Difference between revisions of "RHIO Governance Models"

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== Models for Connected Communities ==
 
== Models for Connected Communities ==
  
'''Federations''' tend to include large, “self-sufficient” enterprises agreeing to network, share, allow access to information they maintain on peer-to-peer basis.  They may develop a system of indexing and/or locating data (e.g., state or region-wide master patient index (MPI)).
+
==Federations==
 +
tend to include large, “self-sufficient” enterprises agreeing to network, share, allow access to information they maintain on peer-to-peer basis.  They may develop a system of indexing and/or locating data (e.g., state or region-wide master patient index (MPI)).
  
'''Co-ops''' tend to includes mostly smaller enterprises agreeing to pool resources and create a combined, common data repository.  They may share technology and administrative overhead.
+
==Co-ops==
 +
tend to includes mostly smaller enterprises agreeing to pool resources and create a combined, common data repository.  They may share technology and administrative overhead.
  
'''Hybrids''' are a combination of Federations and Co-ops and tend to agree to network, share, allow access to information they maintain on peer-to-peer basis; allowing for aggregation across large areas (statewide or regional).  Hybrids may be required for statewide initiatives.
+
==Hybrids==
 +
are a combination of Federations and Co-ops and tend to agree to network, share, allow access to information they maintain on peer-to-peer basis; allowing for aggregation across large areas (statewide or regional).  Hybrids may be required for statewide initiatives.
  
The two primary roles of the connected community’s organizational structure are '''Utility''' or '''Neutral/Convener/Facilitator'''.  The '''Utility''' RHIN/RHIO provides functions such as:
+
The two primary roles of the connected community’s organizational structure are ==Utility==
Centralized database
+
or ==Neutral/Convener/Facilitator==.  The ==Utility==
Patient information exchange
+
RHIN/RHIO provides functions such as:
Clearinghouse
+
* Centralized database
Patient information locator service
+
* Patient information exchange
 +
* Clearinghouse
 +
* Patient information locator service
  
The '''Neutral/Convener/Facilitator''' RHIN/RHIO  
+
The ==Neutral/Convener/Facilitator==
      Builds consensus policies
+
RHIN/RHIO  
Brings together competitive enterprises
+
* Builds consensus policies
Bridges multiple RHIN/RHIOs in geographic location
+
* Brings together competitive enterprises
Seeks an open-standards approach – non vendor specific
+
* Bridges multiple RHIN/RHIOs in geographic location
 +
* Seeks an open-standards approach – non vendor specific
  
 
An example of a RHIO that has taken on a utility role is that of the [http://www.sbccde.org/ Santa Barbara County Care Data Exchange] (SBCCDE)  They have developed technology for patient information exchange which includes a patient information locator service.  [http://www.calrhio.org/ CalRHIO] on the other hand is serving in more of a neutral/convener/facilitator role and building statewide consensus policies and bringing together competitive hospitals for projects like the emergency department linkage effort.  As CalRHIO matures, they will most likely work to bridge multiple RHIN/RHIOs across the state of California.
 
An example of a RHIO that has taken on a utility role is that of the [http://www.sbccde.org/ Santa Barbara County Care Data Exchange] (SBCCDE)  They have developed technology for patient information exchange which includes a patient information locator service.  [http://www.calrhio.org/ CalRHIO] on the other hand is serving in more of a neutral/convener/facilitator role and building statewide consensus policies and bringing together competitive hospitals for projects like the emergency department linkage effort.  As CalRHIO matures, they will most likely work to bridge multiple RHIN/RHIOs across the state of California.
Line 23: Line 29:
  
 
== Challenges and Potential Solutions ==
 
== Challenges and Potential Solutions ==
'''Challenges:'''
+
==Challenges:==
  
 '''General'''
+
* ==General==
Lack of trust and accountability
+
* Lack of trust and accountability
Politics – finding “neutral” ground
+
* Politics – finding “neutral” ground
Pride of ownership
+
* Pride of ownership
Fear of loss of advantage
+
* Fear of loss of advantage
Maintenance of interest and buy-in
+
* Maintenance of interest and buy-in
Individual stakeholder priorities
+
* Individual stakeholder priorities
Costs
+
* Costs
Motivation
+
* Motivation
  
 '''Business / Policy Issues'''
+
* ==Business / Policy Issues==
Competition between stakeholders
+
* Competition between stakeholders
Consensus of common policies and procedures
+
* Consensus of common policies and procedures
Consumer privacy concerns
+
* Consumer privacy concerns
Transparency of process
+
* Transparency of process
Uncertainties regarding liability
+
* Uncertainties regarding liability
Difficulty in reaching multi-enterprise agreements for exchanging information
+
* Difficulty in reaching multi-enterprise agreements for exchanging information
Decreasing debt capacity
+
* Decreasing debt capacity
Return on investment
+
* Return on investment
Governance and leadership
+
* Governance and leadership
Sustainability
+
* Sustainability
Costs –Financial and personnel – especially for Small/Rural providers
+
* Costs –Financial and personnel – especially for Small/Rural providers
Physician and payer incentives
+
* Physician and payer incentives
Economic Factors
+
* Economic Factors
  
 '''Technical / Security Issues'''
+
* ==Technical / Security Issues==
Interoperability among multiple parties
+
* Interoperability among multiple parties
Standards
+
* Standards
Authentication
+
* Authentication
Auditability
+
* Auditability
Security and legal issues
+
* Security and legal issues
  
 '''Internal to the Institution / Network'''
+
* ==Internal to the Institution / Network==
Competition for resources
+
* Competition for resources
Dilution of Effort: Project competing against other pressing needs
+
* Dilution of Effort: Project competing against other pressing needs
Preservation of previous investments
+
* Preservation of previous investments
Increased cost of IT (perceived or real)
+
* Increased cost of IT (perceived or real)
  
 '''External to the Institution / Network'''
+
* ==External to the Institution / Network==
Security – Data & Physical Resources  
+
* Security – Data & Physical Resources  
Rights in Data – who “owns’ the data and who can make changes (tracking changes)
+
* Rights in Data – who “owns’ the data and who can make changes (tracking changes)
Reliability of Data – potential mismatching of patients & data corruption  
+
* Reliability of Data – potential mismatching of patients & data corruption  
Linking Outside: Standards, reliability, controls  
+
* Linking Outside: Standards, reliability, controls  
Business Continuity: Destruction/Recoverability of critical resources   
+
* Business Continuity: Destruction/Recoverability of critical resources   
Lack of Accountability & Control (perceived or real)
+
* Lack of Accountability & Control (perceived or real)
  
  
'''Overcome Challenges'''
+
==Overcome Challenges==
  
Don’t allow the long list of challenges overwhelm you
+
* Don’t allow the long list of challenges overwhelm you
Obtain buy-in from the highest level of each participating entity
+
* Obtain buy-in from the highest level of each participating entity
Engage State leadership and leaders of healthcare organizations to continue to support dialogue/education on the issue
+
* Engage State leadership and leaders of healthcare organizations to continue to support dialogue/education on the issue
View challenges as opportunities for improvement
+
* View challenges as opportunities for improvement
Identify effective leaders and “champions”
+
* Identify effective leaders and “champions”
Identify financial incentives and provider investments in their internal systems  
+
* Identify financial incentives and provider investments in their internal systems  
Identify funding sources for information technology and RHIN/RHIOs
+
* Identify funding sources for information technology and RHIN/RHIOs
Identify funding assistance for rural  and small providers
+
* Identify funding assistance for rural  and small providers
Educate and communicate with providers and the public
+
* Educate and communicate with providers and the public
Recognize opportunities
+
* Recognize opportunities
Recognize improved ease of inter-institution partnering
+
* Recognize improved ease of inter-institution partnering
Identify the value and benefits that accrues to each participant
+
* Identify the value and benefits that accrues to each participant
Establish standards  
+
* Establish standards  
Leverage the efforts of the larger health systems – collaboration not competition
+
* Leverage the efforts of the larger health systems – collaboration not competition
Reduce the number of barriers posed by state and federal regulations (HIPAA, Stark, etc.)
+
* Reduce the number of barriers posed by state and federal regulations (HIPAA, Stark, etc.)
Adopt common terminology  
+
* Adopt common terminology  
Address adjudication of liability
+
* Address adjudication of liability
  
'''Recommendations for Success'''
+
==Recommendations for Success==
  
Involve major players in planning – CEOs, COOs CMOs,  CIOs, nurse executives, legal, risk management/compliance, etc ~ avoid “one champion” or pure tech view
+
* Involve major players in planning – CEOs, COOs CMOs,  CIOs, nurse executives, legal, risk management/compliance, etc ~ avoid “one champion” or pure tech view
Ensure leaders of the RHIN/RHIO are accountable to the community, not their individual interests
+
* Ensure leaders of the RHIN/RHIO are accountable to the community, not their individual interests
Establish a shared vision and common goals
+
* Establish a shared vision and common goals
Plan for governance from the beginning
+
* Plan for governance from the beginning
Keep patient and security and privacy of information at front  
+
* Keep patient and security and privacy of information at front  
Identify all stakeholders and invite everyone to the table
+
* Identify all stakeholders and invite everyone to the table
Prepare stakeholders for real collaboration
+
* Prepare stakeholders for real collaboration
Establish a mission and set measurable and achievable goals
+
* Establish a mission and set measurable and achievable goals
Address governance accountability and sustainability concerns
+
* Address governance accountability and sustainability concerns
recognize that discussion dialogue and debate are part of the process
+
* recognize that discussion dialogue and debate are part of the process
Build trust
+
* Build trust
Plan some quick “wins”
+
* Plan some quick “wins”
Demonstrate value and quality, safety, and cost benefits  
+
* Demonstrate value and quality, safety, and cost benefits  
Share stories and data of success with the reluctant and encourage them to join the collaborative
+
* Share stories and data of success with the reluctant and encourage them to join the collaborative
Secure the services of an experienced legal firm and keep them informed
+
* Secure the services of an experienced legal firm and keep them informed
Address and implement the agreement structure early
+
* Address and implement the agreement structure early
Spell out all interface & data specifications in excruciating detail, and hold everyone to them
+
* Spell out all interface & data specifications in excruciating detail, and hold everyone to them
Communicate expectations and hold all accountable for their obligations.
+
* Communicate expectations and hold all accountable for their obligations.
  
  

Latest revision as of 19:47, 16 October 2011

Models for Connected Communities

Federations

tend to include large, “self-sufficient” enterprises agreeing to network, share, allow access to information they maintain on peer-to-peer basis. They may develop a system of indexing and/or locating data (e.g., state or region-wide master patient index (MPI)).

Co-ops

tend to includes mostly smaller enterprises agreeing to pool resources and create a combined, common data repository. They may share technology and administrative overhead.

Hybrids

are a combination of Federations and Co-ops and tend to agree to network, share, allow access to information they maintain on peer-to-peer basis; allowing for aggregation across large areas (statewide or regional). Hybrids may be required for statewide initiatives.

The two primary roles of the connected community’s organizational structure are ==Utility== or ==Neutral/Convener/Facilitator==. The ==Utility== RHIN/RHIO provides functions such as:

  • Centralized database
  • Patient information exchange
  • Clearinghouse
  • Patient information locator service

The ==Neutral/Convener/Facilitator== RHIN/RHIO

  • Builds consensus policies
  • Brings together competitive enterprises
  • Bridges multiple RHIN/RHIOs in geographic location
  • Seeks an open-standards approach – non vendor specific

An example of a RHIO that has taken on a utility role is that of the Santa Barbara County Care Data Exchange (SBCCDE) They have developed technology for patient information exchange which includes a patient information locator service. CalRHIO on the other hand is serving in more of a neutral/convener/facilitator role and building statewide consensus policies and bringing together competitive hospitals for projects like the emergency department linkage effort. As CalRHIO matures, they will most likely work to bridge multiple RHIN/RHIOs across the state of California.


Challenges and Potential Solutions

Challenges:

  • ==General==
  • Lack of trust and accountability
  • Politics – finding “neutral” ground
  • Pride of ownership
  • Fear of loss of advantage
  • Maintenance of interest and buy-in
  • Individual stakeholder priorities
  • Costs
  • Motivation
  • ==Business / Policy Issues==
  • Competition between stakeholders
  • Consensus of common policies and procedures
  • Consumer privacy concerns
  • Transparency of process
  • Uncertainties regarding liability
  • Difficulty in reaching multi-enterprise agreements for exchanging information
  • Decreasing debt capacity
  • Return on investment
  • Governance and leadership
  • Sustainability
  • Costs –Financial and personnel – especially for Small/Rural providers
  • Physician and payer incentives
  • Economic Factors
  • ==Technical / Security Issues==
  • Interoperability among multiple parties
  • Standards
  • Authentication
  • Auditability
  • Security and legal issues
  • ==Internal to the Institution / Network==
  • Competition for resources
  • Dilution of Effort: Project competing against other pressing needs
  • Preservation of previous investments
  • Increased cost of IT (perceived or real)
  • ==External to the Institution / Network==
  • Security – Data & Physical Resources
  • Rights in Data – who “owns’ the data and who can make changes (tracking changes)
  • Reliability of Data – potential mismatching of patients & data corruption
  • Linking Outside: Standards, reliability, controls
  • Business Continuity: Destruction/Recoverability of critical resources
  • Lack of Accountability & Control (perceived or real)


Overcome Challenges

  • Don’t allow the long list of challenges overwhelm you
  • Obtain buy-in from the highest level of each participating entity
  • Engage State leadership and leaders of healthcare organizations to continue to support dialogue/education on the issue
  • View challenges as opportunities for improvement
  • Identify effective leaders and “champions”
  • Identify financial incentives and provider investments in their internal systems
  • Identify funding sources for information technology and RHIN/RHIOs
  • Identify funding assistance for rural and small providers
  • Educate and communicate with providers and the public
  • Recognize opportunities
  • Recognize improved ease of inter-institution partnering
  • Identify the value and benefits that accrues to each participant
  • Establish standards
  • Leverage the efforts of the larger health systems – collaboration not competition
  • Reduce the number of barriers posed by state and federal regulations (HIPAA, Stark, etc.)
  • Adopt common terminology
  • Address adjudication of liability

Recommendations for Success

  • Involve major players in planning – CEOs, COOs CMOs, CIOs, nurse executives, legal, risk management/compliance, etc ~ avoid “one champion” or pure tech view
  • Ensure leaders of the RHIN/RHIO are accountable to the community, not their individual interests
  • Establish a shared vision and common goals
  • Plan for governance from the beginning
  • Keep patient and security and privacy of information at front
  • Identify all stakeholders and invite everyone to the table
  • Prepare stakeholders for real collaboration
  • Establish a mission and set measurable and achievable goals
  • Address governance accountability and sustainability concerns
  • recognize that discussion dialogue and debate are part of the process
  • Build trust
  • Plan some quick “wins”
  • Demonstrate value and quality, safety, and cost benefits
  • Share stories and data of success with the reluctant and encourage them to join the collaborative
  • Secure the services of an experienced legal firm and keep them informed
  • Address and implement the agreement structure early
  • Spell out all interface & data specifications in excruciating detail, and hold everyone to them
  • Communicate expectations and hold all accountable for their obligations.


From Chritina's Considerations Based on the writings of Holt Anderson