1. Aaron Seib,
CEO, NATE
California
Office of Health Information
Integrity
Robert Cothren, PhD
Institute for Population
Health Improvement,
UC Davis Health System
CMS HIE Community of Practice
September 17, 2013
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2. Agenda
First Half – NATE Overview
1 History
2 NATE‟s Origins
3 Success! The Western States Consortium Pilot
4 Incorporation
5 Growing
Second Half - NATE Programs
6 Trust Community
7 Federated Provider Directories
8 PHRs
Q&A
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3. History
• In the Spring of 2011, State Leaders on the West
Coast began to interact in relation to the ONC‟s
State HIE Grantee Cooperative Agreement
• One of the Program Information Notices (PINs)
required State Grantees to allocate resources to
“enabling interstate HIE”
• This affinity group of states collaborated on a
proposal to pilot mechanisms for multi-state
trusted exchange – resulting in a multi-state grant
award known as the Western States Consortium.
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4. The Western States Consortium
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 ONC State Health Policy Consortium Project focused on the governance
needed to facilitate and support Interstate HIE, using Direct Secure
Messaging
 Resolve policy issues, especially those related to privacy, security and
data use
 Develop standards and requirements for trusted services, beginning with
Direct Secure Messaging
 Project final report released by ONC on Healthit.gov
 Core States: Alaska, Arizona, California, Hawaii, Nevada, New Mexico,
Oregon and Utah
 Pilot States: California and Oregon
 Affiliate States: Colorado, Florida, Georgia, Idaho, Michigan, Ohio and
Washington

5. Success!
• At the end of March in 2013 we had satisfied the requirements of
our grant.
• We had established a „trust community‟ that enabled each State to
independently govern HIE within its state while facilitating cross-
boarder exchange when appropriate.
• Further we had established mechanisms to enable discovery of
providers associated with this „trust community‟ in the nations first
Federated Provider Directory.
• At the end of the grant, we asked ourselves if we should continue to
support the programs we had started.
• I think the best way to sum up the conclusion of the members at the
time was the image that was conjured up when we asked ourselves
“What if the State‟s didn‟t Collaborate on establishing HIE?”
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6. 6

7. Incorporation
 Independent non-profit organization established in Washington DC, May 2013
 Bylaws, governance body, and organizational structure being developed
 Vision: HIE Governance is the path to trusted exchange
 Mission: Initiate and/or participate in the development of national standards that
support ongoing HIE
 Member, DirectTrust (independent non-profit trade association): establishment of a
national Security and Trust Framework in support of Direct Secure Messaging
 State Level Membership
 Member States: Alaska, California, Florida, Hawaii, Michigan, Nevada, North Dakota,
Oregon and Utah
 Interested States: Arizona, Colorado, Idaho, New Mexico, and Ohio
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8. The National Association for Trusted Exchange (NATE) is the national policy
standard-setting and policy support organization created and governed by
state-designated health information exchange (HIE) officials. Through NATE,
state HIE officials establish standards and best practices, conduct peer review,
and coordinate their policy efforts to support and advance HIE. NATE staff
supports these efforts and represents the collective views of the members.
NATE members, together with the central resources of NATE, form the
national system of state-based HIE policy support.
• MEMBERS
NATE has a State based membership – with representatives appointed by
each onboarded state whose role is related to advancing, supporting and/or
regulating HIE in their respective state or territory.
• OUR VISION
A scalable, sustainable Trust and Policy framework that supports and
advances intra-state and interstate HIE.
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9. OUR MISSION
The mission of NATE is to assist state HIE officials, individually and collectively, in
serving the public interest and achieving the following fundamental HIE goals in a
responsive, efficient and cost effective manner, consistent with the wishes of its
members:
 Protect the public interest;
 Develop a roadmap that addresses and eliminates the legal, policy and technical
barriers that inhibit HIE between entities in a state and across state borders;
 Facilitate HIE Governance as the path to trusted exchange through the
convergence of disparate trust models, policies and processes;
 Collaborate with all interested participants to initiate and/or participate in the
development of HIE national standards and best practices;
 Promote the reliability and sustainability of the HIE industry; and
 Support and improve state regulation of HIE.
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10.  Collaborative relationships enabling strategic and operational coordination, while
facilitating oversight for the secure intra-state, interstate and nationwide
electronic exchange of information that supports federal and state laws
 Neutral, transparent forum that convenes State HIE leadership to address
common challenges collaboratively
• Three Primary Components:
• Defining a governance entity role and functions – establishing a convening and
coordination structure, including processes for maintaining transparency and
generating multi-stakeholder public-private collaboration
• Defining accountabilities, oversight provisions and protocols – establishing
mechanisms to ensure that the public benefit is served via national standards and HIE
best practices
• Proven approach to piloting promising practices.
HIE governance
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11. Member States Today
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12. Highlights of Current NATE Programs
• Trust Community
• Federated Provider Directories
• Consumer Engagement
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13. Trust Communities
• Trust
Trusted exchange among unaffiliated organizations (across state lines).
• Scalable Trust
Trusted exchange among unaffiliated organizations (across state lines)
without point-to-point data sharing agreements.
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14. What do you need for trusted exchange?
 Know your conversation is not overheard.
 Know who you are talking to.
 Know who you are talking about.
 Know there is consent for your conversation.
Context: Supporting and promoting inter-organizational exchange
across state lines.
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15. NATE Trust Community
Policies, practices, and technologies…
…that enable and promote trusted exchange…
…among unaffiliated organizations…
…across state lines…
…without the need point-to-point data sharing agreements.
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16. 1. Create Usable Policies
• Based on eligibility criteria for members of the trust community
http://nate-trust.org/work-products/
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17. 2. Create the Trust Community
• Trust Community – A collection of organizations that elect to adopt a
common set of policies and practices in regard to health information
exchange.
• Trust Profile – A set of policies and practices corresponding to a specific
health information exchange purpose or use.
• Trust Bundle – The Trust Anchor certificates for members of a Trust
Community for a specific Trust Profile.
The Trust Bundle is a scalable means for identifying entities that have
agreed to a standard of good behavior.
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18. Trust Bundles
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http://bundles.hiecosystem.net/nate/
Trust
Bundles

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20. 3. Find the Right Provider
• Federated Provider Directories
…based on emerging HPD standards
http://cheq.wikispaces.com/Directory+Services
http://modularspecs.siframework.org/Provider+Directories+Homepa
ge
…managed by the organizations that know the right information
…so the data is accurate.
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22. 22
Regional HISP Regional HISP
Regional HISP
CA State Directory OR State Directory
State HISP
AK State Directory
State HISP
Eachstateknowshowto
queryeachotherstate.
Complexitywithinastateishidden.

23. Next: Communicating with Consumers
• Addressing a need for bi-directional exchange.
• Investigating the use of both tethered and untethered PHRs which
have different regulatory issues.
• Depending upon the use of Direct – therefore, Direct-enabled
PHRs.
• The plan: Follow the path we have established for provider-to-provider
exchange.
• Establish policies and practices for provider-to-patient and patient-
to-provider exchange.
• Create Trust Profiles and Trust Bundles for provider-to-patient and
patient-to-provider exchange.
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24. Emerging Bundle Configuration
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Provider
HISP
Provider
HISP
Current
Bundle
Direct-
enabled
PHR
New Bundle:
Consumer-to-provider exchange
New Bundle:
Provider-to-consumer exchange

25. All Using National Standards
• Exchange using Direct
Compliant with the Applicability Statement for Secure Health
Transport version 1.1
• Certificate management using Trust Bundles
Compliant with the Implementation Guide for Direct Project Trust
Bundle Distribution version 1.0
• Address discovery using Federated Provider Directories
Compliant with Healthcare Provider Directory specification (as
amended in 2013)
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26. Thank You!
www.NATE-trust.org 26