Community Leadership: The Cornerstone of a Solid RHIO Foundation

By Roger Leonard, M.D., Thomas Lewis, M.D. and Laura Kolkman

RHIOs cannot succeed without the full and enthusiastic participation of key stakeholders. When they recognize the value of HIE, stakeholders will come together to create the initiative. They will ensure that patient and consumer data and information will be readily available for exchange, which will result in improved quality of healthcare throughout the community – the outcome by which success will be measured.

But it is difficult for stakeholders to initiate such a complex task when they have so many other priorities competing for their attention and resources. That is why a strong community leadership, one that is willing to take the risks and go through the necessary effort, is required to build the stakeholder foundation upon which the RHIO will be built.

The sooner that community leadership comes together, the better. It is far more difficult to build it during the later stages of formation.

For the Montgomery County HIE Collaborative, strong community leadership was especially critical because of our mission, which is to link emergency rooms and the primary care “safety net” clinics that care for the uninsured and underinsured populations in the Maryland counties bordering Washington, DC.

Early efforts required the cooperation of four hospitals, emergency and primary care physicians, and the safety net clinics, as well as public health and other private agencies charged with the welfare of these underserved populations, and the individuals themselves. That is why, with the guidance of Mosaica Partners, we invested our early resources into establishing a strong leadership and engaging the primary stakeholder groups that would be critical to our success.

The key to this exercise was identifying motivators that would drive early stakeholder participation, and addressing the concerns of those whose participation would drive HIE. Here’s what we found:

  • Consumers:  Important drivers of HIE, we knew that consumers would be instrumental in generating demand for availability of their health information. It was important to us to begin educating them early on the quality and safety benefits of HIE, including better care for the chronically ill. We approached this important task by engaging trusted community organizations to learn consumer concerns and begin building their confidence in HIE.
  • Hospitals: Participating hospitals were actually very enthusiastic about HIE, in part because it would improve the quality of care they provide to their patients. But it would also help them identify individuals in need of a medical home so they can be referred to one of the safety net clinics for their primary care. This would ease the burdens placed upon emergency departments by non-emergent cases, reducing costs and wait times.
  • Physicians:  Adoption of HIE by physicians is paramount to success and is often driven by its ability to improve patient care, increase efficiency and reduce costs. The Collaborative engaged physicians from the county medical society, emergency departments, safety net clinics and private practice to help define the medical data set, governance structure and business foundation of the HIE.
  • Community health clinics:  Because they are the keepers of the data we intend to share, the early support and participation of community health clinics was critical. We worked closely with them to determine a discrete, essential data set that would meet the privacy needs of patients and the urgent needs of emergency physicians. In return, the clinics would receive detailed medical information from the emergency departments, promoting better after-care for their patients. Further, by facilitating identification of individuals in need of medical homes, HIE would aid clinics in their mission to care for the region’s low-income and uninsured populations.
  • Departments of Health: By focusing first on the underserved, who often receive their medical care in an emergency department, our goals for HIE aligned with those of county services that focus on reducing disparities in healthcare.  In return, county government would help disseminate positive information to the public about HIE, and could ultimately serve as a source of future funding to help sustain the initiative.

While these groups were identified as our primary stakeholders, they are not the only ones.  We are also seeking to engage labs and pharmacies, nurses, employers, economic development organizations and healthcare insurers.

The information gathered in the stakeholder and community leadership engagement process helped us establish the parameters for building the initiative, including outlining short-term goals and determining the immediate services we will provide.  This, in turn, helped build the momentum we need to move forward with assessing community readiness and begin conducting high-level community education focused on fostering greater understanding of what HIE is and why it is needed.

The process of building community leadership may seem tedious, but it is a necessary step for establishing the foundation of a successful RHIO.  In our case, taking the time to work through this process was integral to our receipt of a $250,000 planning award from the Maryland Health Care Commission and the Health Services Cost Review Commission that will enable us to continue moving toward the State of Maryland’s goal of implementing statewide HIE.

Roger Leonard, M.D., is Vice President of Medical Affairs of Montgomery General Hospital. Thomas Lewis, M.D., is CIO of the Primary Care Coalition. They co-chair the Montgomery County HIE Collaborative. Laura Kolkman is President of Mosaica Partners, a nationally recognized HIE consulting firm, and Chair of the HIMSS HIE Steering Committee.