hie_toolkit_banner
Introduction
How to Get Started
Environmental Scan
Conducting a Needs Assessment
Developing a Roadmap
Establishing Mission and Goals
Assessing Readiness
Sample Documents
Setting Up a Governance Structure
Stakeholders Roles and Needs
Types of Legal Entities
State Run HIE
Community Based HIE
Governance Challenges
Engaging Legal and Consulting Services
Sample Governance Documents
Legal and Information Sharing Agreements
Importance of Contractual Agreements
Types of Contractual Agreements
Determining Which Agreements to Use
Sample Agreements
Protecting Patient Privacy
Importance of Protecting Patient Privacy
HIPAA Compliance and Enforcement
National Privacy and Security Framework for Electronic Exchange of Individually Identifiable Data
Consent Models
Methods for Notifying Patients of Privacy Policies and Security Policies
Dealing with Variations in State and Federal Regulations
Key Issues to Consider
Sample Privacy Documents
Sustainability
Building a Sustainability Plan
Costs HIEs Should Consider
Revenue Streams
Usage Fee Models
Utility Model
Shared Revenue Model
Services
Grant Funding
Sample Documents
Marketing
Demonstrating Value and ROI
Engaging Stakeholders
Sample Documents
Social Media
Connecting Technically
Introduction
Elements to Consider
Supporting HIE Services
Infrastructure to Integrate with Regional HIEs
Integrating with State Medicaid
Integrating with Statewide Enterprise Services
Integrating with Payers
Using NwHIN Standards
Patient Access to HIE Data
Developing a Technical Infrastructure Plan
Moving Forward
Tracking Your Progress
Enhancing Service Offerings
Future Developments
State Run HIE

Public-Private Partnership
Many state-run HIEs are non-profit entities, and are considered public-private partnerships. States and State Designated Entities (SDE) receive federal funds through the State HIE Cooperative Agreement program. The SDEs are chosen by the governor or the legislative body of a state. The SDE is responsible for implementing HIE statewide in accordance with federal policies and regulations. This type of state run HIE is governed and operated through a partnership of government and one or more private sector companies. Some state-run health information exchanges were in existence prior to the HITECH Act, such as the Utah Health Information Network and others.

Board of Directors

Most of the SDEs are governed by a board of directors. The officers of the board will typically include a president, vice-president, secretary, and treasurer. The SDE may also provide a position on its board for the state HIT coordinator. Many SDEs will also include board representatives from public health, health and human services, or Medicaid. Board members are elected to serve for a limited time period.

Committees

While the number and purpose of committees is at the discretion of the SDE, the following committees are fairly common:

    • Technical – responsible for advising on strategic and operational plans as well as the technical architecture.
    • Consumer – responsible for ensuring consumers have a seat at the table and advising all committees and the board of directors about the consumers' perspective on HIE privacy, security, consent and education.
    • Finance – responsible for advising on use of grant funds, requests for proposals, and contracting; sustainability planning and execution, annual budget and expenditure review, and annual audits.
    • Policy/Legal – responsible for advising on legal matters as well as operating policies for the HIE, including privacy and security.

Stakeholders
A multi-stakeholder arrangement should include leaders from both the public and private realms. This representation is important to the SDE and is required by the Office of the National Coordinator (ONC) for SDEs receiving federal funding. Based on the 2010 HIE survey, the following stakeholders are most commonly involved in the Board of Directors and Committees of this type of SDE:

    • Hospitals
    • State public health department
    • Medicaid
    • Payers
    • Primary care and specialty physicians
    • Employers or healthcare purchasers
    • Patient or consumer groups
    • State Government, which may include the Governor's office

Government Controlled Entity
Some state-run, non-profit entities are solely public entities or controlled by the government. The SDE is not governed by any private stakeholders; it is governed by public stakeholders with input or advice from private stakeholders.

Board of Directors
As of the publishing of this toolkit two states, South Carolina and New Hampshire, are operating their SDEs as a public entity and do not have a board of directors. Instead, they have a committee, which is responsible for governance. The members of the committee are appointed by the governor.

Committees
Where the SDE is a public entity, a committee-based approach is used to govern the operations of the HIE. The public entity uses a governance committee or steering committee. The committee is responsible for overseeing the development of the statewide HIE, drafting policies for governance and security, and overseeing the finances of the SDE.

Stakeholders
SDEs that are a public entity can choose to include leaders from public and private industries, or they may staff the committee with representatives from the state health department. It is at the discretion of the SDE whether the committee is a combination of public/private representatives or purely public. The stakeholder committees in the SDE may include public or private representatives:

    • Hospitals
    • Primary care providers
    • Pharmacies
    • Regional/Local HIE Initiatives
    • Consumers
    • State health department
    • State HIT coordinator

818 Connecticut Avenue, N.W., Suite 500
Washington, D.C. 20006
Tel: 202-624-3270 | Fax: 202-429-5553