Health Information Exchanges and National Networks
National Network Overview
One of the main goals of Connie is to ensure that your health data is where you need it, when you need it. No matter where in the United States and territories you need care, the clinicians who need your health information should be able to access it to make the most informed decisions possible regarding your treatment. To enable that access, our HIE participates in several National Networks.
These National Networks electronically connect HIEs and more localized Health Information Networks (HINs) throughout the country. The National Networks provide a common framework for technology, as well as privacy and security standards – meaning that your health information can get where it needs to go but does not get where it does not need to go.
Currently, we participate in the following National Networks and interoperability frameworks:
• The eHealth Exchange network;
• The CommonWell network; and
• The Carequality interoperability framework.
Each of these networks and frameworks has its own governing body, rules, and legal agreements, but how they work conceptually is the same.
Not every healthcare provider (or even every HIE/HIN) participates in every network, and we want to make sure information is getting where it needs to go when it is needed. That is why we participate in multiple National Networks – we do not want to miss an essential piece of your information just because you need to receive care out-of-state, and that out-of-state healthcare provider participates in one network but not another.
The Trusted Exchange Framework and Common Agreement (TEFCA) is a government-endorsed framework for the nation-wide exchange of health information that is intended to further connect existing National Networks. A goal of TEFCA is to make sure all the National Networks are connected so that no one needs to connect to multiple networks. We plan to participate in TEFCA through the eHealth Exchange, once that framework is up and running.
How do National Networks Exchange Data?
Each National Network participant agrees to use the same technology standards and language to exchange data with other participants in that network. These agreed-up standards allow exchange at large scale across the country. For example: when you see a clinician, they enter your health information into an electronic health record (EHR). That EHR is usually connected to a larger network of healthcare organizations through an HIE/HIN, often at a state or regional level. That HIE/HIN is typically then connected to other HIEs/HINs through one or more National Networks; those other HIEs/HINs are similarly connected to other healthcare organizations and EHRs, back down to a clinician on the other end. So, when a clinician opens your electronic record, it will allow the clinician to electronically retrieve other clinicians’ records through these interconnected networks. If these clinicians have health information about you, the National Network system will return your information to the EHR that your clinician is using during your appointment, and your clinician can see that information in real time. Even though it sounds like a lot of back-and-forth, the entire process takes only a matter of seconds. Below is a picture of what we just described (click on image for full size view).
National Networks provide the fastest way possible to access your information throughout the country because your clinician can “look” in multiple places by simply connecting to one HIE/HIN. Without these networks, clinicians would have to directly contact hundreds of thousands of providers individually (electronically or otherwise) to know if you have health data they should receive – which would take hours, if not days or even months.
How does Connie Protect my Privacy when Exchanging Data through National Networks?
Every HIE/HIN participating in a National Network agrees to a common set of rules or contract. These documents require high standards of privacy and security and ensure that everyone in the network is observing privacy laws. If a participating organization violates privacy laws, the agreements include a process for other HIEs/HINs who are affected to complain to the governing body of the National Network so that the participant violating the rules can be held accountable.
In addition, the National Networks require that when a network participant requests information, they state the purpose for which the information is being requested. Right now, Connie only calls and answers requests when someone who has or is providing you with healthcare services requests information for the purpose of using it to provide you with treatment. We may call and answer different requests in the future, but we will only ever do what we are allowed to do under privacy laws.
In a nutshell, we can only ask for information if your clinician would be allowed to ask for and receive it. The National Networks do not allow for greater access to data or less privacy. Instead, they enable what is already allowed, but they do so in a way that lets your clinician exchange health information more quickly and effectively. That way, your clinician can spend more time treating you.
At a local level, Connie only sends information that we are allowed to send according to both laws and our policies and procedures. We provide additional safeguards. Our policies and procedures around data exchange are based on feedback from many different stakeholders, including patient advocates, and reflect our local laws.
HIE Local Impact Beyond National Networks
HIEs provide value at the local level far beyond national data exchange. By connecting clinicians within our state and region, we can exchange more and more relevant data than what the technology at the national scale can support. We can also engage locally and individually with both clinicians and patients to ensure we are implementing technology and exchanging data in a way that makes sense to the people in our state, based on your individual needs and concerns.
Request to Opt-Out
If you do not want your data to be exchanged through Connie, you may opt-out here. By opting out, none of your data will be shared for any purpose unless we are required by law to disclose the information. This means that your information will not be shared with the National Networks or your local providers. It is also important to understand that, by opting out of Connie you are not opting out of other HIEs/HINs that may also be exchanging data through the National Networks or any local networks.
• EHEALTH EXCHANGE’S DATA USE AND RECIPROCAL SUPPORT AGREEMENT (DURSA): Data Use and Reciprocal Support Agreement (DURSA) – eHealth Exchange.
• CAREQUALITY CONNECTION AGREEMENTS AND FRAMEWORK POLICIES: Resources – Carequality.
• COMMONWELL HEALTH ALLIANCE AGREEMENT: CommonWell MSA (commonwellalliance.org).
• TEFCA COMMON AGREEMENT: Common Agreement for Nationwide Health Information Interoperability (sequoiaproject.org).