National Association for Trusted Exchange (NATE)
Not-for-profit association of organizations, Governed by a Board of Directors
Non-for-profit association of organizations, Governed by a Board of Directors
Geographic Reach (within US)
The National Association for Trusted Exchange (NATE) is a not-for-profit membership association focused on facilitating consumer/patient access to information and enabling trusted exchange among organizations and individuals with differing regulatory environments and exchange preferences. NATE brings its membership and other stakeholders together to find common solutions that optimize the appropriate exchange of health information for greater gains in technology adoption and improvement of patient outcomes. NATE aims to address the legal, policy and technical barriers that inhibit health information exchange between data holders and healthcare consumers, via a number of projects focused on exchange via multiple modes of transport, including Direct secure messaging, FHIR® and other APIs.
How does this approach facilitate exchange?
NATE leads and participates in a number of ongoing and emerging projects focused on exchange via multiple modes of transport, including Direct secure messaging, FHIR® and common APIs.
For example, the flagship NATE Blue Button for Consumers (NBB4C) Trust Bundle contains trust anchors of consumer-facing applications (CFAs) that utilize Direct to securely move data from one application to another. The NBB4C Trust Bundle helps relying parties to identify CFAs that meet or exceed criteria considered the most important characteristics of a trustworthy steward of consumer health information, while still enabling patients to benefit from the value of having access to their health information.
Access Method (use cases)
Consumer-Mediated Exchange, Consumer-Directed Exchange
Participate in ongoing and emerging project in consumer centered data sharing of health information consistent with their mission to address the legal, policy, and technical barriers that inhibit health access to and exchange of information exchange between entities within a state and across states.
Number of live connections and/or participants
10 active vendor participants in the NBB4C
Members are classified into one of the following types: Government,Non-Government Organizations (e.g. Vendors, Health Information Organizations), Associations Individuals
States, U.S. Department of Veterans Affairs, various consumer controlled apps, health IT and health information exchange organizations and associations, provider organizations, interested individuals and others.
Costs (Amount and/or Party Incurring Cost)
Membership fees range from $125 for an individual membership to $500 for small associations and startups, up to $10,000 for government with populations exceeding 10M people and $20,000 for non-government organizations with revenues exceeding $500M. There are costs associated with Trust Bundles, e.g., NATE invoices qualified CFAs an administrative fee of $4,000 before being added to the production NBB4C trust bundle.
Blue Button, FHIR®, Direct, various common APIs
Onboarding Process (Requirements to connect)
Submit an onboarding application and work with NATE.
The flagship NATE Blue Button for Consumers (NBB4C) Trust Bundle contains trust anchors of consumer-facing applications (CFAs) that utilize Direct to securely move data from one application to another. The NBB4C Trust Bundle helps relying parties to identify CFAs that meet or exceed criteria considered the most important characteristics of a trustworthy steward of consumer health information, while still enabling patients to benefit from the value of having access to their health information.
Participation in the NBB4C Trust Bundle facilitates secure exchange of health information from provider-controlled applications to consumer-controlled applications such as personal health records (PHRs) using Direct secure messaging protocols. Provider organizations that wish to send messages to consumers using one of these recognized applications should load this bundle into their trust stores. In most cases, CFAs that are onboarded to the NBB4C have loaded publicly recognized trust bundles of provider facing applications and Direct Secure messaging should be enabled.
Focus on exchange and data liquidity (mobilizing data to consumers). Some NBB4C apps store consumer data, others do not. Secure data storage is addressed in the NBB4C participation criteria.
Certification Requirements for Participation
NBB4C Participants must attest to the completion of specific testing requirements as outlined in NATE's onboarding application.
To accommodate rapid growth in trust bundle participation, NATE designed and developed a new trust bundle administration tool known as the NATE Bundles Administrator (NBA). The NBA facilitates the onboarding process and publishes bundles for download by relying parties that wish to adopt them as part of their patient engagement activities. The NBA serves as a secure portal for downloading trust anchors for use in a relying party’s trust store as well as for uploading documentation related to onboarding to NATE trust bundles. Interested CFAs should upload their onboarding applications and supplementary documentation using the NBA. New applicants will be required to create a profile to upload information, documentation and trust anchors.
NATE Blue Button for Consumers (NBB4C) Trust Bundle version 2.0
NATE Blue Button Directory (NBBD)
NATE Trust Harbor
Consumer Engagement and Access Advocacy Project
Current Collaboration across Efforts
NATE and CommonWell Health Alliance are both members of their respective organizations with goals of collaboration to expand interoperability for patient-generated health data. No services to date between this collaboration. (source)
HIE organizations are included in NATE membership
NATE has expressed support for the Carequality vision and mission (source)