Background Information

The State Alliance for e-Health is a consensus-based, executive-level body of elected and appointed state officials formed to collectively address the unique role states can play in adoption of interoperable health information technology (health IT). It is also intended to be a forum through which stakeholders can address the challenges to implementing an interoperable electronic health information exchange (HIE), work together to identify inter- and intrastate-based HIT policies and best practices, and explore solutions to programmatic and legal issues related to the exchange of health information.

The State Alliance for e-Health has worked to:

• Address barriers to health information exchange and adoption of health IT, while preserving privacy, security, and consumer protections, from a state-specific perspective;
• Build consensus in seeking the harmonization of the variations in state policies, regulations, and laws, where appropriate, and develop standards and/or guidance for modifying such policies, regulations, or laws;
• Allow for dialog among states that will fuel creativity and partnerships among states and with the private sector in the health IT arena; and
• Allow for the appropriate input of experts and others working on health IT endeavors to inform state policymaking.

The State Alliance for e-Health is composed of elected and appointed officials including governors, state legislators, attorneys general, and insurance commissioners. A non-voting advisory committee composed of representatives from both the public and private sectors supports the State Alliance and provides technical expertise on critical issues related to electronic HIE. In the initial year, the State Alliance met quarterly (beginning in January 2007) to address state-level health IT issues including barriers to interoperability, privacy and security issues, state law and regulatory barriers to health IT related to the practice of medicine, and roles for state publicly funded health programs in HIE and HIT adoption.

In its first year, the State Alliance also was supported by three task forces composed of key state-level stakeholders from the public and private sector who provided expertise and experience in addressing state-level health IT issues and presented recommendations to the State Alliance. The taskforces included the Health Information Protection Taskforce, the Health Care Practice Taskforce, and the Health Information Communication and Data Exchange Taskforce. The State Alliance established two more task forces in 2008 that built upon the work and recommendations of the three previous task forces: the Privacy and Security Taskforce and the Public Programs Implementation Taskforce.

Throughout the past year, the State Alliance and taskforces heard testimony from issue experts, state and federal government representatives, private sector leaders, and individuals representing the consumer perspective. One major theme that emerged from meetings of the State Alliance and taskforces was the need for states to consider the impact of policies and actions in the context of other stakeholder efforts, including those by the private sector and federal government, to prevent further siloing and achieving desired interoperability. Six recommendations emerged from the State Alliance and taskforce meetings. The recommendations focused on the critical areas that state policymakers should address to facilitate electronic HIE within and across states. The purpose of the recommendations was to demonstrate avenues for coordinated action by states and offer guidance on ways in which states can enhance existing efforts and advance the policy agenda towards achieving health system transformation and realizing the full potential of HIT and electronic HIE.

The State Alliance recommends six actions that governors and legislators can take to further adoption and use of HIT and electronic HIE:

• Provide leadership and support for e-health efforts;
• Address privacy and security;
• Promote the use of standards-based, interoperable technology;
• Streamline the licensure process to enable cross-state e-health;
• Engage consumers to use HIT in managing their health and health care; and
• Develop workforce and agency capacity to support electronic HIE efforts.

The State Alliance also recommends that states strictly focus the scope of e-health projects, work in incremental, targeted stages, and in coordination with existing efforts to accelerate progress in the adoption and use of HIT and electronic HIE and to improve the efficiency, quality, and value of America’s health care system.