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What are the different governance models for RHIOs?

There is a wide variation among RHIOs and other health information exchange organizations in terms of scale and governance. Many small and local RHIOs are formed to address health information exchange needs identified by members of the healthcare community. These may or may not have formal legal status and have varying levels of participation from local and state health departments and other functions of government.

In developing a state-level RHIO, the existing hierarchy of local health information exchange efforts and statewide health information networks often guides the scope of the effort and, at least initially, the size of the community it will serve. Some current models include:

  • A private-public partnership - Most state-level RHIOs are set-up as public-private partnerships with varying levels of government representation and funding varies greatly. For example, the Delaware Health Information Network (DHIN) was initiated and receives financing from the state government often with matching funds available from private stakeholders.
  • A private stakeholder entity - Some state-level RHIOs have no regular state involvement or funding. For example, CalRHIO, the statewide health information exchange in California, is a not-for-profit entity that received no state funds and was formed as a result of stakeholder interest and support.
  • Collaboration of local RHIOs or other existing data exchange efforts with varying levels of state involvement - Certain state-level initiatives have been formed by local RHIOs or other health information exchange organizations seeking to share data. For example, Colorado, through CORHIO, is attempting to build on the HIE efforts started in Denver with minimal state representation. Massachusetts, as another example, has created a virtual state-level HIE initiative by combining the efforts of four data sharing organizations. The state government is represented on the board of directors for some of these entities.
  • State government initiatives - In some cases, state governments have taken a lead role to foster state-level health information exchange either by creating their own infrastructure, such as Florida, or by coordinating existing community efforts, such as Tennessee. These initiatives often begin with the formation of an advisory council usually established by a governor's executive order. The creation of these councils is often an interim step with the ultimate goal being the determination of requirements for developing and sustaining a state-wide model for health information exchange. In addition, the advisory council often provides the initial business plan for these efforts.

In considering the governance options, one of the important tasks for leadership is choosing the appropriate legal status for the RHIO. Based on many considerations, including the regulatory framework and the history of the membership, leadership will need to determine whether or not the entity should be incorporated or function as a virtual entity via contracts and memorandums of understanding (MOU). If formal incorporation is selected, then the group also must consider the state and federal non-profit statuses based on the RHIO's proposed activities.

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