Most U.S. states developing roadmap to support health care quality improvements through Electronic Health Information Exchange

Washington 17 July 2006Over half of the states in the United States are either initiating planning as a result of state legislation or an executive order or have planning well underway related to health information technology (HIT) adoption or health information exchange (HIE). And an additional seven states are in the process of implementation, according to new survey findings from the eHealth Initiative and its Foundation (eHI).


The 2006 survey takes the pulse of 165 multi-stakeholder efforts across the country, representing initiatives in nearly every state, Puerto Rico and the District of Columbia. This year's survey also takes a special look at a recent rapidly emerging phenomenon - the role of state leaders in planning, co-ordinating and implementing policy and in some cases, practical issues related to the use of HIT in improving health and health care. The full survey report will be released in September in conjunction with eHI's Third Annual Health Information Technology Summit, September 25-27 in Washington, D.C. The Summit attracted more than 900 health care leaders in 2005.

This year, the Summit, co-hosted by the eHealth Initiative and Bridges to Excellence, will convene a national assembly of state leaders driving improvements in health and health care through HIT and health information exchange who will share insights, learn from one another and inform the policy agenda for the nation. It will also include an in-depth look at rapidly emerging policy changes related to both quality and HIT, touching on financial, clinical, organisational, legal, privacy and confidentiality policies, standards and issues.

"This year's Summit will showcase the progress of individual states in their efforts to connect for more efficient, safer, and higher quality health care using health information technology", stated Janet Marchibroda, eHI's chief executive officer. "We will also gain an understanding of the most pressing issues for states, and best practices and policies that are emerging to inform policy makers and private sector leaders who want to improve health and health care through information technology."

Health information exchange efforts from 49 states, the District of Columbia and Puerto Rico responded to eHI's Third Annual Survey of State, Regional and Community-Based Health Information Exchange Initiatives and Organizations. Preliminary results show that statewide, co-ordinated planning for HIT and health information exchange is well underway, with structures and processes in place to ensure statewide representation focused on assessing needs and developing policies for HIT adoption or electronic exchange of health information. According to survey results, twenty-eight states are initiating or are in the process of developing plans for HIT adoption and health information exchange, and an additional seven states have their plans completed, with implementation underway.

"Many states are now launching public-private collaborative efforts to develop plans and roadmaps for improving health and health care through HIT", stated Emily Welebob, vice president, eHI programme operations. "While national standards are needed to facilitate interoperability nationwide, we recognize that health care is essentially local, and leadership at the state, regional and community levels is what drives implementation through a shared vision, goals and a plan."

Other key findings include:

  • About half of the states in the United States have either an executive order or a legislative mandate in place that is designed to stimulate the use of HIT to improve health and health care.
  • Emphasis on quality, patient safety and curbing rising health care costs rank high as the primary drivers for state leadership around health information technology.
  • Most states are convening or participating in multi-stakeholder groups engaged in dialogue to develop plans for improving health and health care through HIT. And, increasingly states are providing grant funds to support not only regional and local HIE efforts, but also the development of plans.
  • In most cases, either the Governor's Office or the state's Department of Health is taking leadership in state-wide efforts related to HIT.
  • States from the get-go are recognizing the importance of local efforts, and are taking steps to closely integrate state initiatives with efforts at the regional and local levels.

According to eHI's most recent July 2006 analysis of state legislative efforts, about 125 HIT-related bills have been introduced in 38 states, with 36 bills in 24 states passed into law. The most common provisions establish a task force to study the impact of HIT, or authorize a committee to create a strategy for the development, implementation and adoption of electronic medical records and/or a health information infrastructure.

Most executive orders authorize a planning committee to develop an HIT strategy or policy. States vary in the level of involvement in activities:

  • Thirty-eight states are participating in a state-wide or local dialogue related to HIT and health information exchange, while 21 states are actually convening stakeholders for planning, communication and co-ordination.
  • Sixteen states are providing staff to plan activities or serve in a project management role;
  • Seventeen states are providing funds to support regional and local efforts;
  • Other state roles included commissioner of a study, stakeholder educator, requiring use of standards, and provider of financial incentives through Medicaid or in the role as purchaser.

"The findings show us both common threads, such as key drivers, but also some diversity in approach", Janet Marchibroda stated. "We are seeing a trend in smaller states with no regional activity, to plan for a statewide exchange initiative. In larger, more highly populated states that already have regional or community activities in place, the state tends to serve as a co-ordinating body to drive consensus on standards and policies that promote higher quality health care through HIT adoption by removing barriers and acting as a central resource for information and education."

Functions that often fall to a state organizing body include setting standards for health information exchange which align with national standards, as they emerge; gaining consensus on privacy and confidentiality policies; co-ordinating state agency interests; identifying best practices; raising awareness of regional and local initiatives; fundraising and administering statewide funding; serving as a liaison to federal initiatives; working with public and private sector payers to embed HIT expectations in incentives programmes; and developing plans for consumer and physician education.

Since 2004, eHI has been providing a range of activities to states and regions towards improving health and health care through HIT and health information exchange. In its work over the years at both the national and local levels, eHI has developed resources and tools designed to support the many stakeholders in this effort to navigate the organisational, legal, financial, clinical and technical aspects of health information exchange.

The eHealth Initiative and its Foundation are independent, non-profit affiliated organisations who engage the multiple stakeholders in health care, including clinicians, employers, health plans, health care IT suppliers, hospitals, laboratories, patient groups, pharmaceutical and medical device companies, pharmacies, and public health agencies, to improve the quality, safety, and efficiency of health care through information and information technology. More news is available in the VMW September 2005 article eHI Foundation releases national report on Health Information Exchange (HIE) efforts.

Leslie Versweyveld

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