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What expertise do we need for implementing a RHIO?

Starting a RHIO may bring technical challenges above and beyond other health IT projects, such as the implementation of an EHR. Exchanging health records among different provider networks will bring various health IT systems of multiples ages and designed by a variety of vendors into contact with one another. A robust RHIO has to be able to adapt to a variety of different existing health IT systems. Even though generating buy-in is an important part of the planning process, the organization needs expert technical knowledge to troubleshoot across different platforms and solve compatibility issues as they arise. Technical staff should have experience working with different software and with interfacing. They should also be knowledgeable in creating a secure network.

Also, as part of the planning process, a RHIO needs to consider both the technical support staff in-house and the resources available to providers in its network. If staffing decisions are made solely on the basis of infrastructure needed at the 'hub' of the RHIO, addressing problems occurring at a 'spoke' clinic may be beyond the capabilities of their staff. The RHIO should be thorough in assessing what connecting to the exchange will mean for community partners, and subsequently providing them with the support they will need. Smaller clinics may not have dedicated health IT staff and may rely on clinical staff to take on IT-related responsibilities. In such instances, the technical staff for the RHIO should be able to fill in the gaps in knowledge and skills that may exist in these settings.

Apart from the technical aspect, the RHIO also requires administrative support. Depending on the scope of activities and budget of the RHIO, the entity may need day-to-day oversight. Based on the governance model, some of these functions, including management and marketing, may be supported by a state agency.

Related Resources:

• CalRHIO's HIE technology guide  - Developed by CalRHIO, this is a guide that contains tools related to technology implementation in the clinical setting.
• Open source HIE prototype  - Developed by the Markle Foundation, this Web-site contains the source code, test servers, and related files for Connecting for Health’s three prototypes.
• Sample health IT Job Descriptions (AHIMA)  - Developed by the American Health Information Management Association (AHIMA), this Web-site contains links to sample job announcements.
• Report to the Field: Getting Beyond Information Technology Basics. Technology Management to Build Capacity and Create Sustainability (CCI) (PDF - 665 KB)  - Developed by Tides and the California Endowment for the Community Clinics Initiative,  this report contains analyses of the technology management experiences of community clinics and health centers in California. (2004)

How do we choose a RHIO that is right for us?

Choosing a RHIO involves a number of considerations. Health centers should assess their environment and infrastructure to determine the type of RHIO that will be most appropriate. Since RHIOs are at various stages of development, each will offer different opportunities.
 
Overall, prior to making any commitment to join or start a RHIO, it is important to assess institutional readiness to engage with others collaboratively. Understanding the purpose and vision for joining and collaborating in a RHIO will provide a more robust experience. In particular, when considering joining a RHIO, there are specific readiness issues that should be considered.

Resources on readiness assessment, planning, and evaluation for RHIO projects:

• HIE Business and Technical Profiles - Developed by the Health Information Management Systems Society (HIMSS), this paper describes the similarities and differences between HIE profiles, technical infrastructures, and capabilities. (2010)
• Evaluating a Potential HIE Opportunity - Developed by the Health Information Management Systems Society (HIMSS), this guide helps providers understand how to participate in HIE. (2009)
• HIE Evaluation Checklist - Developed by the Health Information Management Systems Society (HIMSS), this checklist lists questions that providers should consider before joining a HIE. (2009)