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The purpose of the HIE Cooperative Agreement Program was to
“facilitate and expand the secure, electronic movement and use of health
information among organizations according to nationally recognized
standards” (Office of the National Coordinator for Health IT, 2009, p. 7).
Awards were to be made to the state-designated entities as specified in the
HITECH Act. These could be a state agency, a not-for-profit, or another
organization as determined by the state's governor. The program's intent
was to develop a state-level HIE infrastructure based on statewide policies,
governance, and business operations models.
With the publication of the Funding Opportunity Announcement,
states started on the path of planning and building state-level HIEs. The
program proposal required each state-designated entity to specify its plan
for implementing state-level HIE along five dimensions: (1) governance,
(2) finance, (3) technical infrastructure, (4) business and technical opera-
tions, and (5) legal/policy (Office of the National Coordinator for Health
IT, 2009). Each of these dimensions represented one major variable in the
total strategy to develop state-level HIE. ONC left it up to each state to
determine the HIE governance and technical model that it would follow;
carrying out the plan would be accomplished through a negotiated, coop-
erative relationship between the state and ONC.
Under the State HIE Cooperative Agreement Program, the state-
designated entity was responsible for creating a governance model for
the state-level HIE. Governance was defined by ONC in terms of conven-
ing health stakeholders from both public and private sectors, creating
trust relationships among them, and achieving consensus for the best
way to create the state-level HIE, as listed below (Office of the National
Coordinator for Health IT, 2009):
• Base the governance approach on stakeholder buy-in, trust, and
collaboration
• Establish goals and objectives for the HIE, based on the consensus
of healthcare stakeholders and develop performance measures to
track progress
• Coordinate HIE efforts with Medicaid and public health
• Develop a plan to ensure oversight of the HIE and to enforce
accountability among participants
• Maintain the flexibility required to adapt to future HIE governance
requirements from ONC
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