The Promise and the Perils

The expanded use of health information technology is essential to improving the overall quality of healthcare in the United States.

The American Recovery and Reinvestment Act will provide more than $30 billion to promote the adoption and use of electronic health records among qualified healthcare providers. An additional $2 billion in stimulus funding will strengthen regional health IT infrastructure. As these regional networks are deployed, a nationwide health information network will emerge.

Widespread adoption of electronic health records by healthcare professionals will improve health outcomes for patients by making critical information immediately available to physicians at the point of care. However, the real value of health IT lies in the secure electronic exchange of digital health information among all participants in the healthcare delivery system.

Planning and implementing a regional health information exchange is among the most complex IT projects a state agency can undertake. These projects cut across organizational boundaries that often represent competing or divergent interests. The sheer number of stakeholders and the extensive policy, regulatory and technical considerations -- combined with the need to provide immediate access to sensitive health information while maintaining patient privacy and confidentiality -- poses a demanding set of governance issues.

The risk analysis and contingency planning necessary to successfully manage a single-agency IT project increase significantly when conducting cross-boundary initiatives that involve the seamless exchange of information within a network of healthcare entities.

A Tool to Manage Risk

Like most other states in the nation, Oregon is in the formative stages of developing a statewide health IT plan to compete for ARRA planning and implementation grants. Activities include conducting an assessment of the current health IT environment in Oregon, creating a vision for the state-level infrastructure necessary to exchange health information, and developing a detailed road map to close the gap.

Oregon is evaluating whether the Government Interoperability Improvement Framework developed by the Center for Technology in Government is applicable to our health IT work. (Find the brief at www.ctg.albany.edu/publications/reports/improving_government_interoperability.) Our analysis finds that increasing the maturity of the various capabilities needed to develop and manage interoperability initiatives and effectively share information is a foundational step in mitigating the risks associated with large, cross-boundary efforts like state-level health IT.

State health IT planners can proactively address areas where improvement is warranted by surveying stake-holders to measure the relative maturity levels of each of these capabilities. The risk profile of complex and expensive interoperability projects will be reduced when key areas such as governance, collaboration readiness and business technology and architecture are accurately assessed, and strategies for improvement are devised.

At a time when the nation is making an unprecedented investment in the information infrastructure of our healthcare delivery system, it's clear that we need a rigorous framework within which to manage risk and improve the ability to achieve the full value of health IT.