Public and private sector roles in health information technology policy: Insights from the implementation and operation of exchange efforts in the United States

•Both the US federal government and numerous states are investing heavily in HIT.•Setting technological and privacy standards and funding may be best as federal roles.•States may be best suited to support implementation.•Federal and state HIT policies may not always be mutually supportive.•Public–private partnerships may address the limitations faced by both sectors.

ObjectivesIn the US, the federal and state governments are supporting interoperable health information technology (HIT) and health information exchange (HIE) through policy interventions and financial investments. However, private healthcare organizations and partnerships have also been active in establishing exchange activities, promoting interoperability, and developing technologies. This combination of influence from different actors has resulted in a rapidly changing healthcare environment. In this context, we sought insights into the optimal roles for the public and private sectors in HIT/HIE policy development and implementation.MethodsWe leveraged the concurrency of federal and New York State initiatives to spur HIT/HIE adoption by interviewing HIT experts (n=17). Interviewees represented federal and state government agencies, healthcare providers, and exchange organizations. A semi-structured interview guide with open-ended questions covered the domains of organization, value, privacy, security, and evaluation. We analyzed transcripts using a general inductive and comparative approach.ResultsInterviewees assigned roles for standard setting and funding to the federal government and suggested states were better positioned to offer implementation support. Interviewees forwarded a public–private partnership model as a potential solution to the limitations facing the private and public sectors.ConclusionsHIT/HIE policy is a complex issue involving standards, privacy, funding and implementation. When New York State began funding HIT, significant federal intervention did not exist. Since the launch of New York State’s program and the subsequent federal Meaningful Use criteria, interviewees expressed distinct but complementary roles for both state and federal governments and saw an avenue to include the private sector through public–private partnerships.