Last week's 2011 State Healthcare IT Connect Summit hosted a mix of government participants coming together to examine key topics related to the transformation of health technology. The conference kicked off with keynotes from Julie Boughn, acting deputy director for operations at the Center for Medicare and Medicaid Innovation at the Centers for Medicare and Medicaid Services (CMS), and Farzad Mostashari, the national coordinator for health information technology. Boughn said the country is not getting the health care its public is paying for. With 46 million Americans lacking coverage, the nation's health care is uncoordinated and fragmented. She said the whole system is generally unsupportive of patients and physicians, much less sustainable.

Mostashari discussed last year's notable trends including meaningful use, certification, health information exchanges (HIE), Beacon Communities, workforce programs, and regional extension centers. He predicted as progress is made in health reform, more transparency and data liquidity will occur, and governance will be established for the Nationwide Health Information Network. Ultimately, future direction of a national strategy will be deployed by the states' HIT coordinators, which Mostashai said are the true "boots on the ground" to make "HIE – the verb" happen.

Speaking of state HIT coordinators, California's Deputy Director for HIT Greg Franklin said the state is busy looking for its next HIT coordinator since the spot is currently vacant. For a state that spends $2 billion a year supporting applications, direction is crucial to progress toward future goals of accountability, cost control and privacy. Franklin spoke about the state's grant application for Level 1 establishment for the health insurance exchange project. Franklin said the $40 million grant proposal has $25 million set aside for planning and technology development. Ed Dolly, the state HIT coordinator and deputy commissioner at West Virginia's Bureau for Medical Services, spoke about IT initiatives in his state. After conducting a landscape assessment, Dolly said it was a real eye opener to see the duplicate efforts taking place across agencies. West Virginia received a series of transformation grants and harbored research and results from those efforts in order to reuse them as part of the state's collaborative reform efforts.

Minnesota's Chief Enterprise Architect and CIO for the Department of Human Services Thomas Baden said he was told the human services systems were 20-25 years old when he started his job. He was also told there was a negative budget and a fair amount of staff recently let go. He was then tasked with modernizing everything with no budget or staff. Therefore, Minnesota is using health insurance exchange funding to jumpstart exchange efforts, and Medicaid's 90/10 funding to get modernization efforts off the ground. The insurance exchange and Medicaid eligibility system funds have been moved into one account that is tracked back to their programs. This is a cost-effective measure and helps with sharing resources. Carol Robinson, state coordinator for HIT in Oregon, said the state will soon release a solicitation as it moves towards an operational HIE. Ivan Handler, CTO for the Office of HIT in Illinois, was mostly in a cone of silence since the state just released a request for proposals (RFP) for the ILHIE. The state anticipates contract negotiations in September 2011. Handler provided a description of the core services and peripheral services for the exchange as well as the state's cloud-based architecture.

A common cry from states is that while they want flexibility, they are in need of strong governance and guidance. Speedy health mandate deadlines are prominent stressors for states. Projects on state IT plates include ongoing operation and support projects, ICD10, provider incentive payments, insurance exchanges, eligibility modernization, and HIEs. States don't have time for 5-year build outs; therefore, faster turnarounds will be expected of vendors. Likewise, changes are needed to state procurement rules because the complicated and lengthy process can create barriers to implementation and upgrades. Vendors should be aware that some states are sharing their successful RFP documents and grant application templates with other states. Also, states will be pursuing technology that demonstrates user friendliness in eligibility systems and exchanges due to the sheer volume of people that will soon be participants in the systems.

Penny Thompson, deputy center director of the Center for Medicaid, CHIP and Survey and Certification at CMS, suggested that part of the reason the health environment is in the position it is today is because of the technology choices made 20 years ago. The existing systems are often outdated, disconnected and redundant. There may be temptation to make quick technology fixes to meet today's needs, but most of the time those solutions will not be sustainable for the future. States need to determine their vision for the future, and vendors need to help bridge the gap in the reality of getting there.

Additional insight from the event is available in an Analyst Recap report.