The eHealth Exchange (“Exchange”) is a group of federal agencies and non-federal organizations that came together under a common mission and purpose to improve patient care, streamline disability benefit claims, and improve public health reporting through secure, trusted, and interoperable health information exchange.
Participating organizations mutually agree to support a common set of standards and specifications that enable the establishment of a secure, trusted, and interoperable connection among all participating Exchange organizations for the standardized flow of information, by:
- Sending health information to other participating organizations
- Finding and requesting copies of healthcare information from other participating organizations--where permitted by law and policy
- Matching patients to their data without a national patient identifier
- Subscribing to receive updates to health information
The organizations involved in the Exchange built upon the early testing, demonstration, and development work from the Nationwide Health Information Network Trial Implementations, and built production-level capabilities. In 2009 the first two Exchange participants, the Social Security Administration and MedVirginia, began exchanging data in production to automate and expedite the Social Security disability benefits claims process. Later that year, the Veterans Health Administration, Department of Defense and Kaiser Permanente joined began exchanging summary patient records in support of the Virtual Lifetime Electronic Record. These early experiences helped prove the viability of an interconnected exchange model, and provided invaluable lessons on how to improve, advance, and grow information exchange on a nationwide scale. Today, close to 30 organizations participate in the eHealth Exchange, with another 100+ organizations expected in the coming months. Currently each organization must support a common set of standards and specifications, proving compliance and the ability to interoperate with other Exchange participants through testing. Organizations are held accountable through contractual arrangement and a committee structure.
The eHealth Exchange's objective over the next two years is to grow the community of Exchange participants, increase the quality of data, and gradually expand the use cases supported by the Exchange, as well as continue to refine, mature, and build capabilities to support broader connectivity and nationwide data exchange.
The Office of the National Coordinator for Health Information Technology (ONC) has fostered development of the nationwide health information network since 2004. In 2006, ONC sponsored contracts to explore prototype architectures for a network of networks, followed by trial implementations in 2007 to implement, test and demonstrate a core set of capabilities to enable nationwide exchange. This included development of technical specifications, a trust agreement called the Data Use and Reciprocal Support Agreement (DURSA) and testing strategies and plans. The work largely focused in implementing harmonized standards that were adopted by the Secretary of HHS in support of seven use cases adopted by the American Health Information Community (AHIC).
The Trial Implementations revealed that exchange was not only viable across a diverse set of public and private entities, but that a collaborative approach was the best vehicle for success. The common mission and relationships forged during this early work expedited production efforts and set the stage for advancing nationwide health information exchange (HIE). In 2008, the focus of work shifted from demonstrations to building capabilities to support production pilots.
In February 2009, eighteen months following the start of the Trial Implementations, the first production exchange began between the Social Security Administration and MedVirginia, followed by the Veterans Health Administration and Kaiser Permanente later that year. This represented the beginning of what is now known as the eHealth Exchange.
Today, the eHealth Exchange has become a rapidly growing community of exchange partners, with nearly forty participants, representing thousands of providers and millions of patients in support of treatment, care coordination, disability benefits and public health purposes.
In October 2012, the eHealth Exchange transitioned from operating as an ONC initiative to thrive as a public private partnership supported by Healtheway, Inc., a non-profit organization established to support the eHealth Exchange and to advance HIE implementation.
The HIE market is dynamic and rapidly growing, primarily in the private sector. The growing number of production HIOs will start to shift their focus and begin to expand exchange with other locales, service areas and affiliations. This expansion is dependent upon having a unifying trust framework and common set of rules that enable information to flow across boundaries. eHealth Exchange provides such a framework, enabling expansion, including the ability to exchange with federal agencies. eHealth Exchange will focus on two primary segments of the HIE market:
Organizations who wish to become Exchange Participants (i.e. organizations who either have data or who facilitate the exchange of data, such as health systems, regional, community or state HIOs, governmental agencies, etc.)
- Exchange has almost thirty (30) participants, with over one hundred (100) in various stages of joining.
- Exchange can achieve sustainability by growing participation to approximately one-hundred (100) Participants, which is targeted for fall 2013 or before.
Organizations who offer technology solutions used by Exchange Participants (i.e. where those solutions are tested, deemed "Exchange Ready", and interoperate across a range of other systems without further customization.)
- Exchange will have approximately 30% of technology solution providers supporting Exchange by the end of 2012, and has strong support from the Electronic Health Records Association (EHRA), which represents ninety (90%) of the providers in the US.
- CONNECT is one of more than twenty different solutions supporting Exchange Participants. By the end of 2012, two-thirds of Exchange participants are expected to use a commercially developed solution.
eHealth Exchange Service Offerings
The eHealth Exchange expands access and connectivity to a broad range of organizations, public or private:
- Is built upon an authoritative set of requirements that are proven to work across a broad spectrum of HIE approaches;
- Provides a credible and trusted benchmark to gauge whether HIE systems are secure and interoperable with other systems and in production (i.e. “Exchange Ready” designation);
- Enables eHealth Exchange Participants to test once and exchange with many, expanding connectivity beyond a participant’s service area, geography or affiliation;
- Facilitates exchange with a critical mass of federal agencies, public and private HIOs, health systems and other governmental entities; and
- Holds participants accountable to the rules and provides a mechanism for granting and revoking access if non-compliant.
Alignment with HIT Strategic Plan
The eHealth Exchange strategy aims to align with the ONC HIT Strategic Plan, as well as ONC’s strategy to support a portfolio of nationwide health information network standards, services and policies.
- Over the past eighteen (18) months, the Exchange has moved toward a profile-based approach, which enables partners with common HIE needs to exchange under a common framework.
- Exchange essentially defines “bundles” of capabilities that participants may implement, test and use for Exchange, such as:
- Look up and retrieval of summary patient records;
- Submission of clinical documentation to CMS for the CMS end stage renal disease program (ESRD);
- Submission of clinical data (e.g. Direct transport specifications, other types of payload); and
- The current DURSA permits such an approach, but may need to be revisited in the future (e.g. 2012 or 2013) if different policy and legal requirements would apply.
- Exchange also aligns with other elements HIT Strategic Plan developed by ONC in 2011, such as:
- Aligning with meaningful use (MU) stage 1, such as transfer of care, exchange of patient summary information, submission of clinical data;
- Continue to align and be supportive of MU (Stage 2 and Stage 3);
- Supporting a federated approach to HIE, under a common governance framework and supporting the minimally essential services to enable exchange;
- Utilizing a certification-type approach as an element of the Exchange testing strategy;
- Interoperating across organizational, geographic and other boundaries;
- Aligning with nationwide health information network governance, where applicable and appropriate;
- Supporting query and retrieval of data, with the ability to align with PCAST and adapt as PCAST standards and capabilities emerge;
- Supporting state and regional HIE networks and beacon communities as they implement their HIE strategies;
- Leverage work of the HIT Standards Committee and HIT Policy Committee to inform future direction, where appropriate and applicable;
- Adopting the work products from the Standards and Interoperability Framework; and
- Looking to the national strategy for individual identity verification, as guidelines and strategies emerge.