The Pennsylvania eHealth Initiative (www.paehi.org) has released a report detailing an EHR/HIE roadmap for the state. Seems like an excellent first step. There are already a number of innovative initiatives in Pennsylvania, like the Pennsylvania Health Care Cost Containment Council and the Pittsburgh Regional Health Initiative. I was recently at the National Business Coalition on Health conference on Advancing Value-Driven Health Care at which I heard Governor Rendell describe his Prescription for Pennsylvania program, which would base the state's approach to health care on Ed Wagner's well-known Chronic Care Model, shown below (you can see the Governor's plan here and a story about it here).
I don't know of any other state that's focused it's entire strategy around a specific model like this. It's ambitious and somewhat risky politically because the urgency for such reform stems from a need for cost control, but a comprehensive chronic care approach like the Wagner approach will probably pay dividends over the long-run but may very well cost more in the short-run.
The PAEHI report maps out an EHR/HIE strategy to support the Governor's strategy. This strikes me as the right approach -- first, get state leadership to articulate a vision and strategy for health care, and then articulate an IT roadmap to support the vision. Unfortunately, what's missing from the PAEHI roadmap is the same thing that's missing from most other such plans around the country: $$$.