2 PROFILES OF PROGRESS: STATE HEALTH IT INITIATIVES
exchange definitions and standards within theNIEM framework,along with use cases for testingtransactions.The NIEM framework will incorporateand build upon standards that are already in place.
NASCIO advocates for NIEM adoption and promotesthe methodology for planning,designing andimplementing collaborative information exchange.In 2006,NASCIO released
which examined the vision of NIEM and how it hasexpandedtoincludehealthinformationtechnology.While the State HIE cooperative agreements have afour-yearperformanceperiod,therecipientshavealsoagreedtomatchaportionofthegrantsbeingawardedinthesecondyearoftheaward,2011. Fortunatelythestates are not limited on how these matching fundscan be acquired and the capital can come fromsources other than the state general revenues. ThestateCIOsroleinastateHIEmaydependuponhowinvolvedthestateiswithoverseeingtheprivacy,security,sustainability,anddependabilityoftheHIE. If public expectations are high for strong governmentpresence it will most likely be a government-ledelectronichealthinformationexchange. Ontheotherhand,ifastatechoosestobelessinvolvedinoversee-ingtheHIEanddeterminingthebusinessmodel,itcan let other actors,such as a non-profit entitycreated by stakeholders,operate the HIE.
NASCIOsuggests that a state HIE should develop from a fewguiding principles that,regardless of thegovernance model,state CIOs can provide duringthe planning and implementation phases:
An effective statewide HIE will be able tosecurely integrate data and make it accessi-ble in a federated model.
Secure and standardized sharing of data isessential to implementing an efficient anddependable HIE.
A statewide HIEs primary purpose is to shareclinical data from different sources and maketheminteroperablewiththeNHINstandards.
Although an HIE may mature and includeeligibility,biosurveillance,claims data,reporting,and provide communicationfunctions,it is essential to focus on makingthe HIE compatible with clinical use. The lessstringent HIPAA privacy laws in HITECHrequire a clinical use case as a requirement.
The Meaningful Use (MU) provisions thatwhere announced by ONC in July of 2010can not be met with just a state HIE.A stateHIE is a single component,in combinationwith electronic health records (EHRs),Computerized Physician Order Entry (CPOE)systems,financial exchanges,etc.,that work together to achieve MU.
The HITECH ACT greatly expands the role of statesin planning and implementing health informationexchange.Harmonization between the state-levelHIT coordinators and federal HIT policy organiza-tions is vital to trouble-shooting any gaps that mayexist. As early adopters start to implement HIEs it isimportant that state standards don’t conflict withone another. States should begin to collaborate onhow they will connect to the NHIN and definewhere the NHIN begins and the state HIE ends.Agreatdealofemphasishasbeenplacedontheuseof technology in healthcare and how it can beleveraged to improve patient care,efficiency andreduce costs by electronically exchanging medicalinformation. A statewide HIEs key objective is toprovideanenterprise-widearchitecturethatwillbesecure,efficient,andinteroperablefortheexchangeof informationamongstallstakeholders. ThestateCIOsrecognizethatthereisnobetteropportunitythannowforcarryingoutthesegoals. Themassiveinfluxof federaldollarsprovidesthestateswithanunprece-dentedopportunitytoimplementahealthinforma-tionexchange,butfulfillmentofthisgoalisgoingtorequiretheingenuityofthestates,stateCIOsandstakeholderstomakehealthinformationexchangeasustainablereality. Whilestatespoliciesandprogressvarygreatly,thiscompendiumprovidesacrosssectionofthismomentoustimeinhealthcarereform.
See < http://www.govhealthit.com/newsitem.aspx?nid=73807 >,May 26,2010.
See < http://thomsonreuters.com/content/press_room/tsh/tr_establishes_best_practices_statewide_health >,March 2010.