Trust Community Package Direct Project IGW Sub-Workgroup

1. Trust Community PackageDirect Project IGW Sub-Workgroup January 10, 2013

2. Reminders / Announcements • This meeting is being recorded. If you don’t wish to be recorded, please either remain silent or hang up now. • If you’re not speaking, please mute your line. • But, please don’t put us on hold (though dance breaks are fun). • Happy 2013!

3. Why Scalable Trust -- What Issues Are We Trying to Solve? • Current Direct deployments are “islands of exchange” limited to single HISPs or supported by HISP to HISP business agreements • What’s the problem? • Don’t easily know which HISPs to trust • Don’t have common business/technical mechanisms for establishing trust • This is an urgent issue as the current deployment model does not support our goals of ubiquitous directed exchange to meet stage two of meaningful use • Trust communities have emerged to address these issues, urge adoption of solutions across participants and avoid/limit the need for peer to peer agreements • If these trust communities place different requirements on HISPs, healthcare providers and/or their patients may still find it difficult to engage in secure, directed health information exchange

4. Direct Project Workgroup Ground Rules • Presume good intentions • Help group stick to goals and principles • If you raise a problem, propose a solution • Keep it simple -- minimum necessary • Don’t let the perfect be the enemy of the good enough • Have fun!

5. What is Scalable Trust? An efficient means of enabling Direct exchange between participants on disparate HISPs. Fundamentally, it is predicated on two things: • Common trust frameworks / policies • Technical mechanisms to automate trust between framework participants

6. Scalable Trust in “Three Easy Steps” • Trust Organization defines requirements for participation • Trust Organization enrolls/accredits/certifies entities to be included in an Trust Anchor Bundle • Trust Organization enables mechanism for electronic distribution of Trust Anchor Bundle to all members

7. Example of Scalable Trust Model Trust Organization Centralized Trust Anchor Bundle Store Provider B HISP A HISP B Provider A

8. Example of Scalable Trust Model: New HISP Joins Trust Organization Trust Organization Centralized Trust Anchor Bundle Store Provider B HISP A HISP B Provider A Provider C HISP C

9. What’s needed to make this work? • At the Direct Scalable Trust Forum, we discussed… • Peer to peer agreements between HISPs is not an ideal approach to support ubiquitous directed exchange • What set of elements would be required in a Trust Community to avoid/reduce this need? The proposed/potential list included… • BAA between end-user and HISP • Transparency re: data access / use provisions • Accreditation process for HISPs • Auditing / enforcement of ongoing conformance • Dispute resolution process between HISPs • Trust community federated legal agreement (potentially) • The mission of this workgroup is to 1) clarify if these are the right elements, and 2) provide additional detail (minimum specifications) for these elements, as/if deemed necessary