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Policymaking, Regulation, & Strategy

Health Information Exchange Governance

ONC’s overarching goal for health information exchange is for information to follow a patient where and when it is needed, across organizational, vendor, and geographic boundaries.

HIE governance refers to the establishment and oversight of a common set of behaviors, policies, and standards that enable trusted electronic health information exchange among a set of participants.

ONC is committed to a range of activities to support existing governance initiatives and advance governance goals of nationwide health information exchange to:

  • Increase interoperability;
  • Increase trust among all participants to mobilize trusted exchange to support patient health and care; and
  • Decrease the cost and complexity of exchange.

Activities include:

  • Exemplar Health Information Exchange Governance Entities Cooperative Agreement Program. This grant program allows ONC to work collaboratively with entities already involved in governance of health information exchange to encourage the continued development and adoption of policies, interoperability requirements, and business practices that will increase the ease of electronic health information exchange, reduce implementation costs, and assure the privacy and security of data being exchanged. The selected awardees are DirectTrust and New York eHealth Collaborative Inc, on behalf of the EHR/HIE Interoperability Workgroup.
  • The National eHealth Collaborative (NeHC) launched the National HIE Governance Forum, convened at ONC’s request through ONC’s cooperative agreement with NeHC. The forum convened key stakeholder governance entities to address cross cutting governance issues among various exchange approaches. These entities, whose decisions establish policies and practices for a given community of exchange partners at the national, state, or regional level, are working to identify key issues and common challenges in the governance of health information exchange and the best ways to address them.
  • Forum Resources

    Using the Governance Framework listed below as a guide, forum participants identified Trust as their initial area of focus. Forum participants have developed resources to advance trust in health information exchange for consideration by the wider community of exchange entities. These resources are not to be considered ONC guidance.

  • Governance Framework for Trusted Electronic Health Information Exchange

    The Governance Framework reflects the principles in which ONC believes when it comes to the policy set for HIE governance. This framework is intended to provide a common foundation for all types of governance models. Entities that set HIE policy should look to the Governance Framework’s principles as a way to align their work with national priorities. The four key categories of principles discussed in the Governance Framework include:

    1. Organizational Principles: Identify generally applicable approaches for good self-governance;
    2. Trust Principles: Guide HIE governance entities on patient privacy, meaningful choice, and data management in HIE;
    3. Business Principles: Focus on responsible financial and operational policies for governance entities, with emphasis on transparency and HIE with the patients best interests in mind;
    4. Technical Principles: Express priorities for the use of standards in order to support the Trust and Business Principles as well as furthering the execution of interoperability.

    Read Governance Framework for Trusted Electronic Health Information Exchange [PDF - 383 KB]

  • ONC will establish a monitoring program to ensure the governance goals are being addressed.
  • Materials and Recordings from Listening Sessions and Public Hearing