Time Capsule: RHIOs 2.0 Dying Uglier Deaths than 1.0, but Hardy Survivors Guarantee Another Round

I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).

I wrote this piece in January 2008.

RHIOs 2.0 Dying Uglier Deaths than 1.0, but Hardy Survivors Guarantee Another Round
By Mr. HIStalk

I’m a contrarian. When everybody ignored reality and jumped on the RHIO bandwagon, I enjoyed being the bubble-bursting cynic who loudly predicted that they would all go up in flames. Yet another dumb idea, I said, slyly orchestrated by stake-in-the-game consultants, member organizations, and ad-happy magazines instead of market realities.

Some folks wanted to argue with me. I bet a few wanted to punch me. I was a real buzz-kill, raining rational thinking onto the frenetic, obedient parade of RHIO trough-lappers.

Instead of basking, I’ll continue my contrarian ways with another shocking, out-of-the-box prediction: some RHIOs will succeed, thereby embarrassing everyone.

RHIOs typified what is most wrong with healthcare IT: money and energy wasted by naïve providers easily led astray by slick salespeople touting an illogical but personally profitable pipe dream. I’m not proud of predicting the demise of RHIOs because it was just too easy, like shooting fish in a barrel or observing that most doctors won’t use CPOE unless you pay them or require it by law.

Not all RHIOs are created equal, though. Funding and governance differ. So does architecture. National trends aside, RHIOs are a purely local effort, connected to national trends only to the extent that they followed their simultaneous, ill-conceived creation.

If you’ve seen one RHIO, you’ve seen about 90 percent of them. That still leaves 10 percent that could mutate into a survivable form.

It stands to reason that some RHIOs will eventually exchange data, find ongoing operational funds, settle bitter turf disputes, and actually improve patient outcomes. It won’t be many of them, but even if it’s just one, we’ll finally have a living laboratory.

A living, breathing RHIO? That’s quite a leap from what started this whole mess: worshipful jawing about how wonderful David Brailer’s Santa Barbara project was, right up until the time it self-destructed without benefiting anybody at all except David Brailer.

Once we have a working RHIO, then what do we do? The bar will have been raised, making it obvious that the RHIO concept itself wasn’t the problem — it was the shortcomings of those running them.

Who wouldn’t want interoperability? The technical challenges are demonstrably solvable. Insurance companies want data sharing. Government wants it. Patients want it. Having one working example means everybody else needs to come back to the table and try again, no matter how embarrassing the whole RHIO 2.0 thing has been (I consider CHINs to be RHIOs 1.0).

Healthcare IT often chases fleeting dreams, then moves on to something else and never looks back once the going gets tough. There’s always low-hanging fruit elsewhere that needs picking, especially if you’re scared of heights.

Lack of real, working interoperability is inexcusable. For that reason, it’s a given — there will be a Round 3. Maybe it’s a Nationwide Health Information Network or a takeover of the RHIO concept by insurance companies. Regardless of what form it takes, you haven’t heard the last of interoperability.

Somewhere out there, right now, some HIMSS committee or consultant is trying to come up with a new name that will distance Round 3 from those embarrassing first two, mostly by calling it something different and hoping for new operating concepts driven by experience and Darwinism. Better technology, smarter governance, more clearcut operating parameters. Mark my words: RHIO Redux is coming soon.