The Santa Barbara RHIO: An Impressive Post-Mortem

By  |  October 22, 2007 | 

One of the more interesting recent concepts in the healthcare IT world is that of the “RHIO”: a Regional Health Information Organization. The idea is that – while we’ll never overcome the legal and privacy concerns to create a single national electronic healthcare record (at least not in my lifetime) – we might be able to create one within a region.

In 1997, my friend David Brailer (an extraordinarily smart guy who later became the U.S. government’s IT Czar and now runs a $700 million healthcare investment company) pitched the idea of using his company at the time, CareSciences, to build a RHIO in Santa Barbara, California, that sun-kissed village of mansions, wineries, and Botox about an hour north of LA. It seemed a great test case – a community with hospitals and clinics that played well together; small enough to get it done (only 3 main hospitals in the region) but big enough to put the concept through its paces.

The California HealthCare Foundation (CHCF) [truth in advertising: I’ve done several projects funded by CHCF, and its president, Mark Smith, was my residency classmate and is a good pal] infused more than $10 million into the effort, recognizing that the business case for a RHIO was too meager for one to rise up out of the primordial healthcare swamp. After innumerable starts and stops, missteps, political trials and tribulations, changes in corporate ownership, and various other forms of mishigas, the RHIO finally went flat-line last year (it had been agonal for a couple of years). The verdict: the business case to sustain it just wasn’t there; the Foundation’s money may have even “polluted” the process by giving all the players a free ride, with no skin in the game.

Why is this important? First of all, RHIOs were the cool kid in the class – the much-ballyhooed solution to the IT gaps caused by healthcare silos, and a cornerstone of the federal effort to wire American healthcare. Sure, Kaiser Permanente and the VA could move clinical data from a hospital to a nearby (within-system) clinic or ER; RHIOs would solve this knotty problem for the rest of us.

Second, a very thoughtful post-mortem on the Santa Barbara meltdown was recently published by – get this – the California HealthCare Foundation. That’s right, the very same foundation that burned through $10 mil commissioned a study – publicly released and even hosted on its own website – that is, in essence, a root cause analysis of its own failed initiative. This is an extraordinary impressive example of “learning from one’s mistakes” – part of a general trend by foundations of looking for lessons from both their successes and blunders. It (along with a series of related articles published in the journal Health Affairs, including one by Brailer and another by Marc Overhage, who directs a more successful RHIO in Indiana) makes fascinating, albeit depressing, reading.

About the Author:

Robert M. Wachter, MD is Professor and Interim Chairman of the Department of Medicine at the University of California, San Francisco, where he holds the Lynne and Marc Benioff Endowed Chair in Hospital Medicine. He is also Chief of the Division of Hospital Medicine. He has published 250 articles and 6 books in the fields of quality, safety, and health policy. He coined the term hospitalist” in a 1996 New England Journal of Medicine article and is past-president of the Society of Hospital Medicine. He is generally considered the academic leader of the hospitalist movement, the fastest growing specialty in the history of modern medicine. He is also a national leader in the fields of patient safety and healthcare quality. He is editor of AHRQ WebM&M, a case-based patient safety journal on the Web, and AHRQ Patient Safety Network, the leading federal patient safety portal. Together, the sites receive nearly one million unique visits each year. He received one of the 2004 John M. Eisenberg Awards, the nation’s top honor in patient safety and quality. He has been selected as one of the 50 most influential physician-executives in the U.S. by Modern Healthcare magazine for the past eight years, the only academic physician to achieve this distinction; in 2015 he was #1 on the list. He is a former chair of the American Board of Internal Medicine, and has served on the healthcare advisory boards of several companies, including Google. His 2015 book, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age, was a New York Times science bestseller.

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One Comment

  1. Bob Wachter December 12, 2007 at 4:38 am - Reply

    More evidence that RHIOs are harder than they look comes from today’s issue of Health Affairs. A survey of more 145 RHIOs found that one in four was kaput, and only one in 7 was of at least modest size and exchanging any data at all (mostly test results). Fewer than 10% received fees from member organizations. At least in their present incarnation, this is not the magic bullet, by any means.
    http://content.healthaffairs.org/cgi/content/abstract/hlthaff.27.1.w60

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