lack of trust, a critical requirement of RHIO-building success. Equally as challenging is the fact that among competitors, that which benefits one party is unlikely to benefit another. It may even be perceived as a loss or a direct hit.

These powerful complexities require a leader who possesses large measures of persuasiveness, diplomacy, business-sense, tenacity and charisma. "The most important aspect of my job is to integrate the hearts and minds of the people involved. Keeping the purpose of the RHIO front-and-center is a huge challenge," says Laura Adams, president and CEO of the Rhode Island Quality Institute. "It's very easy to get immersed in the latest technology challenge or funding complexity, but it's imperative to raise as a constant reminder the real purpose of the RHIO." Individuals capable of successfully shouldering the responsibilities of RHIO leadership are rare. Identifying the right person for the job is the primary key to success.

RHIO leadership is an extraordinarily difficult role, not to be underestimated by onlookers to the process. The constant struggle to balance the delicate trust between members, consistent mission and goal reinforcement, funding and incentives and community support is genuine and can wear down the strongest of leaders. Maintaining an interested and invested membership over the protracted period of time required for a RHIO to gain momentum might erode the mettle of the best of the best. Providing support, a confidential ear and other incentives to RHIOs champions will help to keep them at the helm where they are needed, leading the RHIOs.

Establish a Core Set of Goals

In an environment of diverse and possibly opposing interests, it is imperative that a set of unifying goals be established. These goals serve several purposes. They act as a litmus test by which all tactical initiatives can be gauged as in the common interest of the membership. They serve as a behavior moderator by calling out self-interested behavior that may be in conflict with the overall agreed upon goals. They also serve to measure the success of the RHIO.