Seed Funding of the Sub-networks:

• As a general principle, the sub-networks must be self-funded and self-sustaining.
• In order to "prime the pump", accelerate early growth, and demonstrate early success of the Health Information Environment, government grants should be provided as seed funding to a selected group of sub-networks. This has already begun with the initial AHRQ grants.
• Given the intended national scope of the regional sub-networks, significantly more capital will be needed for start-up grants than has recently been made available.
• Recipients of such start-up grants must agree to use the Common Framework and to create requirements for participants within their network to do so. They must, in addition, adopt policies that reflect the public interest including equitable access, participation in governance and policy making, consumer and professional outreach, and transparency.
• A financing model will need to be developed to provide startup and operations support for traditionally underserved communities of interest like those described in question 11.
• To assist with seed-funding of the sub-networks, a range of capital financing vehicles could be employed, including grant funding, long-term revolving loan funds and tax credits to investors. Such funds could come from a wide range of sources, including various public and private sector funds and vehicles. Government participation in the seeding of these activities is critical and will accelerate private sector investment. In addition to direct funding, the Government's provision of guarantees of bond issuances or loans can also facilitate private sector investment.
• All healthcare stakeholders that benefit from the sub-network should work together to assure sustainability and appropriate funding. Costs that could be covered by the model might include those related to the Record Locator Service, community governance, and other community-based operational HIT components.