Massachusetts RHIO Makes Progress

February 22, 2007 | After four years and a $50-million commitment, many of the building blocks for Massachusetts' regional health information organization (RHIO), MA-SHARE (Simplifying Healthcare Among Regional Entities), are being stacked into place.

That's good given this is a critical year for MA-SHARE as grant money starts running out. "If RHIOs do not have a business model by the end of 2007, they will likely not survive until 2008," says John Halamka, CIO of CareGroup Healthcare System and CIO of the Harvard Medical School.

The Massachusetts RHIO, like others around the country, must create an ongoing revenue stream to be financially viable. So far, tentative steps toward financial sustainability are being taken. For example, the Rx Gateway, a statewide electronic prescription access program launched in June, is expected to help MA-SHARE break even this year. It earns subscription fees from payers, pharmacies, and providers. Using Rx Gateway, users can build one interface and negotiate a single contract with MA-SHARE, but retain the flexibility to choose a particular e-prescribing software solution best suited for their individual practices.

Likewise, the Massachusetts RHIO has made progress implementing pilot networks for physicians. This work has been done largely by the Massachusetts e-Health Collaborative. By summer, says Micky Tripathi, MAEHC president, electronic medical record (EMR) systems will connect almost every practice and hospital in North Adams, Newburyport, and Brockton — about 450 physicians ­— to citywide health networks. The towns themselves, however, will not be linked to each other.

In North Adams, this process is slated to be completed early next month and will link 75 physicians. The $50 million from BlueCross BlueShield of Massachusetts funded the necessary IT infrastructure for all the three cities, and provided a concrete incentive for physicians like Michael Garrity to adopt the proposed EMR format.

"It has been a huge time investment," says Garrity who is part of a four-physician practice in North Adams with 5,000 patients. Initially the conversion slowed his business forcing him to see fewer patients. Now, six months into the project, Garrity's practice productivity is reviving, and he says, "Ultimately, I believe efficiency will improve."

In the meantime, work on a National Health Information Network (NHIN) continues. Halamka says RHIOs in Massachusetts, Indiana, and California, have been successfully transmitting patient information, demonstrating the feasibility of clinical data exchange among RHIOs.

Last month in Washington D.C., MA-SHARE was part of a group of four contractors who demonstrated possible architectures for a national network. The MA-SHARE prototype used a centralized record locator sharing patient registration, medication information, and lab results.

In March, a new round of funding from the Office of National Coordinator will be proposed for regional pilot projects. These will be a new breed of NHIN architecture that incorporates HITSP standards (Health Information Technology Standard Panel) and are actual operating networks, not prototypes, says Wes Rishel, a RHIO analyst at Gartner, Inc.

Conversely, MA-SHARE will focus next on developing workflow technology that "pushes" information to physicians, rather than "pulls" information from hospitals and labs, says Greg DeBor, principal of CSC, an El Segundo, Calif.-based company and MA-SHARE partner.

Much work remains, not least the forging of privacy policies, and automation of consents, auditing, and access. "Project management, people and organizational issues, and workflow are greater challenges than technology implementations," says Halamka.

Nevertheless, MA-SHARE participants believe they are making substantive progress. "Clearly, we are able to bring together payers, providers, state government and others in the community to converge on an agenda," says John Glaser, chief information officer for Partners HealthCare System, "but we also learned some harsh lessons early on about becoming more focused, putting some areas in priority and putting some on back burner."

The bigger near-term challenge remains financial viability. Last year, the Healthcare IT Transition Group conducted a nationwide survey of funding for 50 RHIOS. "We didn't find a single commercially viable RHIO," says the report's principal author, Michael Christopher, "Most were sustained by grants, not earned income. The fact that the Massachusetts RHIO hasn't achieved that is not surprising; it would be a reaction boarding on shock if it had."

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