As states work toward creating the infrastructure necessary for statewide electronic health information exchange (HIE), they are making important decisions about what sort of governing body will oversee the exchange of health-related information among organizations. Known as a Health Information Organization (HIO), this body is tasked with ensuring that the exchange of information meets nationally recognized standards. While many states have already created a governance structure for this, there are still plenty of states that have not yet designated a governing body.
According to a report from the State Alliance for e-Health, key factors for success in a governing structure include:
- Balanced stakeholder representation, while being small enough to not adversely affect productivity;
- Skilled and experienced senior leadership to execute the goals of the organization; and
- Flexibility to make changes in composition and roles over time.
To meet those characteristics, there are three primary legal structures that states are likely to choose from: government-led, a public utility with strong state oversight, and private sector-led with government collaboration.
Texas is one state which has decided to go with the public utility model, through the creation of the Texas e-Health Alliance (TeHA). The nonprofit serves as the unifying organization for providers, policymakers, the private sector, and nonprofit and academic communities to promote the adoption of e-Health. TeHA is a nonprofit that:
- Promotes legislative, executive, and regulatory policies that promote the adoption of e-health by health care providers and payers;
- Organizes and hosts an annual summit to foster dialogue and networking among leading e-health experts from both the private sector and local, state, and federal governments;
- Creates and distributes newsletters, emails, blogs, seminars, and commissioned studies on the economic impact, cost containment, and quality improvement impact that the appropriate deployment of e-health can provide; and
- Supports the efforts of health care providers and collaboratives to organize local HIEs across Texas.
Other states—Oregon, Tennessee, and Vermont—have chosen different governance structures:
Oregon: Within the Oregon Health Authority (a state agency set to open in July 2011), the Health Information Technology Oversight Council will coordinate Oregon's public and private statewide efforts in electronic health record adoption and the development of a statewide system for HIE.
Tennessee: The Health Information Partnership for Tennessee (HIP TN), a multi-stakeholder nonprofit organization, and the Office of e-Health Initiatives, a state agency, will provide a coordinated governance model based on two interdependent structures. HIP TN will convene a statewide collaboration process in which stakeholders from all affected parts of the healthcare economy deliberate over and establish technical, legal, and business policies that will govern HIE in Tennessee. The Office of e-Health Initiatives will provide leadership in the harmonization and integration of HIE, health information technology, and related policies among state departments and agencies.
Vermont: Operating as a public-private partnership, Vermont Information Technology Leaders, Inc. (VITL) is a multi-stakeholder corporation formed by a broad base of health care providers, payers, employers, consumers, and state agencies. It receives federal and state funding to collaborate with all stakeholders to expand the use of secure health information technology to improve the quality and efficiency of Vermont’s health care system.
In agreement with federal HIE grants, states must complete their strategic plans for HIE implementation by July. These plans must include governance plans. For that reason, we can expect that over the next several months most states will have designated the governing body primarily responsible for the important work of promoting and coordinating statewide HIE. As work continues in this area, it will be useful for states to learn more about state experiences and the pros and cons of pursuing different governance structures.
Sources
Preparing to Implement HITECH: A State Guide for Electronic Health Information Exchange, State Alliance for e-Health, 2009.
Public Governance Models for a Sustainable Health Information Exchange Industry, State Alliance for e-Health, 2009.
Conversation with Ree Sailors, Health IT Program Director at the National Governors Association
