ONC Issues Governance Framework for HIEs

The Office of the National Coordinator for Health IT (ONC) has developed the Governance Framework for Trusted Electronic Health Information Exchange that healthcare organizations and physicians can use to align their health information exchange systems. The governance framework establishes “a common set of behaviors, policies, and standards that enable trusted electronic health information exchange among a set of participants,” according to the Health Information Exchange Governance website.

The framework discusses four key categories of governance principles:

  1. Trust Principles: Guide health information exchange governance entities on patient privacy, meaningful choice, and data management in health information exchange
  2. Business Principles: Focus on responsible financial and operational policies for governance entities, with emphasis on transparency and health information exchange with the patients best interests in mind
  3. Technical Principles: Express priorities for the use of standards in order to support the Trust and Business Principles, as well as furthering the execution of interoperability
  4. Organizational Principles: Identify generally applicable approaches for good self-governance.


“We’ve published this framework to provide a common foundation for all types of governance models,” said Farzad Mostashari, MD, the national coordinator for health information technology, in a Healthcare IT News article. In essence, the Governance Framework for Trusted Electronic Health Information Exchange lays out guidelines that HIE entities can follow when looking to align their work with national priorities.

The governance model was developed in response to a request for information issued by ONC in 2012 that aimed to gather public input on a potential regulatory approach that would have spelled out “conditions for trusted exchange” like safeguards, technical, and business practices through formal rulemaking.

After receiving comments from some industry stakeholders opposing governance regulations, ONC “decided not to continue with the formal rulemaking process and instead implement an approach that provides a means for defining and implementing nationwide trusted exchange with higher agility, and lower likelihood of regret,” Mostashari said on a blog post announcing the new governance framework. That new approach is the governance framework.

ONC will also establish a program to monitor alignment with the governance goals outlined in the framework.

“It is critical that we are all working from a similar understanding of the expectations for nationwide electronic health information exchange. This Framework is an important step to set that direction,” Mostashari said.

For additional information regarding the ONC approach to health information exchange governance, visit http://www.healthit.gov/HIEgovernance.

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