Gov. Dave Heineman Discusses Nebraska Electronic Health Records

Interoperable communications and statewide e-mail system also among Nebraska priorities.

by / October 11, 2009

When thinking about Nebraska, "technology pioneer" probably isn't the first thing that comes to mind. But in an interview inside the magnificent Nebraska state Capitol, Gov. Dave Heineman told Government Technology he's looking to change that. Heineman leads a number of ambitious initiatives. One such project, statewide electronic health records (EHRs), already is being piloted and has delivered promising results. He is also aiming for truly interoperable public safety communications and a unified statewide e-mail system. Defying the notion of Nebraska as flyover country between the coasts, Heineman is intent on showcasing the Cornhusker State's transformation into an IT powerhouse.

What exactly is the Nebraska Health Information Initiative?
That's our initiative for a Web-based system that's primarily focused on the idea of electronic medical records -- where patient information could be shared if you're in any location in Nebraska. It means the opportunity for prescriptions to be done electronically and to reduce errors. I think we've all heard, but it's really true, that we could reduce significantly the costs in the medical system if we had an electronic-based system.


Watch Video: Nebraska: The Next IT Hotspot? Part 1. Gov. Dave Heineman on statewide EHRs, public safety communication and more.

I'd imagine one of the other challenges would be to integrate private health-care providers that already have an internal EHR built-in.
You just identified one of the biggest challenges. Everybody looks at it from a proprietary basis. The pilot project has been a private-public partnership. The private sector is leading the charge on this issue, so that's been very helpful. And everybody understands. Do we have will to get this done? I think we do. That overrides the technology concerns, and I believe we can get there. But having the private sector put up the money, and be significantly involved has made all the difference in the world.

What lessons have you learned from the EHR pilot?
First of all, involve people. Make it a collaborative process. Make sure their input is listened to. We may not agree on every decision, but if you've had the opportunity to have input it makes a difference. Second, create a private-public partnership. Third, be consumer focused. The consumer is going to have a large say in this, and if they want to opt out, they can. I think we have several hundreds of thousands of patients involved right now, and fewer than 2 percent chose to opt out because it's in their interest. They know that when they're traveling within the state to another location, they need that medical information. Imagine if you travel somewhere and you have a problem. That doctor in the ER in Chicago, New York, Denver or L.A. has immediate access to your record -- they won't have to repeat tests, and they'll know what medications you're taking. It's a big plus for the system.

Given the economy, how is this being funded? Does it end up paying for itself?
Right now, the private sector has taken the lead in funding. There is some state and local funding involved, but everybody is so convinced that, in the long run, this reduces cost and will provide better health care that they are all willing to upfront money. Then, ultimately, we will have to have a system paying for it, but we believe we can get there.


Watch Video: Nebraska: The Next IT Hotspot? Part 2

Let's shift gears to interoperable public safety operations. You have an initiative on that as well.
We're trying to develop a statewide communication system so every law enforcement agency, fire department, emergency management agency and health-care agency can communicate in an emergency. It is very difficult to do. We started out by setting up regional networks -- with the ultimate idea that we would connect the regional networks and have a statewide system. We're well on the way to getting that done. But I will tell you -- with this one, there is no question we had to have everybody in the room at the same time; everybody had to understand the objective. We've had too many situations where a life has been at stake because a county sheriff couldn't talk to a police chief in the same jurisdiction, let alone the state patrol. We're overcoming that now.

The proprietary or territorial nature of the individual agencies must be the biggest challenge here. What did you say to them to get them all on board?
We brought them all together. We outlined our goals. Everyone is in agreement with the goals; it's the details. Then we said, "We'll put up the money. We'll take our homeland security money that is coming from the federal government, and put it into a statewide interoperable communications system." All of a sudden they saw money.

Here was the other key: We had a very successful regional project, and we brought everybody eventually out to the central part of the state and we showed them. Twenty-five counties got together. They're talking to each other and demonstrating that it could work. All of a sudden, a lot of barriers dropped by the wayside. They saw a successful pilot project and that made a tremendous amount of difference.

Nebraska CIO Brenda Decker also said a statewide e-mail system is being created. Can you tell me about that project?
That's another project where you must have a strong will to get this done. When I took over as governor, we had numerous e-mail systems throughout our statewide agencies. In fact, we even had two or three within a given agency. There is not a private-sector company in the world that basically doesn't do I said that's where we want to get to. We want to get to and everybody is going to be part of it. We want to think as a team. We're not really the Department of Revenue, the Department of Administrative Services or the Department of Agriculture -- we're the state of Nebraska. It's a lot simpler in terms of cost, maintenance and the ability for the outside world to send you an e-mail.

We got a little bit of pushback, but with the governor leading the charge I think they understood that one way or another, we were going to get it done.

Photo: Lincoln, Nebraska, by iStockphoto

That's one of those projects that prompts, "Why haven't people done that already?" What is the resistance based on?
Change. It's [people saying], 'Why are you forcing us to change? We don't want to be integrated between the departments of Economic Development and Revenue. That's not how you do it in the private sector, or how you win an athletic contest. We have to get people thinking as one team: offense and defense. You have to

know what each other is doing. What's the game plan? We've been able to share that with them; our CIO and I are on the same wavelength. And we're moving in a direction. I basically told people, "You want to be part of the solution? If you don't, move out of the way. We're moving forward.

"Look at where customers are headed -- I say this all the time. Our kids -- my son -- is never going to City Hall, or to the county courthouse or a state office building. They want to do it using technology. So we have to get in the 21st century. We'll have a more efficient, more cost-effective government.

When you look at the different projects we've talked about -- the EHR, interoperable communication and the e-mail system -- are citizens aware that their governor and state are leading the charge for government IT, and is maybe ahead of most states?
I think they're aware, but we need to make them more aware. I think if you're involved in technology in our state, you know the state is trying to take a quantum leap forward. We want to be prepared for the next generation of consumers who are going to use technology at all hours of the day.

We need to make more of the public aware of it, but they also know we're trying to lead and create a better economic base in the state. We're trying to recruit businesses of all sizes, from all backgrounds and technology-based companies. We've been able to recruit companies from California because we're offering incentives, and they understand we're moving forward in these arenas.


Watch Video: Nebraska: The Next IT Hotspot? Part 3. Gov. Dave Heineman continues discussion of Nebraska interoperability and more.


Chad Vander Veen

Chad Vander Veen previously served as the editor of FutureStructure, and the associate editor of Government Technology and Public CIO magazines.

Platforms & Programs