Regional Health Information Organization (RHIO)

A Regional Health Information Organization is a multi-stakeholder organization that is responsible for motivating and facilitating integration and information exchange among that region's healthcare system through an inter-connected network. In general, the stakeholders involved in developing the RHIO are doing so in an effort to affect the safety, quality, and efficiency of healthcare, as well as the access to healthcare through the efficient application of health information technology. Various regions in the United States use various definitions of 'multi-stakeholder organizations'. For example, in Wichita, Kansas the CPI is a software architecture that they use that also serves as a support environment in which integration exists among outpatient clinic and hospital emergency departments. Another example stems from other regions in Maryland, Virginia and elsewhere where RHIOs are forming with multiple hospitals. Still, others may include medical societies, payers, major employers, and other regional healthcare facilities. Even though there are various different definitions used to describe what constitutes a 'multi-stakeholder organization', the end goal is just the same: to provide
The Big Picture [1]


EMR - Electronic Medical Record
RHIO - Regional Health Information Organization
FHIN - Florida Health Information Network (State Level)
NHIN - National Health Information Network


Healthcare systems are highly complex, fragmented, and use multiple information technology systems and vendors who incorporate different standards resulting in inefficiency, waste, and medical errors. A patient's medical information often gets trapped in silos of legacy systems, unable to be shared with member of the healthcare community. With increasing healthcare costs and looming Medicare bankruptcy, a Presidential executive order was issued for the development and nationwide implementation of an interoperable health information technology infrastructure to improve the quality and efficiency of healthcare. With a need established, work needed to be done in order to find a solution to these problems.
The purpose of a health information network is to electronically exchange health information in a secure format so that the receiver can have access to and utilize the information. So through electronic exchange, RHIOs are expected to enable Health Information Exchange (HIE). HIE provides the capability to electronically move clinical information between disparate healthcare information systems, all the while maintaining the meaning of the information that is being exchanged. RHIOs, in turn are key to reaching the next step: Implementation of the United States Nationwide Health Information Network (NHIN),[2] making them the building blocks of the proposed NHIN implementation.


Levels of RHIOs

It has been indicated throughout their short history that two levels of RHIOs have been developed -- Statewide and Local. However, RHIOs continue to evolve with the spark of contributions being made to the concept of Rural RHIOs.
State RHIO States form RHIOs that create information exchange networks that meet a 'common good' and encourage, promote, and facilitate the creation and operation of regional RHIOs. A state RHIO takes on many of the tasks that are difficult for a local one to control. One instance is that of a state RHIO, until there is a national standard, would identify standards for interoperability between systems for health information exchange. The state RHIO would address issues of privacy and security in compliance with the state laws that are currently responsible for ensuring proper use of personal data. There are also efforts being made at the national level to develop a federal law that supersedes all state laws in order to create consistency and encourage health information exchange on a nation level through a NHIN.
Local RHIO Local RHIOs will be new or adapted organizations that serve a particular region. Unlike state RHIOs, it is anticipated that multi-stakeholder, collaborative models will dominate. As a fundamental base, local RHIOs will create the technology and service that cause health information exchange within a region and to the rest of the sought after NHIN. There are many models to consider but a majority seem to be separate organizations created as non-profits or supporting organizations.Funding has been the difficult issue for many of the local RHIOs, as well as finding the best way to govern their operation given the proprietary and sensitivity of the data. Models are also evolving in order to describe potential sustainability frameworks for these local RHIOs. One of the main goals is to find a functional funding model.
Rural RHIO As RHIOs continue to evolve, new concepts emerge to expand the adoption of current services. Only few RHIOs exist that server rural areas, making it difficult to find information that addresses the unique needs that are faced by these rural regions. As a baseline, a rural RHIOs region could be considered any multi-stakeholder region where a single purchaser of health services does not dominate and the subscriber base is less than the 100,000 anticipated by the eHealth Trust model. Only a handful of conceptual contributions have been made to the concept, but these contributions have presented a widely divergent perception. One early perception was that rural RHIO efforts tend to actually be easier because many are starting from the ground up and the pressing needs – reduce costs, improve patient access – are more universal and clear-cut [3] . Unfortunately, the multi-stakeholder organizations would be forming and relying on already established technologies. Many factors contribute to the simple fact that the rural RHIO climate is the most unusual and difficult to change [4] .
Rural RHIOs must meet special need in certain areas. Although strategies to address these needs have yet to be identified, these unique needs identified in the IOM report include:

  • Adopting a rural focus in the National Health Information Infrastructure (NHII)
  • Ensuring high-speed access to the Internet
  • developing consistent regulations and payment policies
  • Offering or identifying strategies that offer financial strategies for EHRs
  • Assisting collaborations and demonstrations in rural areas
  • Offering or identifying strategies for ongoing educational assistance


There are a number of benefits to take advantage of through the implementation and use of RHIOs. Some benefits include:
  • Improving the quality, safety, and efficiency of healthcare delivery
  • Faster, secure, and easy sharing of EMRs throughout regional healthcare facilities
  • Motivating integration and information exchange
  • Promoting and facilitating the creation of other RHIOs
  • Reducing the amount of redundancy and medical error present in current legacy systems

Resources: - California Regional Health Information Organization - Office of the National Coordinator for Health Information Technology - RHIO Nation - The RHIO Wiki
- RHIOs Long Way From Action - Privacy, Security, and the Regional Health Information Organization - RHIO FAQs


  1. ^ Ebe Randeree - Health Informatics
  2. ^ The White House Website - Transforming Health Care: The President’s Health Information Technology Plan, Promoting Innovation and Competitiveness: A new generation of innovation
  3. ^ -
    Brunner, Lincoln, “IT guru Melissa Chapman: how to make health IT work for the bottom line”, Wisconsin Technology Network
  4. ^ Quality Through Collaboration: The Future of Rural Health Care, The National Academies Press, 2005.