In a growing number of cities around the United States, efforts are under way to organize a regional health information repository. Such a development has implications to change the long-standing relationships laboratories have with physicians, hospitals, patients, and payers.

Two acronyms are used to describe these regional informatics projects. One is RHIO, which stands for Regional Health Information Network. The other is HIE, which stands for Healthcare Information Exchange. Because of the potential for these organizations to change the way laboratories relate to the communities they serve, lab managers and pathologists may want to check out a report issued in recent months by the American Health Information and Management Association (AHIMA) detailing the Development of State-Level Health Information Exchange Initiatives (HIEs). The purpose of the report was “to gather information from existing state-level HIE initiatives to determine successful governance and legal, financial, and operational characteristics; to develop consensus on guidance for developing state-level HIE initiatives; and to disseminate these findings widely” (from the executive summary).

According to AHIMA, HIEs existing in 27 states and over 200 localities. Two key findings of AHIMA’s report were that most state-level HIE initiatives are still in an early stage of development and the mature ones are faced with challenges on how to expand their services in a financially sustainable way. One major problem in getting HIEs to align their form and function is that they have come into existence in a variety of ways and for varying purposes. Some have been founded in response to state legislation. Others were initiated by either the efforts of state agencies or through collective grass roots work by community healthcare stakeholders. AHIMA can find only eight states with an HIE that is more than two years old.

Funding seems to be a big impediment in HIE development and expansion. Some suggestions for financing include charging membership fees, transaction fees, fees for a software package, program or service fees, or some combination of such fees. Beyond financing, HIEs face problems that range from no consensus on the role of state government and lack of coordination among state agencies to minimal participation from private payers and inadequate plans for relating to similar HIE efforts in neighboring states.

Doctors, hospitals, and laboratories are each expected to benefit from the ability to transfer patient information seamlessly across city and state lines, but they must be prepared to pay for this convenience. Dark Daily predicts that, in order to successfully implement HIEs on a state-to-state basis, doctors, hospitals, and laboratories, can expect to pay, at the very least, a membership fee to get the ball rolling. Only time will determine whether HIEs and RHIOs will turn out to be either threats or opportunities for laboratories.