The HIT Transition Weblog

July Grant Roundup

Washington State: $250,000 to Pilot HIE

Arizona: $685,000 in Rural e-Health Grants

Louisiana: Millions More for Electronic Medical Records

Vendor Grants $50,000 to Physicians for EMR in Florida

New Federal HIT Grants to be Announced

Directory of Biomedical and Healthcare Grants

The Health IT Grant Resource Directory

More Uses for English Majors

I feel like I hit the lottery! NAHIT has published its list of healthcare IT jargon definitions. And I win!

We were more or less assuming the RHIO and HIE definitions three years ago. But it seemed like anybody who wanted a for-profit model wanted HIE, while the NPO [Ed. note: That's "Non-Profit Organization," for those of you stuck in the money-making paradigm.], crowd was unafraid of RHIO and its hoary socialist allusions: Regional and Organization. Now maybe everybody won't think they know what I'm talking about when I say RHIO (pinko commie big brother freebie hippie healthcare) versus HIE (fat cat capitalist libertarian survival of the fittest healthcare).

Instead, now HIE -- health information exchange -- is a process of exchanging records, while HIO -- health information organization -- is the thingy that exchanges them, and a RHIO is a "type" of HIO -- presumably a HIO for a R(egion), but NAHIT's still a little cagey on that point.

Glad we got that straight.

Quick! Everybody grab the new keyword!

Grants Roundup for March 2008

$25 Million Gift Seeks Match from Physicians, Includes Bleeding Edge IT

CDC Awards $38 Million to RHIOs

$150,000 for EMR/Cardiac Pilot Project

AHRQ Awards Millions for Clinical Decision Support Systems

Community Foundation Grants Hit Record, Health Tech-Heavy

FCC Grants to Expand Telemedicine in the Rural West

Vermont: Tax Health Plans to Pay for Health Tech?

Delta Dental Awards $50,000 to Prove Digital Expands Access

Practices Can Win $290,000 in Medicare Bonuses through EMR Adoption

Wisconsin Wishes for RHIO Clarity; Tooth Fairy Alerted

Wisconsin has withdrawn its RFP for a statewide health information exchange, issued in December. Apparently, some of the major partners thought that the Request for Proposals hadn't nailed down just exactly how the HIE would be implemented and paid for. Well, those folks in Wisconsin know a lot about cows, but you won't find many cowboys. It takes a real buckaroo to haul off and whip up a RHIO. This here is uncleared land, partner.

Grants Roundup

HHS Awards Grant to Secure Health Information Technology

Independent Sector Urges Senate Finance Committee to Include Nonprofits in Stimulus Package

$1.2 Million for eMAR for Aging Patients

Idaho RHIO To Get $500,000 from State, $11.3 Million from Providers

CDC Grant Opportunity Requires EMRs

AT&T Awards HIT Grantto Local Volunteers in Medicine Group

State HIT Grants in Virginia

PacificCare Gives $700,000 for Safety Net HIE

Opportunity: New Federal Rural HIT Grants

The Old Rural Healthcare Bond Refinancing Ploy

RHIOs Exploring Philanthropy?

Regional Health Information Organizations may be changing their finance strategies. In the wake of high-profile RHIO closings, and in the shadow cast by a recent report published by Health Affairs suggesting that RHIOs are floundering financially, it is not surprising that RHIO organizers are exploring new resources for capital.

Our 2007 RHIO finance survey found that about three-fourths of the U.S. health information exchanges are setup as nonprofit organizations, enjoying both exemption from taxes and the ability to accept tax-deductible contributions from private foundations. However, our report also noted that only very small amounts of private funding was finding its way into the RHIO movement; the majority of the organizations were relying on government dollars to start up operations, and were expecting to pay for ongoing costs by charging healthcare providers for their services.

That’s old news. But now things just might be looking up. There's some interesting evidence that RHIOs may be acquiring some new fundraising chops.

Marty's HIT List 2008

Here's my official list of prognostications for 2008.  In 2006 and 2007, I didn't call them predictions, so I probably don't deserve any credit if anything I said came true.  If you agree -- or not -- you can give me your own scorecard by clicking here.  Give your feedback by January 23 and I'll post the results (and any interesting comments) in a blog at the end of the month. As far as we know, we're the only industry analysts that give you, our valued reader, this critical "You're Full of..." HIT response tool.

RHIO Riposte

My response to the flurry of premature RHIO obituaries has been included in today's Health 2.0 blog.  I was grateful they accepted my request to guest author, even though there are probably a lot of Health 2.0 types who would prefer the industry pursue a commercial model for health information exchange.  Maybe even their commercial model.

I'm actually a very 2.0 kinda guy -- pushing out a collaborative intranet site in the late nineties, publishing various blogs since aught-one and even scheming to accelerate HIT standards adoption with a hare-braned collaborative environment of my own design.  I even ran an industry collaborative project on 2.0-ware without telling anyone until it was over.

Cripes.  It's been four years since I gave that 2.0 testimony.  Maybe I better get busy again.  Sounds like people are paying attention now.

Meanwhile, to show that 2.0 might work even for nonprofits, put your comments over on the H20 version of my editorial.  You don't even have to agree with me.  In fact, it's sorta better if you don't.  "Me too" is so 1.0, ya know?

Seeking Sustainable RHIO Forest; View Obscured by Non-profit Trees

Health Affairs just published a study by a team of Harvard researchers that has cast a pall on the sustainability of Regional Health Information Organizations (also referred to as Health Information Exchanges). The report, The State Of Regional Health Information Organizations: Current Activities And Financing, by Julia Adler-Milstein, Andrew P. McAfee, David W. Bates, and Ashish K. Jha, seems to imply that the maladies suffered by RHIO efforts around the country might be fatal, at least if you read the many news stories and blogs that are talking about it.  I say "seems to" because our analysis suggests that the industry echosphere is still missing quite a bit of the big picture.  Let's take this step by step, starting with the Harvard study and moving into the invisible economy and the nature of the RHIO challenge.

First, the "scary facts" presented by the researchers:

• 25% of previously-listed RHIOs seem to be "defunct"
• Only 20% of the remainder reported exchanging significant volumes of clinical data
• Most of the data they were exchanging falls into the categories of lab results, inpatient data and medication history
• A majority reported receiving in-kind donations, about half reported grants or financial contributions and slightly less than half reported no financial contributions

You might look at these factoids and come to the conclusion that the current generation of RHIOs are unsustainable.  The quote lifted from the report that has been frequently cited to support this conclusion says: "if RHIOs are to succeed as small businesses, they must be built around sustainable business models, which requires both profitability and value creation for participants."

Ice, Ice, Very Ice....

We hear our local weather made the BBC.  Yow.  A-yip-tye-o-ee-yay!

We took in a number of refugees, being the last house among our chosen family to have power.  Then the lights went out at about 4 pm yesterday.  The office is only a half-mile away, and there we have both lights and net, hence this post.

I want to reassure you that this meteorological Black Swan is not going to keep us from doing our webinar tomorrow.  Still, if you have an extra box of double-ought swan cartridges, we could use a little more ammunition.  A rick of seasoned firewood would be nice, too.

Meanwhile, yes, we are going to have something to say about Deborah Peel's attack on her local hospital for daring to store patient records electronically, and even more to say about the premature RHIO obituary that seems to have been published in Health Affairs.

Right now, we're kinda chillin'.

http://hittransition.com/flashpoint/ad_rta.htm

Grant Roundup for 12/05/07

"Disruptive Innovations" Entrants Invited to Apply for Grants
The Robert Wood Johnson Foundation is looking for ways to shake up healthcare, and they may have found some. Among the projects invited to compete for funding:

• Project ECHO: Knowledge Networks for the Treatment of Complex Diseases in Remote, Rural, Underserved Communities - University of New Mexico Health Sciences Center
• Instant Birth Control - Planned Parenthood of the Columbia Willamette
• Develop a universal technology framework for registries focused on capturing outcomes data for cardiovascular disease -- American College of Cardiology
• Clinical Research Information Exchange - CRIX International
• Health Futures Markets - New York University
• The EpiSurveyor Project: Lowering the Barriers and Raising the Bar for Data Collection - The Datadyne Group
• Space age medical care for use on Earth - Henry Ford Hospital
• Rethinking What a Health Insurance Package Can Be - Working Today-Freelancers Union

Colorado Trust Awards $3.9 Million: Some Room for CDSS, eMAR?
Grants totaling $3.9 million to help strengthen patient care and safety in hospitals around the state. Supports the Five Million Lives Campaign, an initiative of the Institute for Healthcare Improvement (IHI) intended to build safeguards against hospital-acquired infections, ADEs, surgical errors and other complications of patient care.

Center for Community Health Leadership: $3 Million Grant for Connected Healthcare
Organization sponsored by Misys Healthcare Systems commits $3 million to the 3 million-population Tampa Bay area.

North Dakota Woman Has A Global Impact
This busy lady was over and above her fair share with her work for rural clinics and working with public safety groups. But then the Navajo nation wanted to track diabetes using PDA/blackberry technology...

Your Grant Dollars At Work: Rochester RHIO Goes Live
The upstate New York RHIO, funded by a $4.4 million state grant and $2 million from local businesses, has started training 20 participating physician office's staff members. Cork the Champagne!

Grant Roundup for November 20

$400 in Grants from FCC for Health Networks
Now that's a government putting its money where its spin usually is. A large majority of the 80 organizations who applied are receiving funding. Examples: the Cabarrus Health Alliance gets $6 million; Copper Queen hospital gets $183,000.

Near Space Technology Brings Healthcare To Navajo Nation
Satellite technology to monitor diabetes funded by the U.S. Department of Agriculture's Distance Learning and Telemedicine Grant program.

Local Philanthropy Funds Health IT
Grocery magnate Hannaford Charitable Foundation gives $25,000 to Saratoga Hospital in its campaign for Electronic Medical Records (EMR) and Computer Physician Order Entry (CPOE).

First Health IT Grant Resource Directory Developed
The "HIT GRD" serves RHIOs, HIEs, hospitals, clinics, rural healthcare and HIT software vendors with information on private funding prospects for RHIO and health IT.

Wealth Transfer To Benefit Illinois Communities
We've been explaining the U.S. intergenerational wealth transfer for years now: Over the coming few decades, many trillions of dollars will pass from the largest generation ever to walk the earth to its heirs and favorite charities (we estimate nonprofit healthcare's slice to be upwards of $2 trillion -- with a T). And we're not alone; communities are catching on...

Resource: Dartmouth Atlas of Health Care
Some of the facts and figues for creating the HIT support case.

New Money for Health IT

Mention the word “grant” to almost anybody in healthcare, and they immediately think “federal.” And that’s odd, because the U.S. federal government is responsible for less than 20% of the grant dollars given annually to U.S. nonprofit organizations.

We know (because Mike Leavitt recently reminded us) that unlike nearly everywhere else in the world, American government doesn’t pay for health IT. So why are we still standing here like a row of prairie dogs waiting for peanuts? It’s time to start thinking differently, and start looking to the country’s 50,000 private foundations, Community Foundations and corporate giving programs for money for health IT.

Rather than just repeating that exhortation incessantly to everyone who will listen, we have been doing some of the footwork. Through a two-year research project involving more tedious reading and databasing than I care to remember, we’ve compiled a list of just over 4,000 prospective funders of health IT. And not one of them is the federal government. Read on...

Health IT Grant Roundup

Creative applications of lifesaving health IT

These examples scarcely glimpse at the wide range of creative ways IT systems are beginning to find philanthropic support, often by emphasizing the critical information technology infrastructure backing up telemedicine and other clinical systems.

Remotely Healthy: Monitors Keep Track of Patients from a Distance
Multi-year grant from Health Foundation of South Florida.

Excellus BCBS Expands Partnership with Hospitals to Combat Hospital-Acquired Infections, Save Lives
$5 million expansion of funding for upstate New York hospitals involving infection control (real-time electronic access to infection-related clinical data component). In the GRD see the related Community Health Foundation of Western & Central New York.

Verizon Foundation Provides Funding for Seven South Carolina Nonprofit Programs
Relatively small grant with a portion for connectivity, communications, translation software.

Indiana HIE Receives $1.7 million Grant
The Indiana Health Information Exchange (IHIE) receives $1.7 million from Regenstrief Foundation to support participation of small primary care practices in the RHIO.

Washington Regional Receives $2 Million From Wal-Mart
Nearing completion of an $8 million clinical information system, the grant supports these technology advancements to generate better information and enhanced data, and streamline processes that produce better patient outcomes.

Case Management Technology Could Cure Some of State's Health Care Ills
Joint venture funding confronts electronic chronic care case management.

Missouri Foundation for Health Infrastructure Grants
17 grants totaling $2.484,023 million to area health departments for infrastructure projects including the purchase of equipment supporting information technology, communication services; includes $576,646 to update the building and information technology equipment for Springfield-Greene County Health Department.

Working with legislators:
Hays Medical Center Receives $500,000 Federal Grant for Telemedicine, Connectivity
"We're very fortunate, Kansans are," said Jodi Schmidt, chief development officer at HMC. "Our congressmen are great about helping us go after federal funds for these sorts of things." Federal grants for these and related projects have totaled about $4 million over 10 years, the most recent (October, 2007) being the largest.

Effective Coattails:
Palo Alto Medical Foundation Receives $1.2 Million Grant for New Diabetes Management Study; Trial Will Evaluate Online Disease Management
Funds a solution developed by several partners including iMetrikus, Epic Systems, Palm and Sprint that will automatically upload blood glucose readings to patient's electronic health record

http://hittransition.com/flashpoint/ad_rhio2.htm

Allscripts Exec Drinks CCD Koolaid, Sees RHIOs Dry Up

"The more important fundamental laws and facts of physical science have all been discovered, and these are now so firmly established that the possibility of their ever being supplanted in consequence of new discoveries is exceedingly remote.... Our future discoveries must be looked for in the sixth place of decimals." – Albert. A. Michelson, German-born American physicist, 1894.

There was so much interesting stuff in Joe Conn's article in Modern Healthcare last week, I nearly had to flip a coin to figure out what to say about it.  Okay, yeah, it's something of a coming-out story for HIMMS' Electronic Health Record Vendors Association (EHRVA), and sure, they've decided to all go ahead and adopt the Continuity of Care Document (CCD), which is the compromise clinical summary standard worked out by the proponents of the competing standards developed by HL7 and ASTM, and, great, they're expecting CCD to be a part of the next round of CCHIT requirements. 

And CCD is, of course, better than a herd of ezras, so we have to kick some sand in the face of the holdouts that are for some reason continuing to espouse CCRs for PHRs and the like, a task to which an Allscripts representative dutifully lends his foot.  (Sorry for not expanding all the mynorcas, but I understand a half-million dollars is being spent by ONCHIT to build a HIT lexicon, so I don't want to steal their thunder)

But then this pops out:

Adoption of the CCD standard by EHR vendors would allow providers using different systems to "support transitions of care without requiring a regional health information exchange to be in place," said Dan Michelson, chief marketing officer for EHRVA member Allscripts, in a news release.

(Continued...)

http://hittransition.com/flashpoint/ad_rhio2.htm

HIT ROI and Incentivizing Swampland Development

I was digging around on some RHIO research (there's a new report out from an organization that is trying to corral the RHIOs into something that might begin to look like a National Health Information Network -- or at least look more like each other). I forgot to take my ADD meds today, so I was clicking away, deeper and deeper into hyperspace when I struck upon Mark Frisse's Policy blog.  Now, Dr. Frisse is a heavy hitter in the RHIO universe.  He sits on blue ribbon panels and he speaks to hifalutin conferences and he coauthors important papers, meanwhile holding a leadership position in one of the country's more forward Regional Health Information Organizations.

So, I expected what I usually get when I see such a luminary has a blog: Two or three cursory posts that read like press releases, followed by many months of neglect.

Imagine my suprise when I discovered his posts were personal, thoughtful, insightful and -- get this!  -- recent.  And long.  (He almost makes me look concise.)  But readable.  Unfortunately, he doesn't include a permalink on his blog entries, so you need to go to his October archive and scroll down to find "Building Nirvana Without Draining the Swamp."

His point -- one of them -- is that it's basically futile to talk about return on investment for healthcare IT, or to determine who should pay for it, until we fix the healthcare system itself.  Since Michael and I are doing a webinar on ROI for healthcare IT in a few weeks, I thought I had better read it. (Continued)

CIA to Take Over VA Medical Records

[Okay, this was originally a clever and slightly scary story about the involvement of the CIA in a certain Health IT company (true) that is developing certain identification technologies (again, true) that take advantage of a very sophisticated database technology (absolutely true).

Unfortunately, the author of the story has been unable to substantiate a direct connection between that HIT company and the company that develops the database technology, and it is that second company that is working with the VA.  So, the wry, but somewhat worrisome tone of the original text falls pretty much flat on its face.  The editor regrets the error, and the author is scrambling for some old notes.  I wish him the best.

We don't usually do conspiracy stories.  Maybe this is why.  Hope you like the cartoon, which is still valid, as it concerns only the proven connection between Company A and The Company, as it were. -Ed.]

From Niche to NHIN Nine at a Time

HHS announced today that its has awarded contracts worth $22.5 million nine RHIOs to start trial implementations of a national network for exchanging electronic health information. I'm all for government paying its fair share (much larger than this) of the cost of getting a ubiquitous health record online for all Americans. But is this putting the cart before the horse?

Acute and Obtuse: Angles on Health IT Funding

Part 2 in a series on health IT funding.
See the other installments in the Grants and Funding category.

You’re a software vendor and willing to throw some effort behind getting your customer’s HIT/telemedicine/clinical technology project funded, but you’ve got exactly zero experience in grant research and grantwriting. Or you’re a hospital IT director frustrated over tight resources – barely enough to keep the lights on – and you’ve got no visibility into the institution’s fundraising operation. Maybe you’re the CIO with the same feelings.

There’s money out there for health IT. The entire U.S. nonprofit sector – an annual $1.4 trillion chunk of the economy – collects only about $70 billion from government, and over $460 billion from private sources...

Rainmakers for Health IT and RHIO

Had a couple calls this week from IT vendors about our RHIO finance report (http://rhio.hittransition.com). Interesting calls. Both wanted to know how to get more involved in their customers' affairs to try to get them off high center and out pounding the pavement for funding. Seems they've been working with RHIOs for over a year now and still haven't seen a check.

"What's it gonna take to move this needle?" was the frustrated question from one. She's with a big software company and not used to sitting on her sales cycle quite so long. The RHIO "hasn't pulled in any funding since the initial grant and now they're running on fumes."

I asked both callers if they themselves had provided any funding. "No, but we haven't been asked" was the approximate reply from both.

Health IT Fundraising Performance

Part 1 of a series on HIT fundraising
See the other installments in the Grants and Funding category.

NOTE: Michael is presenting a webinar, “The Grant Search for Health IT – Resources and Techniques,” on October 2 and 3.

A Brief Intro: Health IT funding topics have become the most-viewed content in our webspace at hittransition.com. We are offering this series to meet a growing demand for “fundraising moxie” among IT administrators. We will proceed as if your institution’s development department or operating foundation has abandoned you or doesn’t exist (maybe you’re a small rural operation), and you’ve got to do it all on your lonesome. Naturally, if we can get cabinet folk onboard, the hospital’s fundraising staff will take over a large part of this work. In any case, you will benefit immensely by knowing the principles involved and where you fit in. This will be a straight-shooting series, no holds barred. When we can point you directly to where the bodies are buried we intend to do just that. So I feel like I need to toss this out right now: Please don’t be offended at my unapologetic use of every tool at my disposal to unearth cash. We speak plainly around here, and this delicate topic will be no exception.

RHIO Business Model Woefully Misunderstood by Health IT Media

More health IT humor at the HIT Bottom Archive.

Juicy Carrot for New York Providers

Perhaps $9.5 million seems like a skinny carrot when you're talking about attracting physicians across the state of New York. Be that as it may, much of this new state money for tackling some nagging healthcare problems seems headed for the right places. Independent Health Association, an IPA, and Taconic Health Information Network and Community RHIO (THINC), an IPA-centered health information exchange (and I thought we had a long company name) are getting some of it. The idea is that the state will be able to better manage chronic illness and epidemics if health information is available. A capitol legislative angle, I would say.

Less RHIO Money from Physicians - And this is a good thing?

Physicians were 88% less likely to be cited as a significant source of earned revenues by startup-stage Regional Health Information Organizations than they were a year ago. Physician contributions to RHIO earnings also dropped among more mature RHIOs. The data comes from the annual Survey of Regional Health Information Organization Finance (http://rhio.hittransition.com). Less money for RHIO. So, how is this a good thing?

Dam the RHIOs?

In a provocative editorial, Fierce Healthcare's Anne Zieger puts forward the arguments for Why RHIOs shouldn't exist.  She cites legal issues, cost issues and the challenge of getting competitors to share data.  She also references a Fierce Healthcare story on our recently-released 2007 survey of RHIO Finance, asking, "how long can this model last if most efforts are paid for by grants?"

She posits one potential RHIO alternative: "[Some] form of medical data banking--by a trusted intermediary rather than providers--seems to solve many problems that straight-ahead data exchanges can."  She also suggests that Patient Health Records, "[once] they become more robust," might be an answer to the data sharing challenge.

She admits to being a bit contrarian.  "All I'm trying to say here is that before we fixate on RHIOs as the answer to patient data sharing, we should probably make sure we treat RHIOs and HIEs with all due skepticism."

Fair enough, but I think she may be missing a point or two, as are many in the RHIO space.

$31.4 Million in Health IT Grants

The federal Health Resources and Services Administration (HRSA) part of HHS, has awarded IT funding to 46 federally qualified health centers across the nation that serve uninsured and underserved populations. $27 million will go directly to EMR implementation projects at 25 federally qualified health centers, ranging from $460,00 to $1.4 million per center. E-prescribing, physician order entry, PHR, smart cards, HIT adoption planning and RHIOs took the remaining funding, ranging from $100,000 to $300,000 per grant.

In another announcement, the Colorado Health Foundation has awarded $2.5 million in grants to twenty-one groups to improve health IT systems through the foundation's Healthy Connections: Strengthening Care Through Health Information initiative. Among the recipients are nine federally qualified health centers.

2007 RHIO Finance Survey Released

Is RHIO expansion incompatible with commercial viability?  Well, yes and no.  Find out why in our just-released report on the 2007 Survey of Regional Health Information Organization Finance, "Sustainable RHIO Funding and the Emerging Business Model."  We know that you love all the free information we bring you on our blog, news pages, HITSync newsletter, etc., but this one is gonna cost you.  Why?  Because it's worth it, and we need to occasionally charge a fee so we can stay in business and keep putting our shoulders to the grindstone of transforming healthcare through HIT.

State CIOs Invite Bigger Role in RHIO

The organization that represents the CIOs of state governments says its members should take a more active role in their states' Regional Health Information Organizations. This would definitely rate a "Duh Of The Month" here at the HIT Transition Weblog, except that I'd like to take a step backward and say that I'm not entirely sure that it's such a good idea until state governments show more willingness to pay for RHIO development.

According to a Government Health IT article, the National Association of State CIOs (NASCIO) is calling for its members to have a bigger say in how RHIOs develop. “Integrating these regional efforts will become a critical aspect of state CIO responsibility,” states a NASCIO brief. State government CIOs could serve as advisors to represent state health programs' technical interests.

Fine idea... but governments are already more involved in RHIO management than the dollars they offer would seem to justify.

Long Ways from RHIO?

An article in Information Week makes clear that the remaining barriers to the build out of Regional Health Information Organizations (RHIOs) are formidable. It states:

"Santa Barbara serves as a reality check on the U.S. health care system's slow progress toward a real EMR network. The diagnosis: It's worse than you think."

The National Health Information Network (NHIN), envisioned as a meta-network of the regional medical records networks, relies on widespread RHIO implementation and a relatively complete provider membership in order to reach the dream of a truly portable health record and the realization of healthcare cost savings estimated by some to be in the tens of billions annually.

In the two-and-one-half years since the Administration first called for a fully implemented NHIN by 2014, we see that no more than about 10% of physicians are using electronic medical records, and perhaps less than 1% are connected in any way to what could even be remotely called a RHIO. At the same time, eHealth Initiative tells us that there are more than 160 U.S. RHIO projects in one stage of development or another. So what's keeping adoption rates so low?

Two words: data sharing...

RHIO Business Model Evolving

UPDATE: The findings from the 007 RHIO finance survey have been posted at http://rhio.hittransition.com. 

A year ago we conducted the first survey of Regional Health Information Organization finance, and published a 50-page report, Funding RHIO Startup and Financing for Life. Over the past year we have had innumerable phone calls and emails from RHIOs with questions, and from publications -- most recently Most Wired Magazine -- with requests for interviews.

The newest callers want to know, What's happened in the past year? And we should be able to tell them (maybe), because we've just completed the 2007 Survey of Regional Health Information Organization Finance. A full report will be forthcoming in June, but it makes some sense to talk about what we'll be looking for in the new data.

2007 RHIO Finance Survey Opens to Respondents

UPDATE: Findings from the 2007 RHIO finance survey have been posted at http://hittransition.com.

For a second year, Healthcare IT Transition Group is conducting its national survey to learn how Regional Health Information Organizations (RHIOs) are funded. Last year, in the first-ever broad-based study of RHIO finance, some surprising things surfaced, including that a sustainable business model was evolving.

The 2007 survey questionnaire is nearly identical to the 2006 survey, enabling a year-on-year analysis. We have added one new section, however; this year information will be gathered on the purchase decisioning process. From talks with industry leaders following last year’s findings, we learned that vendors were finding the RHIO segment a difficult one in many respects, particularly with regard to the variety and number of stakeholders involved and the lack of historical data in this new sector.

FOUND: Sustainable RHIO Business Model

UPDATE: The 2007 findings from the annual survey of RHIO finance have been posted at http://rhio.hittransition.com.  

Against the frequently heard consternations over RHIO financial performance, and against recent pundits' remarks that RHIOs haven't yet found a business model, a new report flies in the face of all this conventional wisdom to state that, au contrare, RHIOs may just have found a sustainable business model. And the report explains why it's a really good one.

HITTG conducted The Survey of Regional Health Information Organization Finance during March and April, distributing survey invitations to a list of 20,000 HIT professionals nationwide partnering with WEDI to reach as many RHIO projects as possible. Financial data on fifty RHIOs spanning the lifecycle of the organizations -- from startup through transition and into production -- is analyzed in the newly published report, "Funding RHIO Startup and Financing for Life: The Survey of Regional Health Information Organization Finance," is available at http://hittransition.com/RHIO_Survey_2006.

Blogposium: RHIO Finance Wiki

Want to know where to go for grants for your RHIO? What and where all the federal HIT programs are that might help you finance a health information sharing project? What all the other RHIOs are doing to pay the bills? The Blogposium is gathering the answers, and a new section of Clinfowiki is the place to find them.

And it's the place for you to put them, too...

RHIO Finance Survey Reasoning

UPDATE: The findings from the annual survey of RHIO finance have been posted at http://rhio.hittransition.com.  

This week we sent thousands of HIT workers an invitation to participate in the first-ever nationwide Survey of Regional Health Information Organization Finance.  There are two simple reasons we did this:  It was a good fit for us and it was something that would help the industry.  The first reason is irrelevant without the second, so I'll start there.

A Hitchhiker's Guide to the RHIO

REVIEW: Forming a RHIO? Christina Thielst, MHA, CHE. 2006. 47 Pages.

Christina Thielst may be the bravest healthcare administrator in the galaxy. Not because she ran a RHIO – with Dr. David Brailer on her advisory committee (she knew him when) – but because she took the huge risk of trying to boil her experience down into a guide running just under 50 pages.

Thielst (pronounced “Tilst”) has written a white paper, Forming a RHIO?, which attempts to demystify many aspects of RHIO development, from pulling the stakeholders together, through crafting a governance framework and bylaws, to sample policies and budgets. For all its brevity, this is not a thin guide.

Brailer Sees Non-profit Future for RHIOs

In the current issue of Health Data Management, Federal HIT czar David Brailer shares his vision of the evolution of the Regional Health Information Organization.  Increasingly, the network will be national (though decentralized) and the connectivity will be built into the participants' systems.

The catalyst, according to Brailer, will be the four pilots underway for the development of a national health IT infrastructure.  The outcome will be a change in mission for RHIOs.  RHIOs that have not reached their own critical mass by the time these pilots gain momentum may change their role from technical enablers to community advisory bodies and regional authorities governing inter-system exchanges.

For these reasons, RHIOs don't have to tackle what many have identified as their biggest challenges--developing a business model and sustainable sources of funding, Brailer says.

Statewide RHIO Envisioned, NAHIT CEO Leads Cheer

At a November 17 conference held in advance of dedicated planning, some of the potential partners in an Oklahoma RHIO expressed a desire to reach out to include the state's many small rural delivery points. Others were content to focus on two urban RHIOs, one for each of the state's major metropolitan areas, Oklahoma City and Tulsa. The conference, sponsored by the Oklahoma Hospital Association, featured as its keynote speaker Scott Wallace, President and CEO of The National Alliance for Health Information Technology (NAHIT) and Chair of the Commission on Systemic Interoperability.

RHIO Finance Whitepaper Released

UPDATE March 29, 2007: The 2007 RHIO finance survey has been opened to respondents. Visit http://hittransition.com/rhio2007 for information and to take the survey.

UPDATE June 21, 2006: We released a new 50-page report on RHIO Finance, available at http://hittransition.com/RHIO_Survey_2006.

When a new species of organization evolves, there are sure to be a lot of different ideas and downright confusion about how they should be built. At a recent conference called to jumpstart planning for a new state RHIO, I heard that favorite cliche, "If you've seen one RHIO, you've seen one RHIO" at least half a dozen times from the dais alone. Well, I'm here to tell you, nonprofit organizations, for all their idiocyncracies, are a lot alike in some critical ways, and you're headed for trouble if you don't get them right. The argument over how RHIOs should be funded was treated by several speakers, including Scott Wallace, President and CEO of The National Alliance for Health Information Technology (NAHIT) and Chair of the Commission on Systemic Interoperability. I thought it was time to address one piece of the finance question head on.

Healthcare IT Transition Group has just released a new whitepaper entitled "The Integrated Path - Incorporating Contributed Revenue in the RHIO Finance Mix: Not Whether but How," available as a free download at

Brave New World of HIT Funding, Part 1

Part 1 of a HIT eNews Series
By Michael Christopher, CTO, Healthcare IT Transition Group

Part 1: Amazing Discoveries
People who have enjoyed successful careers in fundraising sometimes seem awfully nice. We have a reputation for smiling a lot and speaking very sweetly. “Butter wouldn’t melt in our mouths” is what we say in the South. As I am sure you would hear from my close colleagues, I’m not really like that at all. Getting money for the public good is a terrifically competitive and worthy pursuit, and I see no reason to mince words. This series may offend the average fundraiser’s sensibilities, but I think it’s important to lay bare the fundraiser’s art for the benefit of those IT folks who now need to learn something about it.

In the current push (shove?) to set lagging healthcare IT aright, new grants are popping up every week to fund EHR, ePrescribing, RHIOs and a host of other hot IT projects. So, the hospital’s fundraising department or operating foundation will deal with all of this, right? Chances are: No, probably not. They need your help.

Models for Master Patient Index

Government Health IT carries a story about successful implementation of Master Patient Index (sometimes referred to as Master Person Index) systems in Canada and New Zealand.

With a single-code Unique Patient Identifer knocked out of the initial HIPAA legislation by privacy advocates, and a reported prohibition against funding such work added to each year's Continuing Budget Resolution, the "index of identifiers" approach seems to be the best approach.

Read about it in Master index pitched as patient ID alternative.