As Medicaid continues to consume a huge share of state budgets and health care in general commands the attention of state governors, health IT becomes an increasingly important issue to state CIOs. 

NASCIO, led by its Executive Director Doug Robinson, is making sure CIOs tackle this area of IT before it tackles them. Robinson made a push two years ago to get CIOs thinking about health IT because related issues, such as legacy health IT systems, have come to the fore.

"We really looked at the role of the state CIO, and we've crafted some pieces as to what's important to NASCIO and to state CIOs, things like legacy renovation," Robinson said. "You have a lot of existing health IT systems that are major legacy monsters that need to be addressed.

"I think there's a fairly good understanding that the entire health-care arena -- the administrative side, the provisioning side and other issues -- could be supported very strongly by IT," he continued. "Some of the major issues are very familiar to us: interoperability, data formats and standards and the administrative barriers, and then the security and privacy concerns."

Robinson said the health-care IT issues facing state CIOs will mirror other issues that have had CIOs scratching their heads for years.

"It's really about enterprise architecture. As a business discipline, you have to have an architecture framework for health just like we've had for justice, transportation and other lines of business in government," he said. "This is just bigger -- bigger and badder and more complex because you have so many stakeholders involved in terms of the public and private sectors. It's one of those areas where we've decided it was more of a leading indicator issue and not to wait until it got to the point where it was being thrown over a wall for a CIO to tackle."

The push is working as more CIOs are being recognized by health-care boards and agencies, and being seated at discussions regarding the future of this issue. "If you look at governance structures in some of the executive directives [such as e-health advisory boards] and executive orders, a number of CIOs have become members of those bodies, which is important," Robinson said. "They're treated as the leaders of the IT business activities, as opposed to simply the operational entities."