Case Study: State Level Governance of Health Information Exchange - Data Governance: Creating Value from Information Assets - page 202

way healthcare records were recorded, stored, obtained, and exchanged.
The technical infrastructure received a considerable amount of incentive
funds to moving it in the direction of a national healthcare infrastructure
for HIE. However, the change was mostly technically oriented. There was
little guidance for how the complex and expensive HIE systems would be
overseen and governed in their development.
Subsequently, ONC included governance expectations in its HIE Coop-
erative Agreements awards, but left the actual governance of the state-level
HIEs open to the states. It was up to the states and territories to deter-
mine what governance mechanism would work best for them and what
approach would provide the appropriate balance of leadership and con-
sensus to create and maintain the technical infrastructure. This is where
the value of governance lies, in its ongoing collaborative efforts to manage
the important issues of health record exchange and among treating physi-
cians and the consent of patients for that exchange.
Development of State-Level Health Information
Exchange Governance Models
The development of community and state-level HIEs between 2004 and
2011 had occurred at an accelerated pace across the period and provided
models of HIE governance for the state-designated entities created under
ARRA. In addition to the state agencies, universities, and health informa-
tion organizations spurred by the AHRQ and ONC funding programs,
other organizations also were emerging as viable HIE entities. Not all were
successful, and many struggled to find a sustainable business model. The
one thing in common to all of the nascent HIEs was the concerted attempt
to develop a governance model that worked to create buy-in, develop
collaborative partnerships among healthcare competitors, and facilitate
the acceptance of data sharing among healthcare providers.
In 2004, eHealth Initiative circulated its first HIE survey to evaluate
the health information exchange environment across the country. These
surveys have continued every year since (eHealth Initiative, 2005; 2006;
2007; 2008; 2009; 2010; 2011b). eHealth Initiative created an evaluation
framework of six stages that identified at which stage an HIE had reached
in their survey. The first four stages were increasingly functional, but only
in Stage Five was the HIE fully operational, transmitting data, and sus-
tainable. In the final stage, the HIE had moved beyond its initial sphere
of operations to include a broader set of stakeholders (eHealth Initiative,