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development, coordination, oversight and enforcement of policies, stan-
dards, and services; and (3) a clear set of policies, standards, and services.
The HIE governing body must ensure participation, representation,
accountability, transparency, and effectiveness at each stage of HIE devel-
opment to enable the secure and trusted exchange of healthcare informa-
tion (Markle Foundation, 2012). The state-designated entities or the HIE
governing organizations must be able to engage their communities of
interest, coordinate policies and standards, engage in business develop-
ment, and hold participants accountable for their use of health data.
The characteristic values of the HIE governance organization can be
summarized into the following characteristics:
• Authority
• Leadership
• Neutral Convener
• Coordinate Policy Development and Strategic Planning
• Business Operations
• Accountability
• Transparenc y
Authority
The HIE governing body must be granted the authority to engage with stake-
holders as a convening and coordinating body. Under the ONC HIE Coop-
erative Agreements, each state government nominated a state-designated
entity, either a state agency or a not-for-profit Health Information Organi-
zation. With this designation, the authority to convene healthcare stake-
holders was established as well as start-up funding from ONC. However,
it is up to each state-designated entity to craft its governance model and
determine the extent to which it puts together public-private partnerships.
Some state legislators have crafted state laws designating the state-level
HIE, others have relied on executive orders or on the current HIE environ-
ment to delegate authority for state-level HIE. Every state is unique.
Leadership
The state-level HIE governing body will be expected to take the lead in
decisions that define expectations for the HIE, grant power to partici-
pants, and verify their performance. It must take the lead in aligning HIE
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