This paper is an introduction to the Common Framework that puts it into context. It tells you how the Common Framework evolved from the Roadmap report (PDF, 8.0 MB) and a set of policy and technology principles, and how it has been tested in three communities via a Connecting for Health prototype. Download the paper below.

A foundational policy architecture for privacy and health information technology in a networked environment, based on nine principles. The Connecting for Health approach dictates that these nine principles be balanced together and considered as part of one package - elevating certain principles over others will weaken any overall architectural solution to privacy protection in a networked health information environment.

Model privacy policies designed as a starting point for those working to establish sub-network organizations that will utilize a Record Locator Service. The policies establish baseline privacy protections designed to apply to all individuals receiving care from an institution participating in a SNO. The model policies and procedures are intended to accompany and complement the "Model Contract for Health Information Exchange." Issues addressed in the document include, inter alia, policies regarding acceptable uses and disclosures of individual health care information, ensuring individual participation in and control of their health information, and how to handle individual health information that may be subject to special protections.

Recommended policies for what an institution or provider participating in the Record Locator Service should be required to do to inform patients and give them the ability to decide not to be listed in the index, consistent with the privacy principles articulated in "The Connecting for Health Architecture for Privacy in a Networked Health Information Environment."

A review of methods for optimizing the likelihood of finding as many of a patient's records as possible through the Record Locator Service, while minimizing false matches. False matches, in which records associated with one patient are erroneously linked to another patient, can result in "incidental disclosures" of information, which compromise patient privacy. The policies addressed also include whether and how such incidental disclosures should be handled under the Connecting for Health Common Framework.

Recommended approaches for SNO participants to establish user identity for the purpose of access to health information.

The discussion includes a review of the state of the current law on individuals' access to their own health care information and then makes recommendations regarding such policies in the context of a Record Locator Service and a health information sharing environment.

The advantages and disadvantages of audit logs, some criteria for successful audit logs, and issues that sub-network organizations should consider in implementing successful audit systems.

Recommended policies for addressing breaches in confidentiality of personal health information.

This document has been republished as part of the Common Framework for Networked Personal Health Information.

Go to the Consumer Common Framework

A high-level description of the technical philosophy embodied in the Connecting for Health Prototype. This document discusses the basic design principles adopted by Connecting for Health, the technical constraints governing the work, what subsequent choices were made, and why those choices were made.

The core technical document, governing the message standards required for exchange of Common Framework-compliant messages between participating entities within a SNO, and exchange of messages between entities in different SNOs. This document covers the design of the standard messages used in network communication, as well as the operation names used to invoke the required services, and the design of the Patient Identification segment used in queries for patient data. In addition, access to the technical code and test servers created for the prototype are available here.

The standards for expressing a patient's medication history. The exchange of medication history was one of two use cases tested in the prototype; we adopted a version of the NCPDP-proposed standard. There is considerable work on medication history standards, and we anticipate that there will be future changes to this standard in the near term. Because the Common Framework maintains a separation between data description and transport, updates to the medication history standard will not require re-engineering the network to accommodate the new standard.

Describes desired future changes to the Laboratory Results Standard to make it more compatible with a multi-use networked environment. Includes a web link to the Laboratory Results Standard used in exchanges of data in the prototype test (proposed ELINCS 2.0 standard). There is considerable work on lab results standards, and we anticipate that there will be future changes to this standard in the near term. Because the Common Framework maintains a separation between data description and transport, updates to the lab results standard will not require re-engineering the network to accommodate the new standard.

A review of the issues raised by dirty, incomplete, and inaccurate healthcare data, and mechanisms that could be developed and implemented to address these issues. This framework also describes the importance of establishing accountability among those responsible for the reliability of data.

Discussion of the technical and design issues of the Record Locator Service, as constructed in Massachusetts. Provides background on the initial technical conversations; the current state of the architecture is documented in "The Common Framework: Technical Issues and Requirements for Implementation" and "Health Information Exchange: Architecture Implementation Guide."

This document has been republished as part of the Common Framework for Networked Personal Health Information.

Go to the Consumer Common Framework

A brief overview of the elements covered in the full "Model Contract for Health Information." It is intended to provide a general approach to the issues that health information sharing networks must address to increase the likelihood of success of their own electronic health information exchanges.

A model contractual agreement containing sample language and descriptive notes regarding issues that both regional and affinity-based networks must address to increase the likelihood of success of their own electronic health information exchanges. The Model addresses such contractual topics as the implementation of user agreements, general disclaimers, insurance requirements, and enforcement requirements.

The Model is intended to assist in the organization of a SNO by providing a basis upon which to begin drafting that SNO's Terms and Conditions. All language provided in the Model is intended for illustrative purposes only. Each SNO will have to draft its Terms and Conditions based upon its own organization, operations, system and services, regulatory environment, etc. Some of the Model's terms will be inapplicable to some SNOs. The Model shows where some of these variations might be expected to occur.