On the specific issue of technical openness and flexibility:

• The Common Framework does not dictate, recommend or imply specific tools, platforms, products, or vendors. Access to the Record Locator Service and other functions of the environment requires conformance to the Common Framework. Without this, every entity that has to interact with the network would be unable to do so reliably and consistently—multiple and differing approaches to core aspects at the regional level would create undue burden on public and private payers, large delivery organizations, labs, PBMs, pharmacy chains, vendors who supply applications, etc.
• While the Health Information Environment is built using the existing Internet, it has to anticipate and take advantage of migration to next generation technology, which will include better and different approaches to ensuring privacy and security and performing other functions.
• The Health Information Environment must have a wide variety of capabilities as articulated in question 1 (e.g. consumer, provider, research, and public health).
• The Health Information Environment is flexible in several ways. First, it is heterogeneous with regard to the types of technology and function of the sub-networks and other entities that use it, providing that all of them adhere to the Common Framework. This enables users of varying levels of technical and functional sophistication to use it for a variety of processes. Second it is flexible in that it facilitates communication among end-point systems at varying levels of sophistication in the structured and coded representation of data and supports the evolution of systems in this regard. For example, while some might use the Health Information Environment to locate records and request them by telephone, others may draw on it to support the full electronic exchange of highly structured data for sophisticated data analysis and decision support. This is necessary because health information will continue to be a mix of unstructured and structured and coded data. The Common Framework provides standards and procedures that allow two systems that support highly coded data to exchange it without loss of data, a system that supports less or little coding to receive information from comparable and from highly structured systems, and a system that supports a high level of coding to receive, file, and make use of lightly coded data when this comes from another system. Lastly, the Health Information Environment is flexible also in that it is able to evolve over time to address the changing needs of users and to increase in scale as the numbers of users and their transactions grow; it supports a reasonable level of variation and innovation in response to local needs.