"The recent federal recovery bill ... will provide resources to states to take the lead in creating health information exchanges." John Thomasian, director of the National Governors Association Center for Best Practices (pictured)

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

The report, Public Governance Models for a Sustainable Health Information Exchange Industry, states that the adoption of effective HIT and HIE by states will help improve and transform the American health care system. Citing the significant burden of health care costs on state budgets, the imperative to improve the quality of health care delivery and the likelihood of accelerated investments being made in health information technologies in the near future, the report reiterates the critical need for state leaders to keep informed of the key issues involved and the strategies that might be used to effectively leverage investments in these 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 Center for Best Practices, the organizing body for the State Alliance for e-Health. "This report can serve as a valuable starting point for states as they consider governance strategies for building, sustaining, and protecting a system to support electronic health record."

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:

  • Model 1 - Government-Led Electronic HIE: Direct Government Provision of the Electronic HIE Infrastructure and Oversight of Its Use
  • Model 2 - Electronic HIE Public Utility with Strong Government Oversight: Public Sector Serves an Oversight Role and Regulates Private-Sector Provision of Electronic HIE
  • 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.

To inform the State Alliance for e-Health and governors across the country, the University of Massachusetts Medical School convened a multidisciplinary team of researchers and a national Advisory Committee including experts in HIE, public policy and public utilities regulation. This team assessed the current state of the electronic HIE marketplace and the oversight and regulatory roles of state government in other industries. Using this information, a range of public governance models, with specific review of the legal structure, accountability issues and finance considerations, was developed to serve as a framework to support state governments as they consider their appropriate role in the evolving electronic HIE industry.