THERE'S NO DOUBT that the United States is in a transition when it comes to the use of health information technology (HIT). President George W. Bush's executive order for increased use of HIT and health information exchange (HIE) to improve quality and cut costs in August served as a reminder.

MHE Executive view

"I've seen more progress in the last year and a half than we've ever seen in states moving forward to improve health and healthcare through the use of information exchange and health information technology," says Janet Marchibroda, CEO of the nonprofit eHI, a collaborative that helps to foster HIT efforts in the United States. "I would say that activity is at an all-time high."

ARIZONA'S RAPID TURNAROUND

Initiated by an executive order by Gov. Janet Napolitano in September 2005, Arizona's Health e-Connection transitioned in just six months from a steering committee to a completed roadmap for state use of HIT/HIE in April.

"We were fortunate in that with the governor's leadership, she set a clear benchmark for her steering committee," says Chris Cummiskey, the co-chair of the Health e-Connection steering committee and head of Arizona's Government Information Technology Agency (GITA).

Gov. Napolitano assembled hospitals, health plans, consumer groups and doctors at a summit and eHI provided the steering group with the mechanics to get the roadmap's initial momentum and dialogue started.

The roadmap resulting from the hours of meetings and collaboration that took place focuses more on the "who, what, when, and why" aspects involved in HIT and HIE implementation and distinguishes between what strategies are necessary to accomplish specific goals in the two fields rather than the "how."

"The roadmap really sets a course and a strategic path for us to follow, and it sets some clear benchmarks and things we can accomplish in the short term as well," Cummiskey says.

On the HIT side, the roadmap addresses EMRs, e-prescribing, practice management systems and strategic HIT systems. For HIE, guidelines are set for patient health summaries, results delivery services, patient record locators, a statewide Web portal, personal health records, public health alerts/queries and even secure instant messaging for the transmittal of health information.

"It puts some good parameters in place on the core strategic elements that we would need to have in order to make it be successful," Cummiskey says. "We're going to have plenty of time to fight out the specifics of what this thing is going to look like."

A potential spin off into a tax-exempt, nonprofit organization outside of government is being explored, and the Health e-Connection also received a $1.5 million grant funded by the Agency for Healthcare Research and Quality (AHRQ) in partnership with the National Governor's Assn. to analyze security and privacy issues in April 2006, while the Arizona state legislature provided another $1.5 million appropriation to serve Arizona's rural population.

"The thing that we've learned is that the public—and particularly younger folks—are expecting that their government is going to be engaged in this kind of activity going forward," Cummiskey says. "The challenge is that we've got mountains of paper that have developed over decades and that the challenges are pretty significant to get this done, but I think it's going to happen."

STEADY PROGRESS IN OHIO

Ohio's work in producing its own roadmap centers with the Health Policy Institute of Ohio, an independent nonpartisan statewide center, which received a Health Information Security and Privacy Collaboration (HISPC) contract and has completed a draft roadmap that was scheduled for final release in late November.

After initially contracting with eHI to create a report detailing the state's HIT/HIE, the Ohio institute went to work uniting stakeholders to engage them in dialogue about where the state should head and has transferred most of the roadmapping efforts inhouse.

"There's a lot of work that needs to be done," William Hayes, PhD, president of the Health Policy Institute of Ohio, says.

The drafting of the roadmap is the first step in setting up guiding principles and policy recommendations for the state. Next on the agenda is to further hone the plans, which include creating a pool of money to encourage adoption of EHRs among medical providers or the creation of a state-level organization to coordinate the efforts separate from government potentially similar to what Arizona's e-Health Connection is considering, according to Dr. Hayes.

"We are forming workgroups at the moment to look at the specific recommendations in that plan and trying to develop further refinement and precision," Dr. Hayes says. "Simultaneous with the release of the roadmap is moving those conversations and workgroup activities further."

Unlike Arizona, statewide HIT/HIE efforts in Ohio have not had the benefit of an executive order from the governor or legislative action, so raising awareness among state politicians for funding would be necessary.

"This is a collective thought that we've put together," Dr. Hayes says. "We're trying to be the cypher for it."

A GROWING DRUMBEAT

Whether states' HIE/HIT efforts succeed depend on a number of challenges, according to eHI's report. The cost of HIT implementation, especially among smaller providers, remains a major concern as does the need for the initiatives to develop sustainable business models. However, Marchibroda is optimistic about the state of the states, and says that since eHI began its state and regional assistance efforts in 2004, there's been a "growing drumbeat" in the realm.

"I would say within three years we will see a majority—nearly all of the states will have developed some sort of roadmap or a set of recommendations for how this might happen," Marchibroda says.

Benjamin Nagy is managing editor of MANAGED HEALTHCARE EXECUTIVE