States/SDEs play a critical leadership role fostering effective and efficient exchange of health information that leverages existing regional and state efforts and is based on HHS-adopted standards and certification criteria.

States/SDEs are to use their authority, programs, and resources to:

• Develop state-level directories and enable technical services for HIE within and across states;
• Remove barriers and create enablers for HIE, particularly those related to interoperability across laboratories, hospitals, clinician offices, health plans and other health information trading partners;
• Convene health care stakeholders to ensure trust in and support for a statewide approach to HIE;
• Ensure that an effective model for HIE governance and accountability is in place;
• Coordinate an integrated approach with Medicaid and state public health programs to enable information exchange and support monitoring of provider participation in HIE as required for Medicaid meaningful use incentives;
• Develop or update privacy and security requirements for HIE within and across state borders; and
• Coordinate activities across Medicaid and state public health programs, to avoid duplicate efforts and to ensure integration and support of a unified approach to information exchange.

The federal government will advance interoperability and health information exchange through a variety of regulatory and programmatic activities. HHS will:

• Collaborate with states/SDEs to promote, monitor and share efficient, scalable and sustainable mechanisms for HIE within and across states;
• Conduct a national program evaluation and offer technical assistance for state-level evaluations in an effort to implement lessons learned that will ensure appropriate and secure HIE resulting in improvements in quality and efficiency;
• Harmonize and regulate standards and certification criteria to enable interoperability and HIE;
• Provide technical assistance to states/SDEs;
• Coordinate efforts across states and regions in an effort to support nationwide HIE;
• Advance standards-based HIE through the development of the Nationwide Health Information Network (NHIN); and
• Establish a governance mechanism for the NHIN informed by HIE activities across states, and regions, including entities participating in the NHIN.