Lisa Feldner is getting a crash course in health care. The North Dakota CIO came to state government with a background in education, having served as the technology director for Bismarck Public Schools. But in the last year, she has quickly become conversant in terminologies related to electronic health record incentive programs, health information exchange (HIE) and Medicaid eligibility systems.

Because her Information Technology Department centrally manages most of the state’s computer systems, questions about the interoperability of health data often land on her desk.

“I chair the North Dakota HIE advisory committee, and when the state was required to designate a health IT coordinator, I was initially chosen,” she said. Now she talks every day with Sheldon Wolf, who was appointed the state’s health IT coordinator last April and whose office is in her department. Feldner also co-chairs the NASCIO health work group.

With a staff of 300, the Information Technology Department is charged with addressing many of the state-level implications of the federal stimulus package’s Health Information Technology for Economic and Clinical Health (HITECH) Act and the larger Patient Protection and Affordable Care Act. “Our Insurance Department is tiny, just 30 people,” Feldner said. “It doesn’t operate any IT systems. It can’t create a health insurance exchange portal, so that will fall to us to do the IT work. It will have a huge impact on Medicaid eligibility systems, but they are relying on us to figure that out.”

Another state CIO who gets credit for paying close attention to health IT is North Carolina’s Jerry Fralick. When he delivered the keynote address for the first Health Information Technology Advocacy Day at the state General Assembly in May 2010, Fralick said he sees one of his key tasks as recommending tools that will help North Carolina manage the risks that are inherent to state health IT efforts — including ensuring that state enterprise architecture and infrastructure can support a wide-scale HIE — and to work with state agency CIOs to ensure that legacy systems critical to the HIE are robust.

A Higher Priority

Feldner and Fralick may be more involved than most state CIOs in the daily decision-making about health policy, but the topic has definitely risen on state CIOs’ radars — they ranked health care third on their list of top 10 priorities for 2011 in a recent NASCIO survey.  State and local government health IT spending is expected to increase by 19 percent by 2015, according to NASCIO.

At the federal level, beyond the more than $20 billion in provider incentives for health IT adoption, HITECH allocates approximately $2 billion in grants for other projects, including work force development, telehealth initiatives and research. State-level HIE programs will get $564 million in grant funding.

That means public CIOs must become more knowledgeable about and involved in health IT policy issues, say analysts and consultants. “It is absolutely critical that state CIOs be involved in deciding what role the state should play in governance of health information sharing,” said Mark Danis, vice president of public-sector health for IT services company Keane. “It should be part of state CIOs’ strategic planning for next year.”

David Raths  |  contributing writer