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There are other problems facing the state-designated entities. They have
the common problems of a day-to-day governing board participation, but
also have to deal with issues such as a lack of technical knowledge of HIE
among board members as well as competing interests, if not conflicts of
interests, among board members (eHealth Initiative, 2012a). In addition,
government control of the state-level HIE does not necessarily engender
trust in participants, although it can. However, the pattern in many states
is to migrate the control of the state-level HIE from a government agency
to an independent not-for-profit. This could indicate the difficulty of
establishing a functioning HIE with state resources, or it could indicate a
general perspective on the appropriate locus of control. The approach that
state governments and the state-designated entity have taken to build-
ing out the HIE infrastructure, whether a centralized or decentralized or
hybrid model, raises governance issues unique to that model. It is still too
soon to determine which is most successful.
Yet, the requirements of good HIE governance do not go away, and the
state-designated entities are the generally responsible organizations, many
mandated by state statute, to get the job done. The success of the federal
initiative to create a national HIE infrastructure will be determined by
the steady efforts of the state-designated entities as they engage in the HIE
governance of their state-level HIEs and apply the lessons learned from
their community-based counterparts.
REFERENCES
Adams, L. (president and CEO of Rhode Island Quality Institute). 2012. Personal commu-
nication. April 30.
Agency for Healthcare Research and Quality. 2004. AHRQ State and Regional Demonstra-
tions in Health Information Technology. Online at:
http://archive.ahrq.gov/fund/
Agency for Healthcare Research and Quality. 2006. AHRQ Health Information Technology
Programs: Update 2005-06. Online at:
http://www.ahrq.gov/research/hitfact.htm
Albritton, P. (executive director, Colorado Regional Health Information). 2012. Personal
communication, April 4.
Alfreds, S. T. 2008. Examination of public oversight, accountability, and financing of a sus-
tainable electronic health information exchange industry. Web presentation to the
National Conference of State Legislators, September 10. Online at:
http://www.ncsl.
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