The U.S. medical industry faces a federal mandate to incorporate electronic health records (EHRs) into daily operations, and the lumbering health bureaucracy is slowly changing its course.

As part of a nationwide overhaul of health-care IT systems, EHRs will dramatically alter the way physicians practice medicine and how hospitals manage patient data, as well as improve the quality of care patients receive.

Getting to a point at which EHRs are the norm, however, won't be easy.

The world of health care is extraordinarily fragmented -- physicians in private practices run their offices as they see fit, buying and using whatever practice-management software strikes their fancy. Naturally much of this software doesn't play nicely with other practice-management software packages.

A patient getting a referral from a primary care physician to a specialist will be forced to sit in a waiting room filling out forms ad infinitum -- forms designed to capture the same information the patient already disclosed to the primary care physician.

Worse, practice-management software often doesn't share information with calendaring applications, which often don't share data with patient-management applications. It's a recipe for disaster, medically and financially.

This is why the federal government is forcing the issue, and since Uncle Sam is a huge payer for medical services through Medicare and Medicaid, the health apparatus must pay attention.

Yet the grunt work behind the transition to EHRs happens at the local level, with regional health information organizations (RHIOs) doing most of the heavy lifting. These RHIOs get various health-care players in a region together -- large hospitals and health systems, physicians' groups and insurance companies -- to hammer out the details of making EHRs a reality in today's medical world.

It's a process that happens largely independently of state CIOs, and the National Association of State Chief Information Officers (NASCIO) wants this to change.

In February 2006, NASCIO published an issue brief examining state CIOs' role in health IT modernization efforts. NASCIO's goal is educating state CIOs on the importance of health IT, and the role they should play.

"By recognizing early opportunities to make important contributions to this effort, the state CIO will be able to prove his or her relevance to key state executives and to frontline health-care interests," the brief advised.

State CIOs should watch how the discussion of EHRs takes shape in their states over the next 12 months to 18 months, according to NASCIO. State CIOs could help ensure that local RHIOs don't duplicate existing state IT infrastructure or ignore state health-record holdings and public-private linkages used to provide Medicaid services to citizens.

NASCIO's issue brief also raises the issue of state and local governmental health-care interests forming a sort of "public-sector" RHIO that can interface with other RHIOs in the state.

Whatever role state CIOs define for themselves, they can't wait to be invited to take part in health IT modernization. CIOs can add much to this process, and they need to find time to get involved.

Shane Peterson  |  Associate Editor