Virginia is one of many states currently designing and implementing one of the health information exchanges (HIEs), funded by Recovery Act dollars, to share electronic health record data among providers. These will eventually become the building blocks of a national system.

But don’t picture a handful of select state leaders sitting in a room and churning out solutions. “This is the world according to the constituents,” says Kim Barnes, the state’s director of Health IT.

The process starts with the state’s Health IT Advisory Commission, which has a broad range of members from both the public and private sector, and is tasked with engaging stakeholders and guiding the governor and state officials regarding the best use of Recovery Act health IT dollars.

This commission is actually an extension of two earlier councils, notes Barnes. “One thing that we have that I consider an advantage,” she says, “is our constituent group. The same individuals have been involved in this process for eight years. It is an extremely motivated and educated constituent group.”

One key to deciding what course states should take is assessing just where providers currently stand with respect to health IT adoption, in order to get a better feel for what needs to be done—and to gauge later how effective the effort has been. Though this may seem like the most obvious thing in the world, we're pleased to see this kind of base-line data is being gathered now in order to effectively measure results in the future. It’s a step that’s easy to skip, and impossible to make up for. Virginia and other states are presently surveying health providers (including hospitals and managed care organizations) to assess the status and readiness of health IT as the nation gears up for broad health IT adoption.

The Commission’s big work right now is coming up with a strategic and operational plan for the HIE, which must be completed and handed into the Office of National Coordinator for Health IT at the end of July. This is a complex process made no easier given the fact that the definition of meaningful use just came out recently (though it hasn’t been finalized). “That the target is somewhat fluid is,” says Barnes, choosing her next word carefully, “interesting.”