The formation of a health information exchange organization, such as a RHIO, involves multiple steps including:

1. Understanding the present state of health information technology and health information exchange in the community
2. Stakeholder participation/community leadership
3. Making the business case, including the mission and vision
4. Choosing a governance model
5. Developing a financial model, including sources for initial funding and sustainability
6. Identifying short-term and long-term priorities
7. Defining the technical architecture
8. Creating a policy and security framework
9. Developing the marketing and community outreach strategy

These steps may not be sequential.  Based on decisions made at a subsequent stage, certain steps may need to be revisited.  For example, in developing the financial model it may become apparent that involvement of additional stakeholders such as a larger referral center that community providers utilize, may be a potential source of funding or in-kind resources.  In such cases, stakeholder participation may need to be expanded and the governance model revisited. 

Input from the community is important for the creation of a RHIO, especially in smaller and rural areas where hospitals and health care institutions can serve as a hub for local engagement and be the largest employer in the area.  Throughout the formation process, the leadership of the health information exchange should seek to actively engage health care providers and other interested stakeholders, including patients, and make decisions based on their feedback.  Additional effort may be needed to secure trust among stakeholders, to create the necessary networking infrastructure, and to obtain funding.

Resources:

• Rural Healthcare Information Technology Adoption Project - Arizona GITA
• A Practical Approach to RHIO Formation - dbMotion