They might sound futuristic, but the fact is that regional health information organizations (RHIOs) are already here in some communities. So the question for the behavioral healthcare field is no longer whether community-wide databases and communications systems will exist in healthcare, but rather how they will affect mental health and substance abuse professionals' service delivery.
The subject of much anticipation, some excitement and, for many, considerable concern, RHIOs have the potential to transform how behavioral healthcare professionals interact with primary care and acute care professionals, along with healthcare organizations. Industry experts say there definitely is the potential for greater continuity of care and better overall communications, but privacy, security, cost, and care coordination concerns remain important hurdles.
RHIOs in Brief
A RHIO is a nongovernmental organization that oversees interoperable electronic health information, allowing for the sharing of data among physicians, hospitals, local public health agencies, and other entities. At press time, only a handful of RHIOs actually are sharing data, but dozens are in the final planning or early implementation stages. The federal government, through the Office of the National Coordinator for Health Information Technology, envisions RHIOs as the building blocks for the goal, articulated by Congress and the Bush administration, of building the National Health Information Network, a nationwide data-sharing structure that could act as an overall umbrella for all RHIOs nationwide. While all healthcare leaders trying to create and develop RHIOs share certain broad goals, such as improving patient care and creating greater clinician efficiency, the specifics of individual RHIO initiatives vary greatly. In other words, if you've seen one RHIO, you've seen one RHIO.
Among the many challenges ahead are creating efficient operational mechanics for each data-sharing organization, developing effective governance structures, garnering broad participation from a variety of providers and patient care organizations in a community or region, funding the operation of each RHIO, and handling security and privacy concerns. Considerations specific to behavioral healthcare professionals include concerns regarding patient privacy, interactions with other healthcare professionals, technology development and financing, and interconnectivity.
An Early Success
Behavioral healthcare professionals and industry leaders with understandable concerns about some of the challenges involved in RHIO development might want to check out what's happening in Mesa County, Colorado. In Grand Junction, the county seat, a coalition of the three main hospital organizations, the main physician organization, and the area's largest insurer has been organized to build a RHIO from the ground up. Although the RHIO is still quite new—it went live in late October—the information organization has been designed with scrupulous concern for the needs of behavioral healthcare professionals, primary care physicians, specialists, and patients alike, says Dick Thompson, executive director of the RHIO (named Quality Health Network). For example, after meeting with representatives of all the health disciplines involved, their interests, considerations, and concerns were built into the process at Quality Health Network.
“We founded this RHIO with the vision that everybody needed to ‘play,’ because our goal is to exchange information in order to optimize the health of the community, and everything is driven by that,” Thompson emphasizes. In fact, one of the first healthcare professionals to be plugged into the network was John Halvorson, PhD, a clinical psychologist who is the coordinator of the Behavioral Sciences Program and Residency within the St. Mary's Family Practice Residency, which is the training organization at St. Mary's Healthcare in Grand Junction.
The RHIO's implementation facilitates Dr. Halvorson's communications with physicians, residents, and staffers at St. Mary's Family Practice Residency. While his laboratory, pathology, and other orders are delivered directly to his database, as clinically appropriate, Dr. Halvorson can direct encounter notes, transcriptions, and other materials electronically to the appropriate physicians he needs to communicate with at St. Mary's. From the other direction, he can receive electronic referral information from any physician in his RHIO-certified electronic address book.
Dr. Halvorson says he has been very pleased with how things have gone so far. “The few problems have been very minor,” he adds, “and Dick Thompson and his crew have provided excellent training and support.” Dr. Halvorson says he might be a good test case for the performance of RHIOs, being a classic mental health professional who has long been extremely careful to guard the privacy, security, and confidentiality of patients’ records.
According to Thompson, thoughtful, purposeful collaboration among disciplines is key to building a successful RHIO that includes behavioral healthcare. “I truly believe a collaborative approach enhances the potential for improving outcomes,” he says. “That's very clear. The challenge is to coordinate that care so that the behavioral health professional and the patient are satisfied that the confidentiality and privacy of that special relationship are maintained.” Quality Health Network hasn't had any specific problems incorporating behavioral healthcare data into the RHIO thus far, but it's still very early in the process, Thompson concedes.