On the specific issue of interoperability:

• The interoperability of the Health Information Environment is premised on conformance to a Common Framework, which consists of the essential technical and policy requirements to enable the interoperation of standard interfaces and transactions at the local, regional and national level.
• Without this, every entity that has to interact with the network will be unable to do so reliably and consistently—multiple and differing approaches to core aspects at the regional level would create undue burden on patients and providers that cross sub-networks, public and private payers, large delivery organizations, labs, PBMs, pharmacy chains, vendors who supply applications, etc.
• The technical standards address secure transport over the Internet and other networks, and provide the essential required components for the infrastructure including secure connectivity, reliable authentication and a suite of defined interchange formats for health care data.
• The policy standards address the privacy, security and use and access policies for the exchange of health information.
• The Common Framework also provides a uniform methodology for the identification of users.
• The modular character of the Common Framework permits rapid attainment of an interoperable information environment using essential requirements but also scales to a more complete structured data interchange for enhanced performance. The suite of interoperability standards will be enhanced over time.
• The Common Framework is the basis of all subsequent use cases that require specific, uniform interoperable standards to support information exchange. Use cases and accompanying information standards will be specified for each of the myriad of health information exchange requirements and will be supported by detailed implementation guides.
• The participants in sub-networks will determine which profiles are appropriate to address the requirements established by their stakeholders.
• The Common Framework, and mechanisms to enforce compliance with it, ensures the creation, interoperability, scalability, efficiency and ongoing evolution of this environment.
• This work will necessarily involve choices that eliminate some of the variability in the standards while attaining interoperability.
• The Common Framework enables a set of open, non-proprietary interfaces and information transfer protocols to be developed to achieve interoperability. This also permits less standardized records to be accessed reliably and rapidly; it facilitates the best possible interoperability among end-points systems of differing levels of sophistication.
• The Common Framework relies upon standards for data content and transmission developed by nationally accredited organizations using an open and consensus-based process. It builds upon existing standards development activity and HIPAA.
• The Common Framework should be required across all health communities, including the clinical research community, public health, etc.