Back in September, the Foundation of Research and Education (FORE) of the American Health Information Management Association (AHIMA) released a report of preliminary findings in their research on advancing health information exchange (HIE) infrastructure development. The findings were discussed at a Consensus Conference, "Building Sustainable Health Information Exchange: Roles for State-Level Public-Private Partnerships," held November 5-6, 2007 in Washington, D.C

The National Coordinator for Health Information Technology, Dr. Robert Kolodner, opened the conference speaking about the vision of the Office of the National Coordinator (ONC). He said that the "tipping point" for the adoption of health information technology (HIT) is near, estimating that it will happen between 2009-2011. However, the five critical components necessary for the national exchange of health care data including governance, a foundation of privacy and security, standards and HIT products, adoption of IT solutions, and the network will have to reach a level of maturity to make it happen. Kolodner also discussed the three phases of governance for these efforts, including:

1. Governance of the U.S. Department of Health and Human Services Secretary with American Health Information Community (AHIC) guidance, along with the ONC funding core activities
2. An early hybrid of a public/private partnership with AHIC 2.0
3. A self-sustaining public/private AHIC 2.0

Throughout the rest of the event, participants discussed the findings from the State level HIE Consensus Project as it related the state's roles for HIE governance, sustainability, and nationwide practices. Recommendations from the discussion on governance included the need for state-granted authority and a state-level entity with public/private composition. There's also a need for some organized standards for consistency from state to state. They also concluded that there's a definite role for consumers and employers, but leadership from payers was not deemed as desirable. However, figuring out how to involve consumers is turning out to be problematic. One participant noted that if the HIEs don't organize centrally and get consumer's needs at the center of their efforts, they will fail. Another undesirable was the dictation of technology solutions, though the dictation of standards is welcome. However, it was noted that statewide RHIOs should not dictate to other regions what they should be doing technology-wise.

Stimulating ideas for HIE sustainability included aggregating data as a revenue source, marketing the secondary use of data and contracting with vendors to pay for it. It was cautioned that these ideas do sound attractive, but if done improperly could sabotage the efforts. The operations should be funded by those who benefit but exactly who should pay and how are still points of debate. And finally there still remained questions of how the HIEs will relate to the NHIN; this vision has not yet been well formulated.

INPUT's Take:

• Though the future of HIT advancement is taking a beating, we can't shortchange the work that has been done through the state-level HIE initiatives
• A key takeaway is that in order for a HIE to be successful there is a need for strong state leadership, strong private leadership, and strong financial relationships
• State-level participation is needed at AHIC 2.0