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Figure 1. State Responses to E-Health Survey WA MT VT NH ME ND MN OR ID WY WI UT AZ CO MI PA IL KS OK NM WV VA MO KY NC TN AR SC MS TX OH IN AL GA LA AK FL HI Responses Received Source: The Commonwealth Fund and National Governors Association E-Health Survey, conducted by Health Management Associates, 2007. MA NY IA NE NV CA SD NJ DE MD DC RI CT Figure 2. Top State E-Health Priorities for Next Two Years Electronic HIE Adoption 25 Electronic HIE Policy Development 12 EHRs and EMRs 9 E-Prescribing 7 Privacy and Security Issues 5 Quality & Transparency 3 Telehealth 3 Public Health Registries 2 PHRs 2 Medicaid HIT or MMIS Upgrades Other 1 6 Number of States Source: The Commonwealth Fund and National Governors Association E-Health Survey, conducted by Health Management Associates, 2007. Figure 3. State-Reported Barriers to Release of Health Data, by Service Area Disability 8% School-Based 8% Adolescent 8% Mental Health 17% Substance Abuse 16% General 11% Genetic Testing 9% Communicable Disease 9% HIV/AIDS 14% Source: The Commonwealth Fund and National Governors Association E-Health Survey, conducted by Health Management Associates, 2007. Figure 4. Breakdown of State-Reported Barriers Related to Release of Health Data in Electronic HIE Substance Abuse 25 Mental Health 27 HIV/AIDS 17 16 22 General Health 13 Communicable Disease 12 Genetic Testing 14 Disability 12 School-based Adolescent 13 11 20 16 Implementation of Consent Process 12 Lack of Authorization and Authentication Standards 9 Lack of Access Control and Audit Standards 10 8 10 19 11 11 10 10 10 12 24 14 15 16 9 13 0 14 11 9 14 14 6 Federal Privacy Requirements 9 30 40 50 60 70 Number of Barriers Reported Source: The Commonwealth Fund and National Governors Association E-Health Survey, conducted by Health Management Associates, 2007. 80 Figure 5. Measures of Utilization and Performance Within Medicaid and State Health Benefit Plans HEDIS CAHPS State Designs Medicare Measures Medicaid Managed Care State Health Benefit Plans NQF Measures Medicaid FFS 0 3 6 9 12 Number of States Source: The Commonwealth Fund and National Governors Association E-Health Survey, conducted by Health Management Associates, 2007. 15 18 21 24 Figure 6. Lead State Agencies for E-Health Activities Governor's Office 12 Public Health 9 Medicaid 9 Information Technology Shared Across Agencies 8 3 Number of States Source: The Commonwealth Fund and National Governors Association E-Health Survey, conducted by Health Management Associates, 2007. Figure 7. E-Health Activities Implemented Within Public Health (Total = 234 Activities Reported by 41 States) Disease Registry 41 Immunization Registry 39 Newborn Registry 38 Surveillance Registry 36 EPSDT Tracking 17 Decision-Support Tools 14 Telehealth 13 12 eProvider Enrollment or Certification Electronic Medical Record 5 Electronic Signature 5 Metadata Repository 5 Electronic Health Record 3 Advance Directive Repository 3 E-Prescribing 3 Number of States That Have Completed Implementation Source: The Commonwealth Fund and National Governors Association E-Health Survey, conducted by Health Management Associates, 2007. Figure 8. E-Health Activities Implemented Within Medicaid (Total = 170 Activities Reported by 37 States) Web-Based MMIS EPSDT Tracking 27 22 21 20 Decision-Support Tools Telehealth eProvider Enrollment or Certification Immunization Registry 15 11 10 E-Prescribing Metadata Repository 9 9 Electronic Signature Electronic Health Record 8 Electronic Medical Record Personal Health Record 5 5 Disease Registry 4 Newborn Screening Registry Surveillance Registry Advance Directive Repository 3 1 0 States That Have Completed Implementation Source: The Commonwealth Fund and National Governors Association E-Health Survey, conducted by Health Management Associates, 2007. Figure 9. Barriers to Accomplishing E-Health Priorities 26 Funding 20 Stakeholder Impacts, Buy-in 13 Establishing Business Case, Sustainability 12 Lack of Standards 11 Privacy/Security Concerns Governance Issues 4 Technical Resources 4 Legal Issues 4 Other 7 Number of States Source: The Commonwealth Fund and National Governors Association E-Health Survey, conducted by Health Management Associates, 2007. Figure 10. Lessons Learned from State E-Health Activities Collaboration & Engagement 24 10 Time Required Communication & Education 8 Unknown/Too Early 7 Funding 7 Consumer Focus/Involvement 5 Leadership 5 Governance 5 14 Other Number of States Source: The Commonwealth Fund and National Governors Association E-Health Survey, conducted by Health Management Associates, 2007.