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Carrying Forward Provider Health Information Exchange

By Frank Irving

- The California Association of Health Information Exchanges (CAHIE) and the National Association for Trusted Exchange (NATE) announced in early October a collaborative effort to more effectively enable health information exchange among providers, and between providers and consumers.

The California Association of Health Information Exchanges takes over operation of the Provider-to-Provider Trust Bundle.

As of Oct. 9, CAHIE assumed operation of the Provider-to-Provider Trust Bundle, which had been established by NATE in 2012 as the first national framework dedicated to facilitating Direct messaging among providers.

NATE has moved on to concentrate on enabling information exchange with consumers. “NATE wanted to pass along the work that they started three years ago,” explained Robert Cothren, executive director of CAHIE, which has initiated efforts to expand exchange among providers nationwide.

CAHIE has started its work by gathering participants to help establish a voluntary process to manage and govern the new national trust community. HealthITInteroperability.com recently spoke with Cothren to get more detail on how CAHIE will be handling the transition. The transcript of that discussion follows.

HealthITInteroperability.com: How do you describe what is happening with trust bundles among providers?

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Robert Cothren (pictured): Think about a hospital trying to decide with whom it is going to enable exchange of PHI. That hospital would have to contact every other hospital that it had any relationship with, and then go through legal agreements to enable information exchange. On top of that, there would be technical work to make sure that the hospital could actually enable the exchange of information.

The whole idea behind trust bundles is that you create a trust community — a group of people who have voluntarily agreed to a set of policies that they will all follow. The trust bundle is a collection of digital certificates for everybody in the community. Parties within the community know who is sending messages, and the messages are encrypted so they can only be read by the recipient.

When you join the trust community, you make use of the trust bundle to enable exchange with all of those organizations that follow the same policies that you do.

HITI.com: Will your work moving forward build on the model you have established in California and surrounding states?

RC: It will partially build on what we’ve done here in California, but it will draw on the work from NATE as well. There’s quite a bit of experience and a technical infrastructure that we’ll leverage here as part of our organization. Both CAHIE and NATE have governance structures and policies, and that will be the foundation for the work that we do.

On October 12 we put out a call for participants to help us form the governance structure and set of policies. At the latest count, we had 31 people signed up to participate from across the country. We’ll be convening our first meeting in about two weeks.

HITI.com: What types of people and organizations are getting involved?

RC: Most of them are on the provider side, but some are vendors that provide services and some are service providers for Direct messaging. Some of them are hospitals, some are health information exchanges, and then we have policy people as well as technical people. So there’s a lot of different expertise and stakeholders that are being represented. We’re very happy about that.

We’re also getting good geographic coverage. I was initially concerned that it would be difficult to get beyond California, but that did not happen. We have people from across the country.

HITI.com: What work lies ahead for CAHIE in expanding exchange among provider organizations nationwide?

RC: The first step is to convene a group to get input. We want to make sure that we represent policies and processes that establish trust. We will be advancing the trust community that NATE set up, and that will always be based on the voluntary processes that everybody agrees to follow, and what will make organizations comfortable in exchanging PHI with others. That conversation is a very important one. We’ll be exploring that in a couple weeks, when we hold our first meeting.

Once that’s complete, then we’ll move forward to take new applicants. We are expecting a lot of growth in the trust community. Direct is becoming much more widespread as part of what’s going on with meaningful use and there is big demand for mechanisms that better facilitate exchange using Direct. We are expecting to see growth in the trust community very rapidly.

HITI.com: What is the ultimate goal in taking this forum nationwide?

RC: The ultimate goal is to make sure that the right information is in the right hands at the right time. Our near-term objective is to provide good means to facilitate proper exchange of information among providers. In addition, we’re going to continue to work with NATE to make sure that through that partnership, we enable exchange between providers and consumers. We’re also interested over the coming years in exploring exchange among a broader set of stakeholders, including public health and payers, where appropriate.

Over time, we’re going to be looking at what we can do to expand stakeholders and make sure that the trust community allows proper exchange where it is authorized. If the right organizations, good security and good processes are in place, we should be successful in enabling exchange.




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