I don't think the "mission" of RHIOs will change dramatically over the next few years, however, their role will likely change as the realities of the future come into focus. I agree with Dr. Brailer that a RHIO is a journey, especially if you are like me and see it as a community wide quality improvement effort.
At this point, we don't know how, or if, the DHHS contracts for prototype NHINs will change the role of RHIOs. Perhaps it will be hard for some to justify their IT plans, however, others may have the resources to proceed with their implementation plans. I believe it will all come down to the strength of the community collaboration and the resources they can commit to move their plans forward.
I agree with Dr. Brailer that the most important role for RHIOs is their ability to organize the governance and collaboration aspects. I think there will come a time when the technology is "plug and play" and RHIOs will no longer be expected to "innovate and develop technology". Instead, they will be responsible to the community for ensuring that the technology is implemented in a manner consistent with stakeholder needs. These RHIOs will also provide the ongoing oversight and authority structure which will be vital to the success of a national health information infrastructure.
As I mentioned in my post on the Forecast for 2006 I think that size does matter and at some point, RHIOs will begin to find shared visions and realize the benefits of combining their resources with other communities. For example, Santa Barbara County "collaborates" with Ventura and San Luis Obispo Counties in many different ways and forms a "natural" region. At some point it may make sense for these three "communities" to combine their resources and form one RHIO to represent the interests of their combined stakeholders.
In summary, if you are a RHIO leader, this article only means that you need to keep an eye on the horizon and be ready for change!