Non-Profit Independent Organizations
Most non-profit entities that operate at the local, regional, state, or multi-state level have a multi-stakeholder governance structure. This type of HIE is typically a community or regional health information organization. Some HIEs operate at the local level, while others operate at the state or multi-state level, especially where it is geographically necessary and beneficial. Since these organizations are non-profit, their governance structure will be similar to any non-profit.

Board of Directors
Board composition is at the discretion of the organizing entity. However, there are trends that can be identified across HIE initiatives. The officers of the board will typically include a president, vice-president, secretary, and treasurer. Each stakeholder type has representation on the board, and members are selected by a vote of the stakeholders annually.

Committees
While the number and types of committees are at the discretion of the organizing entity, the following committees are fairly standard across HIE initiatives:

• • Finance – responsible for the annual budget as well as regular audits.
  • Technical – responsible for advising the board on strategic and operational plans and the technical architecture.
  • Governance and by-laws – responsible for developing the by-laws and reviewing them annually.
  • Nominating – responsible for the annual nominations to the board of directors.

Stakeholders
Based on the 2010 HIE survey, the following stakeholders were more commonly involved in the Board of Directors and Committees:

• • Hospitals
  • Primary care physicians
  • Community health centers and/or public health clinics
  • Payers
  • Specialty care physicians
  • Local/state public health departments
  • Consumers
  • Behavioral or mental health providers and/or state agencies

For-Profit, Private Sector Organization
For-profit entities operate at the local, regional, state, or multi-state level. For-profit HIE initiatives may not have a formal board of directors or committee. Often the primary stakeholders are the decision-makers and typically will be homogeneous (i.e., not be multi-stakeholder entity). There are a few exceptions. At least one for-profit HIE initiative is managed by a board of directors. HIEs are owned by hospitals, integrated delivery systems, or by physician groups who form to meet a specific business need with targeted return on investment (ROI) goals.

Hospital Based or Integrated Delivery Network (IDN)
Hospital based or enterprise level entities do not typically have a multi-stakeholder governance structure. The hospital or IDN HIE may be either for-profit or not-for-profit, and this is usually consistent with the operating structure of the governing hospital or IDN. That is, for-profit hospitals/IDNs usually run for-profit HIEs and non-profit hospitals/IDNs usually run not-for-profit HIEs. The hospital/IDN may operate at the local, regional, state, or multi-state level depending on the size of their network and service area. This HIE is seen as pivotal for supporting the organization's patients wherever they may be seen in the healthcare continuum. The HIE may be governed by the hospital or IDN and/or may be physician led and directed.

Board of Directors

This type of HIE is usually not governed by a separate Board of Directors, but rather falls within the hospital or IDN's Board oversight responsibilities. Governance is maintained within the leadership of the hospital or IDN, usually at the Senior Executive level, sometimes within the structure of the Information Technology or Medical Affairs Departments. An executive officer is usually appointed to oversee all of the HIE operations, planning, strategy and business development.

Policies and procedures are developed for the HIE. They are consistent with the governing organization's policies; with HIE policies extending beyond the scope of hospital/IDN based policies, when necessary to maintain patient privacy and security of personally identifiable health information. The HIE policies and procedures usually fall within the purview of the Compliance Department for oversight and adhere with Compliance policies and practices. The HIE also adheres to the governing entities audit plan and conducts comprehensive annual compliance audits.

The HIE's strategy and development structure is usually maintained under the governing organization's strategic planning umbrella. It is integral to the organization's business plan and strategy platform.

The HIE leadership is responsible for ensuring the HIE's technologies and business practices are consistent with that of the governing organization, including vendor management, contract development, and performance management.

Committees
Some hospital/IDN governed HIEs form committees to meet specific business needs or to gain input and buy-in from the medical and/or patient community. These committees are usually not multi-stakeholder; rather they are comprised of hospital/IDN customers and leaders within the governing organization.

Stakeholders
Some hospital/IDN governed HIEs include other stakeholders in the HIE in order to better serve their physician community. These stakeholders usually include reference laboratories, large specialty groups, and diagnostic facilities. These organizations usually are not part of the governing body of the HIE. They are considered business associates whose clinical data is made available to HIE users.