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“This case addresses the issues of leadership and change management in the process of transforming an industry through an innovative public-private partnership approach to policy making. In 2005, the Governor of Arizona issued an Executive Order to create a roadmap for the state to achieve statewide electronic health data exchange between various entities in the health care delivery system. The Roadmap development project, a key initiative for Arizona, was led primarily by the State CIO. Being one of the first states to develop a statewide Roadmap, Arizona was being recognized as a national leader in the area of healthcare IT. While CIO and his team had successfully initiated a large-scale transformation within the state, they were now faced with the challenge of transforming the blueprint into reality. This case documents the process of creating this Roadmap and the issues that need to be addressed to achieve a true and lasting transformation in the healthcare arena.”