Situated just south of Lake Ontario, Rochester, NY, has been a hub of American innovation for more than a century. In the 1820s, construction of the Erie Canal, which curves around the southwest edge of the city, helped fuel Rochester’s growth from small town to small city, a harbinger of many canal-induced boomtowns. Frederick Douglass called Rochester home for a time and opened an antislavery newspaper 16 years before Lincoln signed the Emancipation Proclamation. Women’s Rights, Western Union, and Kodak each originated in Rochester as well.
Although it doesn’t have the same visual grandiosity as, say, a 363-mile flooded trench, the Rochester Regional Health Information Organization (RHIO), is far from insignificant. RHIO is a nonprofit organization that facilitates the exchange of electronic health information among area health care providers. It’s also part experiment.
Will Irwin, president and owner of UltraMobile Imaging is part of the collective. UltraMobile provides many different types of x-rays, ultrasound, and cardiac monitoring to customers in long-term care facilities or private residences. “I felt that I needed to participate as soon as possible. It was a community responsibility,” Irwin said. “One of the reasons health care has been so expensive is that health care providers have operated in their individual silos of care. Because of that, particularly in diagnostic testing, tests are repeated, and information isn’t shared across the system. We’re a long way from eliminating that kind of thing, but RHIO represents a sincere effort to begin to address that problem.”
About 40 health care organizations in the Rochester area provide patient information to RHIO. RHIO orchestrates information sharing by gaining pre-arranged consent from patients who opt in. “Without it, cases arise when I have to go back to an individual resident and obtain consent from them or a son or daughter,” Irwin said. “It’s not very practical. That consent issue is figured out at the front end.” More than 400,000 patients have enrolled in the program. RHIO helps prevent repeated testing, and it clears the red tape and errors that can occur during emergency care or when using handwritten records. To ensure transparency, patients can track who views their files.
RHIO was based on an incentive-based, entrepreneurial model. The federal government offered some funding with a stipulation that if the program attracted a certain number of providers, a second round of grants would follow. The state government, area businesses, hospitals, and insurers have contributed, too. Eventually, Irwin says the program, currently supported by grants, will charge fees. The capability of the program is evolving, too. At first, the program facilitated the exchange of reports. Gradually, the images are being added, as well.
Irwin says programs like RHIO will help the national health care system shift to a more sustainable model. “How we care for the elderly has got to be become more affordable,” he said. “We’ve got to be able to do more home care, allow more people to age in place. And the only way that we can keep costs down for that is by beginning to share the information we already have. That’s why I am so enthusiastic. I personally think my mobile business is part of the solution. We shouldn’t make children of an elderly patient take a day off to drive them to a hospital to get an x-ray or ultrasound. It should be easy to get that data to the people who can act on it.”
For UltraMobile, getting that data to RHIO required more than simply signing on. Irwin’s company uses RIS and PACS from MediMatrix. “We had the data,” he said. “We captured it every day. The problem was how to get it into a format that was acceptable to the RHIO. It was really a mapping problem. We had the radiologists’ reports, but we had to map their interpretations into consistent fields understandable to the RHIO.” Working with MediMatrix, radiologists’ reports from UltraMobile were converted to the universal format employed by the RHIO calledHL7.
Irwin said the program took some time to gain enough critical mass to be useful on an everyday basis. But, more and more, the RHIO’s potential is being realized. And, as it proves useful, more people sign up. Many constituencies benefit. For one, the RHIO makes it easy for providers of different sizes to interact: Small companies don’t face prohibitive start-up costs and large hospital systems aren’t stuck with extra responsibilities. Patients, especially those in rural New York, benefit from the simple sharing of diagnostic data between health care providers.
The long-term goal is for successful programs to be replicated across the country. Eventually, those programs would be linked together. This bottom-up approach works only if communities like Rochester commit. Committing to new programs come with risks, but failing to commit to some kind of future is equivalent to committing to the status quo, which most agree is not sustainable. “RHIO is a very democratic thing,” Irwin said. “It has nothing to do with a fee for service model. It is based on taking care of populations of people.” RHIO doesn’t provide an all-encompassing vision of the future, but it’s one piece of the puzzle.