Data Sharing for RHIOs / RHINs

As various members of the healthcare ecosystem begin to participate in regional health information organizations (RHIOs), they must develop data sharing policies and technologies to deploy appropriate processes and audit mechanisms. One approach is to use Initiate software to interface their data to the RHIO.

RHIOs commonly use enterprise master person index (EMPI) technology that employ sophisticated algorithms to enable patient identification and linking. Such technology links and matches patients by using available demographic attributes such as name, address, date of birth or ZIP code. In a RHIO environment, the EMPI matches and aggregates medical records and information across participating systems without requiring either existing (e.g. SSN) or new (e.g. national health number or a RHIO-specific number) unique identifiers to locate and match patient information.

A Record Locator Service

A key component to RHIOs is a record locator service (RLS). This centralized function provides healthcare providers with a single search portal where they enter patient demographic data and receive a list of locations for medical records for that patient throughout the region. There are two common methods to achieve this:

• Patient demographic data subset. The first method requires participating facilities to send a subset of their patient demographic data to the central record locator service. The service indexes this data to support real-time demographic searching. As part of this approach, the facility needs to send updates (either real-time or periodically) to the central service reflecting additions or modifications.
  
• Real-time search capability. The second method requires participating facilities to provide a real-time search capability which can be described as a distributed query function. In this model, the requestor’s query, including patient demographic data, is launched to each participating node or gateway that “fronts” the participating RHIO members. The query is distributed to each participant and the response unique to each facility. This approach does not require the transfer of the demographic data to the central service, but it does require that the participating facility support real-time search requests. An EMPI can readily serve as the gateway or front porch utility or a RHIO. In addition, this distributed query approach is very attractive for RHIO to RHIO or Sub Network Organization (SNO) to SNO record locator service, as a centralized record locator service on a national level is not envisioned.

Likely, most RHIOs will be hybrids. That is, the function of determining who the patient is and where they have records will be managed in a federated manner. Access to clinical data, which is a separate function from the patient matching and record locator service, may also be federated, or some data may be maintained in a centralized repository.