On the specific issue of enforcing compliance with the Common Framework:

• The Common Framework, and mechanisms to enforce compliance with it or other applicable standards and policies will be an essential condition of the development of the Health Information Environment. The Common Framework ensures the creation, interoperability, scalability, efficiency and ongoing evolution of this environment. Mechanisms to test and validate compliance may be necessary in several domains, including the "highest" or network environment level, the sub-network level, and the level of end point applications (e.g., EHRs). Validation methodologies should be appropriate to the information exchange, requiring only the elements and protocols essential to participation in the Health Information Environment, in a way that encourages innovation and new entrants to the market.
• An external mechanism for validating compliance with the standards of the Common Framework is required for the early phases, but the network may eventually become entirely self-validating. There is uncertainty about how long the outside compliance validation mechanism may be necessary—until the point at which there is a significant level of stability in the Health Information Environment. From the beginning, self-assessment should be built into the compliance validation mechanism because it helps to assure that programs are on track on a continuous basis, rather than waiting for an outside party to identify significant problems.
• Interface and transaction interoperability standards should allow for the appropriate and authorized integration of financial transaction information with related clinical transactional data.
• The Health Information Environment is inclusive of participants of varying levels of technical and functional sophistication. Its standards, rules and vocabularies can accommodate a wide variety of participants at any one time and can also be revised over time as user requirements evolve.