Medical errors often occur during handoffs, when a patient moves from one site of care to another but patient information does not. The lost information also costs time and money because health care providers schedule unnecessary and expensive tests. As a result, this week, Geisinger Health Systems announced that it has contracted with enterprise content management company Vignette to create a portal that lets doctors at one site see details of care at another site.
Geisinger and two other unaffiliated community hospitals have agreed to share information as part of the Geisinger RHIO (regional health information organization), which covers more than 3 million patients. Up to eight other health systems are slated to join the RHIO over the next three years.
RHIOs strive to get all of a patients care information in front of a physician even when care is delivered at different institutions. Well over 100 RHIOs have sprung up over the past few years, but fewer than 10 percent are believed to be actively exchanging information.
Geisinger CIO Frank Richards estimates that the new RHIO will probably not exchange information for a year but said that it is starting out with an advantage that other RHIOs lack: All of Geisingers 650 physicians are already recording and accessing patient information electronically.
Earlier this year, Geisinger contracted with Sun Microsystems to create a master patient index, so that a system at one site could recognize and integrate patients records at other sites without confusing people with the same name or overlooking people entered under different names. David Crean, vice president of Vignettes health care solutions unit, said teams from Vignette and Sun will work together, but with each sticking to their own strengths.
He said it is too early to tell whether the companies will work together on other RHIOs. Vignettes portal platform has given hospital-based physicians "a single place to log into that doesnt require navigating separate systems," said Crean, so taking that to the RHIO level is the logical next step.
Before launching the Geisinger RHIO, CIO Richards spoke with other RHIOs and found there was a lot of variation, depending on local government, politics between health care providers and state initiatives. "The technology probably has the least number of options," he said. Still, all sorts of vendors are trying to get into the market: "Everybody has an answer for the RHIO problem, even if theyre selling Q-tips."
When health care providers come together to form an RHIO, "a hodgepodge of systems" comes together, said Ross Armstrong, a senior analyst with Info-Tech Research Groups.
That puts a lot of technology vendors in a position to move the RHIO forward, he said, but it doesnt mean vendors understand all the pieces theyd be moving from place to place or the regulations that govern how sensitive data can be shared. "The established health care companies should start stepping up now," he said. "You dont necessarily want the Suns and the Oracles."
Richards said that since health care providers in the Geisinger RHIO are already storing information electronically, the least expensive solution is one that lets different databases come together, rather than one that requires building new databases.
Geisinger has a three-year, $1.5 million grant from the Agency for Healthcare Research and Quality that Richards expects to cover almost all of the costs of getting the RHIO up and running, but he isnt sure how the RHIO will pay for itself when that funding ends or even how much the RHIO will cost to maintain. He thinks doctors offices will contribute to some costs because their patients will expect them to have access to the information an RHIO will provide.
Although health insurance companies and other payers save most of the money when doctors stop ordering unnecessary tests, Richards says they arent backing the RHIO financially yet, but he believes he can persuade them to do so once the RHIO generates enough data: "As the value becomes apparent, that will be an easier conversation to have."