Kicking off the 21st Century Cures Act

ONC recently convened several major interoperability efforts in discussions that intend to connect the health IT ecosystem. The 21st Century Cures Act requires a trusted exchange framework and common agreement provisions as outlined in Section 4003. At the inaugural ONC meeting, eight trust frameworks were presented: Carequality, CARIN Alliance, CommonWell Health Alliance, Digital Bridge, Direct Trust, eHealth Exchange, National Association of Trusted Exchange and the Strategic HIE Collaborative. Each group presented their current approach and key principles or goals that guide the development and use of their framework.

A common denominator among each of these groups is that they advance ubiquitous, secure and interoperable health data and information exchange. Although, and not surprising to many within the health IT community, each effort has a slightly nuanced approach to achieving their goals. For example, as each entity discussed current efforts and plans for the future, it was clear that there are varying governance structures, onboarding processes, and cost structures, making it difficult to understand how they might work together.

Understanding the gaps and assessing the alignments

After analyzing these various frameworks, Audacious Inquiry, LLC. (AI) shared key takeaways, which further crystallized that each approach is valuable and addresses a ‘need’ within the marketplace, but further illustrated that these frameworks are operating in silos. Although, there are a few exciting examples of partnerships forming between these efforts to leverage each other’s work.

For example, CommonWell Health Alliance and Carequality announced their collaboration last year, and SHIEC’s Patient Centered Data Home™, leverages the eHealth Exchange framework. But, it is not yet clear which approach, or route, might meet a provider’s needs. AI made the following observations about areas where these eight interoperability approaches differed:

  • Purpose and scope of the arrangement
  • Permitted purposes for data exchange
  • Permitted participants
  • Identify proofing and authentication
  • Technical approach and infrastructure
  • Cooperation and Non-Discrimination
  • Accountability

ONC wants to hear from you

ONC has asked the public to provide comments by Friday, Aug. 25 via an online platform, focused on the following topic areas:

  • Standardization: Adhere to industry and federally recognized technical standards, policies, best practices, and procedures.
  • Transparency: Conduct all exchange openly and transparently.
  • Cooperation and Non-Discrimination: Collaborate with stakeholders across the continuum of care to exchange electronic health information, even when a stakeholder may be a business competitor.
  • Security and Patient Safety: Exchange electronic health information securely and in a manner that promotes patient safety and ensures data integrity.
  • Access: Ensure that patients and their caregivers have easy access to their electronic health information.
  • Data Driven Choice: Exchange multiple records at one time to enable identification and trending of data to lower the cost of care, improve the health of the population, and enable consumer choice.
  • General Comments: Stakeholders may submit additional comments in this section that do not fit in the above categories.


HIMSS will be submitting comments, and we encourage you to reach out to Jeff Coughlin, HIMSS senior director, federal affairs or me to share your perspective.

To learn more about HIMSS-related efforts around interoperability & standards and health information exchange, visit our topic pages and join the Interoperability & HIE Community!