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issues for the state and the need to maintain consensus across a diverse set
of healthcare communities.
Decentralized Model
The state-designated entity acts as a facilitator for the HIE, convening
meetings of stakeholders, building trust as a neutral body, and developing
HIE policy for the public good. In this model, the state-designated entity
does not provide core HIE services, but coordinates local HIE infrastruc-
ture. Nonetheless, it has the responsibility to ensure that the state-level
HIE is operational. The benefit of this model is that it leverages the com-
munity basis of existing HIEs, but both governance and technical chal-
lenges increase. The governance organization has to maintain trust and
buy-in from multiple stakeholder organizations, and must craft consistent
public policy from potentially divergent perspectives.
Hybrid Model
The state-designated entity facilitates the development of statewide
HIE and also provides HIE services as one of several HIE entities. The
state-designated entity is still responsible for the construction of the
state-level HIE, so must remain positively engaged in governance activities.
The governance advantages of this HIE model are that it can still lever-
age existing community HIEs, and minimize its liability issues, while
still driving unified public policy for the HIE. The governance challenge
is again technical in that it must oversee the interoperability of multiple
HIEs and manage input from diverse communities across the state.
Variations of Value from Governance of State-Level HIE
In each of the state-level HIEs discussed, there is evidence of state legisla-
tures and state-designated entities working to engage in meaningful gov-
ernance activities to carry out the requirements of the HITECH Act and
the HIE Cooperative Agreement Program. In some states, the governance
functions are working well; in others, they are slowly being organized.
When the various technical approaches to implementing the state-level
HIE are multiplied by the different challenges of HIE governance models,
the complexity and difficulty of deriving one best practice for governing
data sharing becomes evident.
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