Commercialization — While the development of some commercial applications that are integrated into the Health Information Environment is desirable and should be encouraged, it is important to differentiate and constrain those commercial uses that may hamper the ability of providers and patients to gain maximum benefit from access to clinical information, or compromise their trust. The Health Information Environment should not be used as a method to selectively steer commercial interests to the point of care in an unrestricted way or in a way that alters the neutrality of the infrastructure. Which types of commercial activity based on the Health Information Environment should be discouraged? Who should decide and how should this decision be enforced?
Finance — What is the best financial model to support the development and maintenance of the Health Information Environment? How should public and private funds be allocated? How should incentives for use of the environment be structured? What is the best model to support traditionally underserved communities?
Patient Control/Education — What are the implications of patient control of health information? What are the best ways to educate the public about how to use health information and ensure that patient consent to information exchange is meaningful? How should the public understand or engage with the Record Locator Service? What process and / or entities should carry out patient education, and how can multiple efforts best be coordinated?
Reconciliation of Potentially Conflicting State Laws — How do some state laws impede our ability to achieve vital national objectives? How should differences in state laws regarding access to or use of health information be addressed? What are the sources of leadership for reconciling state and federal legislation?
Standards and Policy Entity — The SPE may be an existing organization or a new organization modeled after other quasi-governmental or public-private organizations. Immediate, near-term efforts need to include an analysis of both the public and private sectors for viable models. These efforts should be completed in no more than one year. The analysis of organizational models could be conducted by the Institute of Medicine (IOM), an agency of the NRC such as the CSTB, a new specially appointed Commission/Task Force, or other existing entity with the appropriate stature and credibility.
Validation of Conformance and Interoperability — What processes should be used for validating compliance with the Common Framework? Should the mechanism be persistent? How should compliance be enforced?
