Types of RHIO Architecture
The two broad types of architecture, Centralized and Federated, correspond to the "Data Warehouse" and "Federated database system" models of data integration. In the Centralized configuration (e.g., The Santa Cruz Community and the Michigan UP Network), all providers send their data to the RHIO's central repository on a periodic basis (daily), while in the Federated model or Record Locator service, the data stays at its original location, and the RHIO only has a "pointer" to that information.
The pros and cons of each architecture follow from the approaches. For the Centralized design, once data is centralized and restructured into a uniform data model, it is easier to query and analyze: however, because movement and restructuring is generally a complex batch process involving the well-known steps of "extract, transform, load", the centralized data may be somewhat out of date if the (logistically challenging) target of daily updates is not achieved. Also, there may be concerns among the individual RHIO participants who originate the raw data that they are giving up "control" and "ownership" once the data is copied to a central site. Also, creation of the central repository requires close collaboration to determine exactly what data will be centralized and how it will be structured.
Federated systems, where the RHIO software merely has information on which patient's data is available at what locations, are often more politically feasible than Centralized systems. However, designing a protocol by which the RHIO can query (heterogeneously structured) individual provider data stores is technically challenging, and the software at the individual sites must ensure authenticate electronic requests to ensure that they are legitimate and authorized: no standards that can be used for this purpose currently exist. A federated setup requires greater network bandwidth than the centralized approach, because a request by a user of the central RHIO software can be farmed out to multiple provider systems.
The Centralized and Federated approaches are not mutually exclusive, and hybrid setups can be employed. In one proposed hybrid model, the health record trust), all data for each patient would stay in a single repository (the data bank), but patients could choose which data bank to use for their records.
Read more about this topic: Regional Health Information Organization
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