Ten years ago, there was a largely shared vision of HIE. This focused on regional collaborations among healthcare providers, and often included health departments and insurers. These regional health information organizations (RHIOs) are typically not-for-profit, though they may deploy software from a for-profit vendor. These were typically viewed as utilities, serving virtually all providers in a community. RHIO members connect using many different brands of EHR systems, typically participate in governance, and support the organization through membership and/or use fees. These organizations have developed and operate successfully in many communities. However, different technical and organizational developments have spawned alternative models that have called into question the long-term prospect of the "universal utility RHIO" model.
Other HIOs focus on a common EHR system, sharing among different customers working with a particular EHR vendor. While relatively simple technically, this approach may create barriers for providers using a different EHR brand. As more universal standards emerge for inter-HIE exchange, however, these barriers may lower.
Some HIOs begin by serving a selected network of organizations, such as those serving military personnel and veterans, members of an Accountable Care Organization (ACO) or community health centers belonging to a Health Center Controlled Network.
The 2009 HITECH Act funded states and their State-Designated Entities (SDEs) to assure state-wide HIE services, and to support a nationwide model of change. Some SDEs accommodated existing HIOs, while other competed with them. SDEs have quasi-official status in many state governments, so they are powerful features of the HIE landscape, though federal funding is rapidly waning and the importance of SDEs in relation to other HIE initiatives is likely to evolve.
Also, large provider integrated delivery networks (IDNs) or hospital provider systems may launch an HIO. These may or may not have a separate organizational structure, such as an LLC. It is anticipated that these enterprise HIOs will continue to grow and develop, especially in areas that may not have another HIO option available.
The business model for HIOs keeps changing rapidly in response to both technical and public policy developments. In this tumultuous environment, there has been considerable turnover of HIOs across the nation. Picking a long-term HIE partner ideally includes selecting a management team that studies and responds promptly to such environmental changes.
If a health department's frequent information sharing partners, or trading partners, aren't connecting to an HIO, there will be no benefit no matter how elegant the technology.