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Health IT Legislation and Regulations

State HIT Policy Levers Compendium

The State Health IT Policy Levers Compendium was developed by the Office of National Coordinator for Health Information Technology (ONC) in coordination with states. It is intended to support state efforts to advance interoperability and can also be used in service of delivery system reform. The Compendium includes a directory of health IT policy levers and nearly 300 examples of how states have used them.

The information is displayed via an interactive display on the ONC dashboard and also as an Excel workbook [XLSX - 168 KB] with three tabs that allow for useful filtering of state-level data. All examples in the Compendium have been validated by state officials. It is important to know that there are several limitations to the Compendium, described below[1].

A health IT policy lever can be defined as any form of incentive, penalty, or mandate used to effectuate change in support of health IT adoption, use, or interoperability. Please read the Compendium Overview and Guide [PDF - 557 KB] for more information pertaining to the Compendium.

The Compendium’s information is organized as follows:

  • Policy Levers Directory – This describes each policy lever and its potential uses to advance health IT and interoperability. Where known, state examples are enumerated. Policy levers are also tagged as to whether they can be considered a state-level authority, which correspond to specific calls to action made in the Interoperability Roadmap that states expand the use of such levers.
  • Example Activities Catalogue – This lists example health IT policy lever activities within a state, categorizes them by the policy levers being employed, and provides hyperlinks to primary sources for further information. 

The compendium includes a State Points of Contact List [PDF - 279 KB]. Please contact any of these individuals for further information about how a state is implementing a particular policy lever.

In early 2015, ONC released Connecting Health and Care for the Nation: Shared Nationwide Interoperability Roadmap (FINAL Version 1.0) which made specific calls to action of states to use policy levers to advance interoperability in support of delivery system reform. This tool is designed to support these calls to action and to help advance the country toward a delivery system with better care, smarter spending, and healthier people



[1] Limitations to the Compendium include the following:

  • The Compendium does not represent a comprehensive analysis of all policies that impact health IT and interoperability.
  • The Compendium does not represent an endorsement of any particular policy lever or activity, nor does it evaluate the effectiveness or impact of any activity.
  • The data sources were limited in their scope. The comprehensiveness of example activities occurring within a state or the level of details documented may vary between and within states.
  • ONC suggests states also research other sources, such as George Washington University’s HealthInfoLaw.org, which contains information about state-level privacy and security laws and other policies.
  • The policy levers described in the Compendium are not necessarily mutually exclusive, i.e., some levers could be included in the description or interoperability uses of other levers. The Compendium seeks to achieve a balance between strict categorization and ensuring that levers are labeled in the most useful manner possible.