RHIOs exist predominantly to allow the exchange of patient information between participating hospitals or even regions. I personally only have insight into how two RHIOs operate. Both are very interested how they can turn FHIR into another avenue to distribute patient information.
The issue is that most EHR/EMR vendors have very limited limited interoperability with FHIR. As a lot of these vendors are struggling with CCD 2.1 implementations. The exciting space is allowing patients through 3rd party apps to request specific information or even send it to the HIE (RHIO in this case) and let there GPs know of certain events.
Which means a lot of work to bend over backwards to get APIs exposed for these 3rd parties.