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Aaron Seib, CEO, NATE

California Office of Health Information Integrity

Robert Cothren, PhD

Institute for Population Health Improvement, UC Davis Health System

CMS HIE Community of PracticeSeptember 17, 2013

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AgendaFirst Half – NATE Overview

1 History

2 NATE’s Origins

3 Success! The Western States Consortium Pilot

4 Incorporation

5 Growing

Second Half - NATE Programs

6 Trust Community

7 Federated Provider Directories

8 PHRs

Q&A

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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.

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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, Oregon and Utah

Pilot States: California and Oregon Affiliate States: Colorado, Florida, Georgia, Idaho, Michigan, Ohio and

Washington

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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?”

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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

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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.

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OUR MISSIONThe 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.

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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.

HIE governance

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Member States Today

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Highlights of Current NATE Programs

• Trust Community• Federated Provider Directories• Consumer Engagement

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Trust Communities• Trust

Trusted exchange among unaffiliated organizations (across state lines).

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

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What do you need for trusted exchange? 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.

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NATE Trust CommunityPolicies, practices, and technologies……that enable and promote trusted exchange……among unaffiliated organizations…

…across state lines……without the need point-to-point data sharing agreements.

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1. Create Usable Policies• Based on eligibility criteria for members of the trust community

http://nate-trust.org/work-products/

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2. Create the Trust Community• 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

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

Trust Bundles

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3. Find the Right Provider• Federated Provider Directories

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

…managed by the organizations that know the right information…so the data is accurate.

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Regional HISP Regional HISPRegional HISP

CA State Directory OR State Directory

State HISP

AK State Directory

State HISP

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Next: Communicating with Consumers• 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

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Provider HISP

Provider HISP

Current Bundle

Direct-enabled

PHR

New Bundle:Consumer-to-provider exchange

New Bundle:Provider-to-consumer exchange

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All Using National Standards• Exchange using Direct

Compliant with the Applicability Statement for Secure Health Transport version 1.1

• Certificate management using Trust BundlesCompliant with the Implementation Guide for Direct Project Trust Bundle Distribution version 1.0

• Address discovery using Federated Provider DirectoriesCompliant with Healthcare Provider Directory specification (as amended in 2013)

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Thank You!

www.NATE-trust.org