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CMS HIE Community of Practice September 17, 2013. History. In the Spring of 2011, State Leaders on the West Coast began to interact in relation to the ONC’s State HIE Grantee Cooperative Agreement

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CMS HIE Community of Practice

September 17, 2013


History
History

  • In the Spring of 2011, State Leaders on the West Coast began to interact in relation to the ONC’s State HIE Grantee Cooperative Agreement

  • One of the Program Information Notices (PINs) required State Grantees to allocate resources to “enabling interstate HIE”

  • This affinity group of states collaborated on a proposal to pilot mechanisms for multi-state trusted exchange – resulting in a multi-state grant award known as the Western States Consortium.


The western states consortium
The Western States Consortium

  • ONC State Health Policy Consortium Project focused on the governance needed to facilitate and support Interstate HIE, using Direct Secure Messaging

    • Resolve policy issues, especially those related to privacy, security and data use

    • Develop standards and requirements for trusted services, beginning with Direct Secure Messaging

    • Project final report released by ONC on Healthit.gov

  • Core States: Alaska, Arizona, California, Hawaii, Nevada, New Mexico, Oregonand Utah

  • Pilot States: California and Oregon

  • Affiliate States: Colorado, Florida, Georgia, Idaho, Michigan, Ohio and Washington


Success
Success!

  • At the end of March in 2013 we had satisfied the requirements of our grant.

  • We had established a ‘trust community’ that enabled each State to independently govern HIE within its state while facilitating cross-boarder exchange when appropriate.

  • Further we had established mechanisms to enable discovery of providers associated with this ‘trust community’ in the nations first Federated Provider Directory.

  • At the end of the grant, we asked ourselves if we should continue to support the programs we had started.

  • I think the best way to sum up the conclusion of the members at the time was the image that was conjured up when we asked ourselves “What if the State’s didn’t Collaborate on establishing HIE?”


Incorporation
Incorporation

  • Independent non-profit organization established in Washington DC, May 2013

    • Bylaws, governance body, and organizational structure being developed

    • Vision: HIE Governance is the path to trusted exchange

    • Mission: Initiate and/or participate in the development of national standards that support ongoing HIE

    • Member, DirectTrust (independent non-profit trade association): establishment of a national Security and Trust Framework in support of Direct Secure Messaging

  • State Level Membership

    • Member States: Alaska, California, Florida, Hawaii, Michigan, Nevada, North Dakota, Oregon and Utah

    • Interested States: Arizona, Colorado, Idaho, New Mexico, and Ohio


The National Association for Trusted Exchange (NATE) is the national policy standard-setting and policy support organization created and governed by state-designated health information exchange (HIE) officials. Through NATE, state HIE officials establish standards and best practices, conduct peer review, and coordinate their policy efforts to support and advance HIE.  NATE staff supports these efforts and represents the collective views of the members. NATE members, together with the central resources of NATE, form the national system of state-based HIE policy support.

  • MEMBERSNATE has a State based membership – with representatives appointed by each onboarded state whose role is related to advancing, supporting and/or regulating HIE in their respective state or territory.

  • OUR VISIONA scalable, sustainable Trust and Policy framework that supports and advances intra-state and interstate HIE.


OUR MISSION national policy standard-setting and policy support organization created and governed by state-designated health information exchange (HIE) officials. Through NATE, state HIE officials establish standards and best practices, conduct peer review, and coordinate their policy efforts to support and advance HIE.  NATE staff supports these efforts and represents the collective views of the members. NATE members, together with the central resources of NATE, form the national system of state-based HIE policy support.The mission of NATE is to assist state HIE officials, individually and collectively, in serving the public interest and achieving the following fundamental HIE goals in a responsive, efficient and cost effective manner, consistent with the wishes of its members:

  • Protect the public interest;   

  • Develop a roadmap that addresses and eliminates the legal, policy and technical barriers that inhibit HIE between entities in a state and across state borders;

  • Facilitate HIE Governance as the path to trusted exchange through the convergence of disparate trust models, policies and processes;

  • Collaborate with all interested participants to initiate and/or participate in the development of HIE national standards and best practices;

  • Promote the reliability and sustainability of the HIE industry; and

  • Support and improve state regulation of HIE.


Hie governance
HIE governance national policy standard-setting and policy support organization created and governed by state-designated health information exchange (HIE) officials. Through NATE, state HIE officials establish standards and best practices, conduct peer review, and coordinate their policy efforts to support and advance HIE.  NATE staff supports these efforts and represents the collective views of the members. NATE members, together with the central resources of NATE, form the national system of state-based HIE policy support.

  • Collaborative relationships enabling strategic and operational coordination, while facilitating oversight for the secure intra-state, interstate and nationwide electronic exchange of information that supports federal and state laws

  • Neutral, transparent forum that convenes State HIE leadership to address common challenges collaboratively

  • Three Primary Components:

    • Defining a governance entity role and functions – establishing a convening and coordination structure, including processes for maintaining transparency and generating multi-stakeholder public-private collaboration

    • Defining accountabilities, oversight provisions and protocols – establishing mechanisms to ensure that the public benefit is served via national standards and HIE best practices

    • Proven approach to piloting promising practices.


Member states today
Member States Today national policy standard-setting and policy support organization created and governed by state-designated health information exchange (HIE) officials. Through NATE, state HIE officials establish standards and best practices, conduct peer review, and coordinate their policy efforts to support and advance HIE.  NATE staff supports these efforts and represents the collective views of the members. NATE members, together with the central resources of NATE, form the national system of state-based HIE policy support.


Highlights of current nate programs
Highlights of Current NATE national policy standard-setting and policy support organization created and governed by state-designated health information exchange (HIE) officials. Through NATE, state HIE officials establish standards and best practices, conduct peer review, and coordinate their policy efforts to support and advance HIE.  NATE staff supports these efforts and represents the collective views of the members. NATE members, together with the central resources of NATE, form the national system of state-based HIE policy support.Programs

  • Trust Community

  • Federated Provider Directories

  • Consumer Engagement


Trust communities
Trust Communities national policy standard-setting and policy support organization created and governed by state-designated health information exchange (HIE) officials. Through NATE, state HIE officials establish standards and best practices, conduct peer review, and coordinate their policy efforts to support and advance HIE.  NATE staff supports these efforts and represents the collective views of the members. NATE members, together with the central resources of NATE, form the national system of state-based HIE policy support.

  • Trust

    Trusted exchange among unaffiliated organizations (across state lines).

  • Scalable Trust

    Trusted exchange among unaffiliated organizations (across state lines) without point-to-point data sharing agreements.


What do you need for trusted exchange
What do you need for trusted exchange? national policy standard-setting and policy support organization created and governed by state-designated health information exchange (HIE) officials. Through NATE, state HIE officials establish standards and best practices, conduct peer review, and coordinate their policy efforts to support and advance HIE.  NATE staff supports these efforts and represents the collective views of the members. NATE members, together with the central resources of NATE, form the national system of state-based HIE policy support.

  • Know your conversation is not overheard.

  • Know who you are talking to.

  • Know who you are talking about.

  • Know there is consent for your conversation.

    Context: Supporting and promoting inter-organizational exchange across state lines.


Nate trust community
NATE Trust Community national policy standard-setting and policy support organization created and governed by state-designated health information exchange (HIE) officials. Through NATE, state HIE officials establish standards and best practices, conduct peer review, and coordinate their policy efforts to support and advance HIE.  NATE staff supports these efforts and represents the collective views of the members. NATE members, together with the central resources of NATE, form the national system of state-based HIE policy support.

Policies, practices, and technologies…

…that enable and promote trusted exchange…

…among unaffiliated organizations…

…across state lines…

…without the need point-to-point data sharing agreements.


1 create usable policies
1. Create Usable Policies national policy standard-setting and policy support organization created and governed by state-designated health information exchange (HIE) officials. Through NATE, state HIE officials establish standards and best practices, conduct peer review, and coordinate their policy efforts to support and advance HIE.  NATE staff supports these efforts and represents the collective views of the members. NATE members, together with the central resources of NATE, form the national system of state-based HIE policy support.

  • Based on eligibility criteria for members of the trust communityhttp://nate-trust.org/work-products/


2 create the trust community
2. Create the Trust Community national policy standard-setting and policy support organization created and governed by state-designated health information exchange (HIE) officials. Through NATE, state HIE officials establish standards and best practices, conduct peer review, and coordinate their policy efforts to support and advance HIE.  NATE staff supports these efforts and represents the collective views of the members. NATE members, together with the central resources of NATE, form the national system of state-based HIE policy support.

  • Trust Community – A collection of organizations that elect to adopt a common set of policies and practices in regard to health information exchange.

  • Trust Profile – A set of policies and practices corresponding to a specific health information exchange purpose or use.

  • Trust Bundle – The Trust Anchor certificates for members of a Trust Community for a specific Trust Profile.

    The Trust Bundle is a scalable means for identifying entities that have agreed to a standard of good behavior.


Trust bundles
Trust Bundles national policy standard-setting and policy support organization created and governed by state-designated health information exchange (HIE) officials. Through NATE, state HIE officials establish standards and best practices, conduct peer review, and coordinate their policy efforts to support and advance HIE.  NATE staff supports these efforts and represents the collective views of the members. NATE members, together with the central resources of NATE, form the national system of state-based HIE policy support.

Trust Bundles

http://bundles.hiecosystem.net/nate/


3 find the right provider
3. Find the Right Provider national policy standard-setting and policy support organization created and governed by state-designated health information exchange (HIE) officials. Through NATE, state HIE officials establish standards and best practices, conduct peer review, and coordinate their policy efforts to support and advance HIE.  NATE staff supports these efforts and represents the collective views of the members. NATE members, together with the central resources of NATE, form the national system of state-based HIE policy support.

  • Federated Provider Directories

    …based on emerging HPD standardshttp://cheq.wikispaces.com/Directory+Serviceshttp://modularspecs.siframework.org/Provider+Directories+Homepage

    …managed by the organizations that know the right information

    …so the data is accurate.


State HISP national policy standard-setting and policy support organization created and governed by state-designated health information exchange (HIE) officials. Through NATE, state HIE officials establish standards and best practices, conduct peer review, and coordinate their policy efforts to support and advance HIE.  NATE staff supports these efforts and represents the collective views of the members. NATE members, together with the central resources of NATE, form the national system of state-based HIE policy support.

AK State Directory

CA State Directory

Each state knows how to query each other state.

State HISP

OR State Directory

Complexity within a state is hidden.

Regional HISP

Regional HISP

Regional HISP


Next communicating with consumers
Next: Communicating with Consumers national policy standard-setting and policy support organization created and governed by state-designated health information exchange (HIE) officials. Through NATE, state HIE officials establish standards and best practices, conduct peer review, and coordinate their policy efforts to support and advance HIE.  NATE staff supports these efforts and represents the collective views of the members. NATE members, together with the central resources of NATE, form the national system of state-based HIE policy support.

  • Addressing a need for bi-directional exchange.

    • Investigating the use of both tethered and untethered PHRs which have different regulatory issues.

    • Depending upon the use of Direct – therefore, Direct-enabled PHRs.

  • The plan: Follow the path we have established for provider-to-provider exchange.

    • Establish policies and practices for provider-to-patient and patient-to-provider exchange.

    • Create Trust Profiles and Trust Bundles for provider-to-patient and patient-to-provider exchange.


Emerging bundle configuration
Emerging Bundle Configuration national policy standard-setting and policy support organization created and governed by state-designated health information exchange (HIE) officials. Through NATE, state HIE officials establish standards and best practices, conduct peer review, and coordinate their policy efforts to support and advance HIE.  NATE staff supports these efforts and represents the collective views of the members. NATE members, together with the central resources of NATE, form the national system of state-based HIE policy support.

Provider HISP

New Bundle:Provider-to-consumer exchange

Direct-enabled PHR

Current Bundle

Provider HISP

New Bundle:Consumer-to-provider exchange


All using national standards
All Using National Standards national policy standard-setting and policy support organization created and governed by state-designated health information exchange (HIE) officials. Through NATE, state HIE officials establish standards and best practices, conduct peer review, and coordinate their policy efforts to support and advance HIE.  NATE staff supports these efforts and represents the collective views of the members. NATE members, together with the central resources of NATE, form the national system of state-based HIE policy support.

  • Exchange using Direct

    Compliant with the Applicability Statement for Secure Health Transport version 1.1

  • Certificate management using Trust Bundles

    Compliant with the Implementation Guide for Direct Project Trust Bundle Distribution version 1.0

  • Address discovery using Federated Provider Directories

    Compliant with Healthcare Provider Directory specification (as amended in 2013)


Thank you
Thank You! national policy standard-setting and policy support organization created and governed by state-designated health information exchange (HIE) officials. Through NATE, state HIE officials establish standards and best practices, conduct peer review, and coordinate their policy efforts to support and advance HIE.  NATE staff supports these efforts and represents the collective views of the members. NATE members, together with the central resources of NATE, form the national system of state-based HIE policy support.

www.NATE-trust.org


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