Some cover states, some just parts of states. These are voluntary organizations of hospitals, doctors, and other stakeholders who agree, among one another, on how to move health data among them and then do it.
It's one of the smartest things going in health IT.
Sean Hogan, IBM vice president of health care delivery systems, points to the Western North Carolina Health Network as a success story.
What most successful RHIOs like this one have in common, however, is a key vendor driving the exchange process. In the case of WNCHN, of course, it's IBM.
Which leads to big problems taking the next step, combining RHIO efforts into a nationwide network so that if, say, someone from Asheville turns Nashville into crashville, their records will find them before an EMT injects them with something they're allergic to.
As an IBM spokesman told me just yesterday, "Vendors with a command and control approach to the marketplace see standards as a threat to their business models."
To return to the example above, if AT&T is the key vendor in Nashville and IBM is the key vendor in Asheville, someone has to spend their money to connect the systems, and someone has to compromise on their way of doing business.
Now Open Health Tools, which happens to be based in Asheville and was founded by the genius behind the Eclipse open source group, is making a new effort to herd these cats around open standards and open source.
They are working with Tim Elwell of Misys, an open source health tools vendor, to build components to integration patient profiles among health exchanges. The first such profile to be delivered, next February, will be one for cross-referencing patient records and queries on demographics -- age, sex, race, etc.
Asheville, after all, has to make sure the Bob Miller who crashed in Nashville is the 45 year old black factory worker in its records and not the 18 year old native American dancer from over in Cherokee.
This is the kind of cooperation, the kind of blocking and tackling, that will be necessary to beat down the walls between vendors and make health records work. The easy work has been done. Getting to work on the hard stuff now is pretty smart.