The Health Information Environment will grow incrementally with the creation and expansion of sub-networks:

• Stakeholder trust and patient care needs will drive the formation and evolution of sub-networks.
• The Health Information Environment will be developed through a combination of "top-down" (i.e., nationally-defined) policies and standards, and "bottom-up" (i.e., community and market-driven) initiatives.
• Development of the Health Information Environment MUST be facilitated and supported by:
  • Ensuring that all sub-networks conform to the Common Framework, in order to interconnect with each other in a consistent and uniform manner.
  • Early demonstration of the ability to effectively exchange usable patient information within and among sub-networks.
  • Early establishment of a Reference Implementation Process on a significant scale to reliably and quickly develop the technical and policy requirements for the Common Framework. The first formal version of the Common Framework will be completed after learning from this process and will serve as a basis for others.
  • The accuracy, responsiveness, security, and scalability of the system as demonstrated by the Reference Implementation Process, which will foster broader implementation by vendors, and accelerate deployment in sub-networks. The same cycle will need to be repeated as the Common Framework is extended.
  • The Standards and Policy Entity (SPE), which, when it is established, will take over primary responsibility for the development of the Reference Implementation Process and policies of the Common Framework.
  • Subsequent reference implementations that define the profiles or suites of standards for a complete set of use cases that will also be a primary responsibility of the Standards and Policy Entity (SPE).