The success of a RHIO is dependent on all of the following EXCEPT

• A. involvement of healthcare payers
• B. trust between stakeholders
• C. local government support
• D. perpetual maintenance of business agreements

Answer: (C)

Successful RHIOs hinge on broad collaboration, strong governance, and sustainable data-sharing arrangements rather than on government backing alone. When multiple stakeholders—clinicians, hospitals, and especially payers—participate, there is a critical mass of data and a shared incentive to exchange it, which drives interoperability and usefulness of the network. Trust between these participants is essential because it underpins accurate data, timely updates, and a willingness to share sensitive information across organizations. Equally important is the ongoing maintenance of business agreements that spell out what data is shared, who can access it, privacy and security obligations, and funding or governance responsibilities; without continuously updated agreements, participation can waver and the ecosystem can falter.

Local government support, while beneficial for legitimacy, regulatory alignment, or initial funding, is not a prerequisite for a RHIO’s success. The network can thrive through private-sector collaboration and voluntary participation governed by clear agreements and trust.