Office of Health Information
Robert Cothren, PhD
Institute for Population
UC Davis Health System
CMS HIE Community of Practice
September 17, 2013
First Half – NATE Overview
2 NATE‟s Origins
3 Success! The Western States Consortium Pilot
Second Half - NATE Programs
6 Trust Community
7 Federated Provider Directories
• 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
ONC State Health Policy Consortium Project focused on the governance
needed to facilitate and support Interstate HIE, using Direct Secure
Resolve policy issues, especially those related to privacy, security and
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
• At the end of March in 2013 we had satisfied the requirements of
• 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?”
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.
NATE 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 VISION
A scalable, sustainable Trust and Policy framework that supports and
advances intra-state and interstate HIE.
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
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.
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
• Proven approach to piloting promising practices.
Highlights of Current NATE Programs
• Trust Community
• Federated Provider Directories
• Consumer Engagement
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?
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
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
• Based on eligibility criteria for members of the trust community
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
• 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.
3. Find the Right Provider
• Federated Provider Directories
…based on emerging HPD standards
…managed by the organizations that know the right information
…so the data is accurate.
Regional HISP Regional HISP
CA State Directory OR State Directory
AK State Directory
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
• The plan: Follow the path we have established for provider-to-provider
• Establish policies and practices for provider-to-patient and patient-
• Create Trust Profiles and Trust Bundles for provider-to-patient and
Emerging Bundle Configuration
All Using National Standards
• 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)