With e-health initiatives across the United States in various stages of development, states now have an opportunity to determine the best regulatory and governance framework to support and advance electronic healthcare IT and health information exchange (HIE), according to a report prepared for the State Alliance for e-Health by the University of Massachusetts Medical School.

The report said that the adoption of effective healthcare IT and HIE by states will help improve and transform the U.S. healthcare system. Citing the significant burden of healthcare costs on state budgets, the imperative to improve the quality of healthcare delivery and the likelihood of accelerated investments being made in health IT in the near future, the report noted the need for state leaders to keep informed of the issues involved and the strategies that might be used to leverage investments in the technologies for health system improvement.

"This report is particularly timely in light of the recent federal recovery bill, which will provide resources to states to take the lead in creating health information exchanges to serve patients and providers," said John Thomasian, director of the National Governors Association (NGA) Center for Best Practices, the organizing body for the State Alliance for e-Health.

The report details three conceptual models of public governance that could lead to the practice of sustainable HIE and delves into specific rationale and description, legal structure and financing and accountability considerations for each model:
 

1. Model 1 – Government-Led Electronic HIE: Direct Government Provision of the Electronic HIE Infrastructure and Oversight of Its Use;
2. Model 2 – Electronic HIE Public Utility with Strong Government Oversight: Public Sector Serves an Oversight Role and Regulates Private-Sector Provision of Electronic HIE; and
3. Model 3 – Private-Sector-Led Electronic HIE with Government Collaboration: Government Collaborates and Advises as a Stakeholder in the Private-Sector Provision of Electronic HIE.

States will also have responsibility for enforcing privacy rules and establishing sustainable business models that will “allow [the National Health Information Network (NHIN)] to flourish over time,” Thomasian said. “What is not quite clear is who will build the exchange and with what monies.”  Although the American Recovery and Reinvestment Act of 2009 will issue approximately $300 million for regional efforts, “hopefully that is a floor,” he observed.