So with CCHIT accomplishing the important work of product testing there will also need to be a trust fabric in place which will allow accreditation of validated entities. Since the Office of the National Coordinator for Health IT announced it is not currently seeking regulation of HIE and discarded its plan for enforcing Conditions of Trusted Exchange and Network Validated Entities, there has been a need for the private market to provide a voluntary mechanism for this trust fabric to flourish.

DirectTrust has stepped into fill this gap. The organization was formed by members within the Direct Project and was formerly known as the Direct 'Rules of the Road' Workgroup (disclosure: I am currently a board member of DirectTrust). DirectTrust has leadership from organizations like The American Academy of Family Physicians, Surescripts, Walgreens, Cerner, DigiCert, HealthWise, the Rhode Island Quality Institute, MedAllies and Gorge Health Connect.

Now the Electronic Healthcare Network Accreditation Commission (EHNAC) has partnered with DirectTrust to create a national accreditation program for health information service providers (HISPs). HISPs serve as the backbone of the Direct community by providing the framework for secure exchange of clinical messages. With conformance testing by CCHIT and accreditation provided by EHNAC/DirectTust, the trust fabric looks to be developing along strong lines.

Even with product testing and entity accreditation accomplished, there are still issues with identity management when trying to scale health data exchange. The National Strategy for Trusted Identities in Cyberspace (NSTIC) is a White House initiative overseen by the Department of Commerce's National Institute of Standards and Technology (NIST). NSTIC envisions an "identity ecosystem" in which technologies, policies and standards support greater trust and security when individuals, businesses and other organizations conduct sensitive transactions online.

Now five organizations have received more than $9 million in grants to pilot identity solutions that increase confidence in online transactions, prevent identity theft and provide individuals with more control over how they share their personal information. Resilient Networks will be doing two projects, one centered around health care and the other dealing with child safety online. The health care pilot, called Patient-Centric Coordination of Care, will seek to enable convenient multi-factor, on-demand identity proofing and authentication of patients, physicians and staff at a national scale. Resilient is partnering with our own Gorge Health Connect in Oregon and the San Diego Beacon Community, as well as a host of national organizations (American Medical Association, Aetna, American College of Cardiology, LexisNexis, NaviNet, Kantara Initiative and the National eHealth Collaborative, to name a few).

There also is the work of a group of state-level HIEs called the Western States Consortium, one of the projects of the State Health Policy Consortium. The purpose of the consortium is to enable safe and secure exchange of health information between and among health care providers in the western states. The Western State Consortium partners include:

    Alaska;

    Arizona;

    California;

    Hawaii;

    Nevada;