Lori Evans

This paper explores the risks, benefits and lessons learned for hospitals and health systems contemplating or engaging in RHIOs in their communities. The first two sections provide an introduction to recent public and private sector efforts to expand HIE nationwide, while the third describes the characteristics of RHIOs. The fourth section offers case studies of three diverse RHIOs and answers seven key questions often raised by hospital executives when contemplating participation in a RHIO:

• What are the benefits for patient care?
• What is the cost, and who provides financing?
• What is the return on investment?
• Who will have control of the project, and how will it impact the competitive marketplace?
• Is the technology ready?
• Can privacy and security be achieved?
• What legal barriers can be anticipated?

The final section explores and summarizes observations from hospital executives involved in RHIOs. These observations, listed below, provide guidance to executives as they contemplate whether to participate in health IT collaborations in their own communities, and how to structure them if they do.

• Be proactive.
• Assess your internal capacity.
• Consider the risks and benefits of being a pioneer.
• Let clinical and care improvement priorities drive the project.
• Recognize the need to build trust and good will.
• Create a platform for shared investment and financial sustainability.
• Build privacy and security into the business and technical infrastructures.
• Develop a strategy for engaging public partners.
• Be realistic about timeframes.