Editor's Corner

What is the business model for sustaining a RHIO? As venerable exchanges like the Santa Barbara RHIO begin to collapse under the weight of their expenses (see below), it's a question that should be asked more often.

Right now, RHIO efforts are funded almost exclusively by grants from federal, state and local governments and a handful of private foundations. I'm not saying that's a bad thing. After all, intermediaries like governments and foundations should be out ahead of the market when they can, running visionary projects which will someday benefit everyone.

But the thing is, you can only dodge the dollars and cents issue for so long. Eventually, RHIOs will have to carry their own weight or fold. After all, even the federal government can't afford to create a complete, seamless, interoperable health information network embracing the entire country on its own, any more than it could have created the U.S. infrastructure for the Internet.

So how will participating health organizations fund their RHIO efforts? Here's a few models which are bouncing around out there in other settings:

• RHIOs might be funded by accepting advertising on the portals and key destination pages within their system.
• RHIOs might sell anonymized health data to researchers, pharmaceutical companies, health insurance organizations and others interested in big pools of clinical data.
• RHIOs could conduct specialized research projects on behalf of outside organizations (universities, biotechs, pharma), using their uniquely deep database to, perhaps, offer detailed outcomes studies on a particular disease.

These are just a few ideas which I've seen implemented in other settings--and they're not particularly novel. But it may not take novel concepts to save the RHIO movement. It will just take thinking of these exchanges as a line of business, rather than an ill-defined mess into which you pour money.

As wonderful as the potential clinical benefits and cost savings might turn out to be, I think RHIOs will be perceived as a "nice to have" not a "need to have" as long as the benefits are intangible and the costs palpable. But if RHIOs can be turned into self-funding projects--or even profit centers--just watch how fast the movement will take off! - Anne

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