Databases Reference
In-Depth Information
securely transmit and receive protected health information. The certifi-
cate guarantees that users will abide by a set of rules that create a circle of
trust (Housley et al., 1999; Giles, 2012). Users connect through a Health
Information Service Provider (HISP) that maintains the certificate author-
ity for each participant. The HISP also maintains a Provider Directory to
allow providers to locate the NwHIN Direct address of any other physi-
cian participating in the email network.
Both of these approaches are covered under the governance oversight
of the state-level HIEs, but the patient lookup model is generally the
center of governance attention and drives decisions on data sharing and
patient authorization requirements. The secure messaging model is often
equated with the direct physician-to-physician communication of a fax
used for treatment purposes (Health IT Policy Committee, 2010a), while
health information exchange is associated with the need for patient con-
sent and enhanced security to maintain the privacy and confidentiality
of patient records.
VALUES OF GOVERNANCE
IN HEALTH INFORMATION EXCHANGE
Following the passage of the American Recovery and Reinvestment Act
in 2009, a nationwide project was initiated to build an HIE infrastructure
that would support the exchange or records for the coordination of care
all across the United States. One of the key actions of ARRA for building
this nationwide network was to require each state government to estab-
lish a “state-designated entity.” These organizations would be responsible
for managing the funding for state-level HIEs provided in the act and for
engaging resources within the state to actually construct the HIE infra-
structure. With this action, the federal government passed the role of
HIE governance to the states. Following ARRA, ONC launched the HIE
Cooperative Agreement Program for state-level HIEs and governance of
HIEs by the state-designated entities became an important state issue.
Governance of local HIEs is manageable, because many of the healthcare
stakeholders are familiar with each other. At the state level, governance
takes on greater complexity in part because the diversity of stakeholders
can increase substantially, especially in large states, and the effort to foster
collaboration and data sharing increases exponentially.
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