Enabling Trusted Exchange: Governing the Nationwide Health Information Network

Dr. Farzad Mostashari | September 7, 2012

An overarching goal for ONC is that information follows the patient where and when it is needed, across organizational, vendor, and geographic boundaries.  We believe that the current state of information exchange and care coordination is far from this ideal, and that in addition to technical challenges with interoperability, the absence of common “rules of the road” may be hindering the development of a trusted marketplace for information exchange services.

RFI on Governance of the Nationwide Health Information Network

As you know, we issued a request for information (RFI) earlier this summer to gather public input on a potential regulatory approach that would propose to spell out “conditions of trusted exchange” (safeguards, technical, and business practice) through rule-making, and establish a voluntary accreditation and certification process for validating organizations as being legitimate participants in the Nationwide Health Information Network (NwHIN). We started with an RFI because we recognized that the health information exchange marketplace is still in its infancy, and we wanted to get broad input before issuing a proposed rule. Based on what we heard and our analysis of alternatives, we’ve decided not to continue with the formal rulemaking process at this time, and instead implement an approach that provides a means for defining and implementing nationwide trusted exchange with higher agility, and lower likelihood of regret.

Let me tell you why…..

First and foremost, we heard that there are a lot of promising health information exchange activities currently underway and emerging, perhaps more than is widely appreciated. There are also existing and emerging consortia and voluntary governance bodies, both for directed Exit Disclaimer as well as query-based exchange Exit Disclaimer. One concern we heard repeatedly was that the very act of beginning a regulatory process may actually slow the development of trusted exchange at a time when we cannot afford that.

Our goal is to encourage the exchange activities that are gaining steam across the country and across the industry, and not to hobble them. As we are accelerating the implementation and expectations of standards-based exchange in Stage 2 of Meaningful Use, this is the last thing we want.

So how will we take action to promote trusted exchange? 

We heard that we should identify and shine the light on good practices that support robust, secure, and interoperable exchange and provide a framework of enduring principles to guide emerging governance models, and we will do that.

We heard that we should learn from and actively engage with entities currently serving in governance/oversight roles for specific groups of exchange partners, so that we can promote emerging good governance practices/models within and across communities, and we will do that.

We heard that we should continue to use our existing authorities and convening powers to create consensus and provide guidance and tools around specific barriers to interoperability and exchange, and we will do that.

We heard that we should continue to evaluate how and what consumer protections can be appropriately applied to health information exchange through existing regulatory frameworks, and we will work with our federal partners to do that.

And we must rigorously monitor and learn from the wide range of activities that are occurring.  And let me assure you that if systemic problems or market break-downs emerge that might require regulatory action, we will again seek input from the public and our stakeholders, including the Health IT Policy and Standards Committees.

Thank You for Your Feedback

I’d like to thank those of you who contributed to the public dialogue on this subject, especially those who submitted comments to our RFI and the members of the Governance workgroup who contributed countless hours to helping us think through these complex issues. You are truly helping us establish government that works “for the people, by the people,” to accomplish what none of us can do individually.

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