For asthma and diabetes, for example, they had a pioneering movement of information from asthmatic children who may be diagnosed in the hospital setting – sharing information with the clinic, with the health department when it's needed for outreach with the schools to make sure, for instance, the school athletic program has the right information for follow-up, if necessary. It used to be a cumbersome paper process and now they're working to make the process available, of course with the appropriate safeguards and willingness of the parents. So a very exciting, pioneering effort. Mayo is one example in that area of helping lead that community-driven approach to improve care using health IT. And also to incorporate the public health department, so it's not just individuals, it's the health of the community. That's also critical in the long-term here.

Q: What sort of political support does health IT enjoy in Minnesota? Do both sides of the aisle recognize its value?
A: Historically, since the initiative was established by the legislature in 2004, it's been a very strong bipartisan issue. [Both parties] have been supportive of encouraging people to participate in it, and seriously looking at the recommendations of the advisory committee to the commissioner of health and through the legislative reports the commissioner has filed, based on those kinds of recommendations. They have incorporated those recommendations.

Minnesota was the first state in the country to adopt a mandate requiring interoperable electronic health records by 2015 – even before the HITECH Act. In addition, it required the use of e-prescribing. They've also been supporting the issue of an open and free market for exchange and using the strategy that there is a limited but strategic role of government in oversight to help secure a free market and private sector innovation for exchange moving forward. So yes, it's been a very bipartisan issue.

[See also: Minnesota law brings savings.]

Q: And funding? Are your health IT programs sustainable?
A: In Minnesota, the major funding has come through the HITECH Act. Federal dollars. Came to Minnesota for exchange through the health department. Through the Regional Extension Center that covers Minnesota and North Dakota, the Beacon Program and then incentives through Medicaid, dollars have come through those channels and it's largely been federal dollars. That's been the biggest bulk.

Q: Do you have any closing thoughts?
A: We have two more big steps to get to the right level of adoption: effective use of the [EHR] tools, and then the exchange of information securely across all settings in Minnesota. Implementing EHRs is a complex activity. It involves behavioral change, organizational change, and the adoption of some complete EHR functionality. The workforce is crucial in this. That's an ongoing effort: education. Both the frontline workforce and then at the level of informaticians – the new specialist that bridges the gap between IT and the health professional. That emerging discipline, we believe, is a critical element for continued success. Because it just gets more complex as you move into use and exchange of information.

In Minnesota, we have some of the best assessment data in the country. There's very few states that have the level of data to describe 1) status, 2) where are the barriers and 3) where are the gaps. Then we can target our dollars and resources and knowledge and best practices to help close those gaps. You have to have the data on which to base group action and policy action. We think that's another critical area, moving forward.

Follow Mike Miliard on Twitter: @MikeMiliardHITN

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