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Anthony Guerra
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Guerra On Healthcare: Follow The HIE Leaders

CHIME, the National Association of State Chief Information Officers, and several private organizations are all influencing the development of health information exchanges.

While most advice on executive conduct focuses on leadership, equally important is the ability to skillfully follow. Internally, you lead the IT department and increasingly--with the growing integration of technology into every aspect of clinical and administrative processes--the organization. Externally, you must follow and comply with federal, state, and local laws, regulations, and best practices. And you must do these things not just as pertains to meaningful use, but also those for accountable care organizations, ICD-10/HIPAA 5010, and health information exchanges (HIEs).

It is in pursuit of the latter that the skill of following may be raised to an art, for nowhere must you stay in closer step with all influential entities than with respect to HIEs. Further complicating matters, in no area is an issue's leadership so diffuse. Rather than wait for the HIT Policy Committee's Information Exchange Workgroup to have all the fun, the National Association of State Chief Information Officers (NASCIO) recently got into the act by releasing a report, "A Call to Action: Information Exchange Strategies for Effective State Government." With Medicaid meaningful use dollars radiating from the states, this is a document worth perusing.

To facilitate aggregation of state HIE activities, CHIME established StateNet--in which each state is represented by at least one local CIO who is assigned with "identifying key developments for input into this website and sharing best practices within and across states in preparation for demonstrating meaningful use of [electronic health records, or] EHRs." In late February, StateNet released its foundational operating guidelines for regional extension centers (RECs) and HIEs.

In addition, private entities are blazing trails on the HIE front. With some--such as the recently announced collaboration among Kaiser, Mayo, Geisinger, Intermountain, and Group Health--their size means the exchange methodologies and protocols employed may evolve into de facto standards. In fact, Kaiser Permanente CIO Phil Fasano said he hoped such might be the case.

What's a Conscientious CIO To Do?

As usual, there are no easy answers. And unfortunately, the only solution is simply more hard work. In this case, the hard work will be keeping up with every development, initiative, regulation, law, and "best practice handbook" released from every entity that warrants your attention. You, or someone you designate, should become the keeper of your organization's HIE strategic blueprint, against which any new guidance should be laid for comparison. In following this course, you will continually conduct gap analyses to ensure your gauge matches that selected by organizations with whom you hope to exchange data.

As CIO, to lead your organization means you must closely--but discerningly--follow the direction of those shaping policy in these fast-evolving areas. To be sure, some providing guidance will go off the tracks, as some suggested "principles" get swept into the dustbin of history, but others will form the foundation of the HIE house you must build. As CIO, you're getting paid the big bucks to tell the difference.

Anthony Guerra is the founder and editor of, a site dedicated to serving the strategic information needs of healthcare CIOs. He can be reached at

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