The State Alliance publishes white papers as resources for states to use in developing and implementing electronic health policies and best practices.

Recent Publications

  • Sustaining State Health Information Exchange: A State Toolkit
    Sustainability remains the top issue of concern as states continue to develop their health information exchange capabilities. Given the states' current financial challenges, it is important for states to implement a cost-effective and sustainable health information exchange (HIE) infrastructure. A recent report commissioned by the National Governors Association Center for Best Practices and the State Alliance for e Health addresses how health information organizations can create and deliver value to achieve long-term sustainability.

  • Licensure Portability Summit Summary Document
    The State Alliance for e-Health License Portability Summit was inspired by several State Alliance recommendations related to state health care licensure requirements. One recommendation challenges state medical boards to work together to streamline the licensure process to ensure license recognition by other states. In February 2009, a group representing 22 State Medical Boards met to establish a consensus-based approach that provides a platform for the greatest number of states to participate in a license portability process. This document captures the group's findings and recommendations.

  • Preparing to Implement HITECH: A State Guide for Electronic Health Information Exchange
    The HITECH Act, enacted as part of the 2009 American Recovery and Reinvestment Act, expands the role of states in fostering health information exchange and adoption of electronic health records over the next five years. This report recommends actions states should begin undertaking now to successfully implement the HITECH Act.

  • Public Governance of Health Information Exchange Report | Appendices
    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 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 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, financing and accountability considerations for each model.

  • Accelerating Progress: Using Health Information Technology and Electronic Health Information Exchange to Improve Care
    In its inaugural report, the State Alliance examines the challenges states face in implementing HIT and HIE, including provider concerns about implementation costs, variations in technical standards for interoperability and consumer concerns about data privacy and security.

Electronic Prescribing

  • Accelerating the Adoption of Electronic Prescribing
    E-prescribing, is computer-based electronic generation and transmission of a prescription. Implementing strategies to promote e-prescribing will move states toward a higher quality, more efficient health care system. E-prescribing also can serve as an important step in the movement toward fully integrated electronic health records (EHRs) and the electronic exchange of health information. This issue brief outlines several strategies available to states in promoting an e-prescribing agenda including: developing e-prescribing policies; incorporating e-prescribing into state publicly funded health programs; and implementing financial incentives for e-prescribing.

  • State Alliance for e-Health statement on electronic prescribing (Adopted May 12, 2008)

Electronic Health Information Exchange

  • Report From the Public Programs Implementation Taskforce to the State Alliance for e-Health
    This report presents the recommendations made by the Public Programs Implementation Taskforce during 2008 and adopted by the State Alliance for e-Health. The recommendations are focused on two themes: promoting standards-based health information technology (HIT) adoption and use, and enabling bi-directional electronic data exchange that supports improved quality outcomes for clinical care and public health within and across states. These recommendations are meant to stimulate state HIT and HIE policy development and inform State Alliance technical assistance efforts in 2009.

  • Facilitating Electronic Health Information Exchange in State Publicly Funded Health Programs
    To support the Health Information Communication and Data Exchange Taskforce, the University of Massachusetts Medical School conducted an analysis of state agencies across the country that have significant HIT and electronic HIE initiatives planned or underway. The report presents a current view of the level of HIT and electronic HIE initiatives undertaken by Medicaid, public health, and state employee health plans; the challenges and obstacles these agencies have encountered in the planning, development and implementation of these initiatives; and their recommendations to address those challenges and obstacles.

  • Report from the Health Information Communication and Data Exchange Taskforce to the State Alliance for e-Health
    This report reflects the early outcomes of the Health Information Communication and Data Exchange (HICDE) Taskforce. It identifies challenges as well as opportunities that publicly funded health programs possess in this arena, in particular: the structure of the HIT/HIE initiative; leadership; financial and contributory responsibility; interoperability; and consumer involvement. The report sets forth recommendations for the success of electronic HIE initiatives driven by publicly funded health programs.

  • State e-Health Activities in 2007: Findings from a State Survey
    This report is based on a 2007 survey of states and the District of Columbia, which aimed to identify current e-health initiatives, priorities, and challenges within state governments. The findings show virtually all states are now actively engaged in e-health strategies to facilitate the use of information technology to make the health care system more effective while providing greater value and higher quality. The survey also shows states see e-health initiatives as high-priority; however, they and their private sector partners face significant challenges that accompany such initiatives, including the issues of cost and time required for implementation and for realizing a return on investment. Nevertheless, as reflected in the wide range of e-health activities across the states, a consensus has emerged that these policies and initiatives are significant.


  • Analysis of Licensure Laws, Rules, and Procedures as They Relate to e-Health and Telehealth
    To support the Health Care Practice Taskforce, the Center for Telehealth and e-Health Law analyzed state licensure laws and regulations to assess how these laws can be a barrier to the practice of telehealth within the physician, nursing and pharmacist professions. The findings include examples of the barriers and administrative hurdles created by the current licensure system. The report also sets forth five concrete solutions to address the various reasons state licensure is a barrier to telehealth.

  • Report from the Health Care Practice Taskforce to the State Alliance for e-Health
    This is the first of two reports from the Health Care Practice Taskforce. In this report, the taskforce begins to identify and address licensure and liability issues that create barriers to electronic HIE. The primary focus is state licensure requirements.

  • Second Report from the Health Care Practice Taskforce to the State Alliance for e-Health
    This is the second report from the Health Care Practice Taskforce. It identifies several barriers to electronic HIE in the current credentialing process, including the way credentialing verification is conducted, the lack of uniform core credentials and variations in requirements related to criminal background checks. It also sets forth recommendations that address credentialing issues.


Electronic Health Legislation

  • State Legislative Actions in Health IT and Electronic Health Information Exchange Financing
    This study examines how states are financing HIT. It looks at what HIT states are financing, how legislators view HIT financing and analyzes state legislation. It identifies current and proposed state activities and points to issues that continue to be debated within and among states. To support the State Alliance, NCSL analyzed recent legislative activity related to HIT funding and interviewed key state legislators, legislative staff and state budget and financing experts. The report provides a discussion of the variety of HIT activities states are financing, and describes where this issue sits with states. The report also discusses what states still need to better understand, such as the business case and true incidence of costs, so they can play a role in aligning the benefits and incentives of HIT.

  • Health Information Technology: 2007 and 2008 Legislation
    Lawmakers around the country introduced more than 370 bills relating to health information technology during an 18-month period between 2007 and 2008, according to this report written by NCSL for the State Alliance. The report identifies and analyzes major policy trends within enacted state health information technology legislation. Some state bills address simplifying the ways to link vital pieces of patient data scattered across providers. Others ensure patient medical records are kept private. The report concludes that states consider health information technology an integral part of their health reform initiatives, and although health care has been slow to adopt the information technology wave that has swept other sectors of the U.S. economy, states and the health care industry now view health IT as a chance to improve quality and reduce costs.