BRENNAN healthsystems LAB
Modeling Participation in the NHII
Regional health information organizations (RHIOs) form the core building blocks of any approach to creating the National Health Information Network. RHIOs are computer-supported information sharing alliances composed of health care institutions that need to share clinical, financial or administrative data. Institutions considering joining RHIOs require trustable financial projections. Current approaches to health information technology investment rely on a net-present value analysis, which is inadequate to capture the dynamic, uncertain course likely to occur in the RHIO environment. Thus, our team of medical informaticists, operations researchers and computer scientists proposes to apply methods from operations research (real options models and stochastic programming) to aid decision makers in exploring the cost and consequences of various RHIO structures.
To insure that the models provide valuable and useful advice to their intended audiences, we will partner with the Indiana Health Information Exchange (IHIE) to characterize the essential business processes, gain real-world data, and solicit concurrent reactions to the models and their output. The long-range goal of this research is to create a suite of decision support tools that can guide RHIO pricing options, discount rates, and optimal configuration choices. However, we must first develop the modeling core of the decision support system. Our approach in this feasibility study will consist of four stages. First, we will obtain preliminary data from our primary industry partner, IHIE, in order to understand the business processes, operational concerns, and strategic priorities of this regional health information exchange. Second, we will use these data to develop preliminary operations research models that capture key aspects of the process under study, namely, formation of information-sharing alliances. Third, we will consult with IHIE and a second partner, the Wisconsin Health Information Exchange, to refine these models, adding to their scope and introducing additional detail and complexity as warranted. Fourth, we will validate our models by examining the decisions they propose through scenario evaluation and simulation studies. Validation will occur at intermediate stages of the process, involving consultation with our partners, comparison with published reports, and computer simulations of evolving information-sharing alliances.
Although the operations research methods we propose to use are valid and well established, they have not been applied in a health care information technology decision context. They offer substantial advantage over existing deterministic approaches to economic valuation of health information technologies because they employ multi-period, dynamic stochastic models that explicitly address such important aspects as the impact on one institution of the activity by another institution. We will use the results of this feasibility modeling project to create a proposal to conduct a large-scale test of a suite of models involving awardees of the AHRQ-Connecting Communities for Better Health grants. We will engage additional partners through dissemination and consultation with IHIE and WHIE.