Elements of the Common Agreement:
Stakeholder Feedback Opportunity

Elements of the Common Agreement Now Available (PDF)

Why is the Common Agreement needed?

The 21st Century Cures Act calls on the Office of the National Coordinator for Health IT (ONC) to “develop or support a trusted exchange framework, including a common agreement among health information networks nationally.”  To that end, the Common Agreement would establish the infrastructure model and governing approach for users in different information exchange networks (“networks”) to securely share clinical information with each other—all under commonly agreed-to expectations and rules, regardless of which network they happen to be in.  ONC awarded a cooperative agreement to The Sequoia Project to serve as the Recognized Coordinating Entity (RCE) to develop, update, implement, and maintain the Common Agreement.

The goal of the Common Agreement is to establish a floor of universal interoperability across the country for health care. The Common Agreement would define the baseline legal and technical requirements for secure information sharing on a nationwide scale. This would allow users in different networks to securely share clinical information with each other for specific purposes. By facilitating this exchange, the Common Agreement would create simplified connectivity for use by Individuals, health care providers, health plans, public health agencies, as well as other stakeholders.

The Common Agreement would provide the governing approach necessary to connect and scale the interconnected Qualified Health Information Networks (QHINs)—these would be health information networks that meet certain criteria to demonstrate that they can successfully support the requirements of the Common Agreement. The Common Agreement itself would be a legal agreement that the Recognized Coordinating Entity (RCE) would sign with each QHIN. The RCE would then designate QHINs following a standardized assessment process. Some provisions of the Common Agreement would flow down to Participant and Subparticipant entities via other agreements.

How is the Common Agreement being developed?

In July 2021, ONC and the RCE announced a timeline and process for publishing the Common Agreement in Q1 of 2022.

The RCE has worked closely with ONC to consider stakeholder feedback on previously released Common Agreement materials and has obtained additional feedback on specific issues. Since September 2020, the RCE has received stakeholder feedback through monthly public informational calls, stakeholder meetings, and public feedback sessions on specific topics to inform joint ONC and RCE work to develop the Common Agreement. During that time, the RCE has hosted dozens of events that engaged more than 3,000 people.

ONC and the RCE intend the Common Agreement to build on the successes of existing network capabilities and infrastructure – not replace them. The goal is to fill the gaps of cross-network exchange by keeping what works and creating alignment where there is variation.

The Elements of the Common Agreement is an overview document outlining descriptions of elements that the RCE plans to include in the Common Agreement. The Common Agreement is under development, so references to it in this overview reflect the current understanding of what it will provide. The purpose of this overview is to provide information to the public about certain topics and solicit feedback to help inform development of the Common Agreement. Furthermore, some elements of the Common Agreement will be further specified in Standard Operating Procedures (SOPs), while the QHIN Technical Framework (QTF) identifies the functional and technical requirements that QHINs must meet. The final terms of the Common Agreement may differ from the elements described below.

Elements of the Common Agreement: 

1. Definitions
2. Exchange Purposes 
3. Participants and Subparticipants
4. Required Flow-Down Provisions
5. TEFCA Information and Required Information 
6. Governing Approach to Exchange Activities Under the Common Agreement
7. QHIN Designation and Eligibility Criteria 
8. Cooperation and Nondiscrimination 
9. RCE Directory Service
10. Individual Access Services
11. Privacy and Security 
12. Special Requirements (including Consent) 
13. Fees

The Common Agreement would reference the SOPs and QTF. Attachment 1 identifies the content areas for the initial SOPs. The QTF and an associated executive summary have been published and are on the RCE’s QTF webpage. The RCE also sought stakeholder input on the QTF. 

The Common Agreement is currently under development and will be released in final form in Q1 of 2022. In preparation for release of the finalized Common Agreement, the RCE will share more details and accept input on anticipated elements of the Common Agreement through a set of feedback opportunities announced on the RCE Community Engagement webpage. The RCE is committed to understanding stakeholder perspectives, and the input gathered will inform the drafting of the final Common Agreement. Once ONC approves the final Common Agreement, it will be published publicly.

How can stakeholders provide feedback on the Common Agreement?

The RCE welcomes feedback on elements of the Common Agreement. The RCE will conduct a stakeholder engagement process that will include public webinars and website content that will enable interested parties to learn more about topics covered in the Common Agreement with opportunities to share their feedback during webinars, via email (rce@sequoiaproject.org), and via an online form on the RCE website by October 21, 2021.

The draft of the QHIN Technical Framework (QTF) and its executive summary were also published for stakeholder input and are available on the RCE’s webpage for the QTF.

The webinars on the Common Agreement will provide more information and provide an opportunity for input. The following topics will be presented:

• Change Management,
• Confidentiality and Accountability,
• Exchange Purposes and Permitted Requests,
• Fees,
• Governing Approach,
• Individual Access Services
• Permitted Uses and Disclosures,
• Privacy,
• QHIN Eligibility Criteria,
• Required Responses, and
• Security.

The RCE is committed to routinely convening stakeholders to support continued engagement. Sign up for announcements about the Common Agreement and upcoming feedback opportunities on the RCE Community Engagement webpage.