Official website of the State of California
Official website of the State of California
No, Nationwide Networks or Frameworks, including the TEFCA QHINs, are not required to sign the DxF DSA in order to be used by a DxF Participant to meet some or all of its Exchange obligations under the DxF. However, as a signatory to the DxF DSA, DxF Participants must ensure that the data sharing or other agreements they execute with any Intermediary, including a Nationwide Networks or Frameworks or QHIN, do not conflict with the DxF DSA or its P&Ps in such a way that the Participant cannot meet DxF DSA or P&P requirements.
The Department of Health Care Access and Information (HCAI) will assess any organization, including a Trusted Exchange Framework QHIN or Nationwide Network or Framework, if it applies to become a QHIO during an open application period. Only organizations that apply for QHIO status during an open application period can be granted QHIO status. QHIO application periods may be offered based on feedback from Data Exchange Framework (DxF) advisory committees.
DxF Participants are not required to use a QHIO, and may use “any health information exchange network, health information organization, or technology that adheres to [DxF] standards and policies” as stated in Health and Safety Code section 130290(a)(2). In accordance with Health and Safety Code section 130291 and the Qualified Health Information Organization Policy and Procedure, which can be found on the Policies and Procedures section of the DxF website, HCAI has created the QHIO Program as an option that may help a Participant meet their DxF obligations. It is up to the Participant to ensure that the health information exchange network, health information organization, or technology they select adheres to DxF standards and policies.
No, the DxF does not require any Access, Use, or Disclosure of Health and Social Services Information (HSSI) that would be unlawful. The DxF Data Sharing Agreement (DSA) requires Participants to share HSSI, which includes PHI and medical information, for Required Purposes, which can be found in the Permitted, Required, and Prohibited Purposes Policy and Procedure, and subject to Applicable Law. If sharing HSSI is not permitted under Applicable Law, a Participant must respond to the requestor in accordance with the Requirement to Exchange Health and Social Services Information Policy and Procedure, Section III.1. Refusing to share HSSI because it is unlawful under Applicable Law is not Information Blocking under the California Information Blocking Prohibitions Policy and Procedure.
HCAI encourages Participants to request patient Authorization to share HSSI when possible when Applicable Law does not permit sharing for a Required Purpose in the Permitted, Required, and Prohibited Purposes Policy and Procedure. Nothing in the DxF, DSA, or the Policies and Procedures (P&Ps) limits a patient’s right to decline to sign an Authorization to share their information. When it is unlawful to share information without patient Authorization and the patient did not sign an Authorization, the Participant must not share HSSI under the DxF DSA. In such instances, the DxF Participant would respond to the request for HSSI consistent with Requirement to Exchange Health and Social Services Information Policy and Procedure, Section III.1. All P&Ps listed above can be found on the Policies and Procedures section of the DxF website
The DxF requires Participants to share HSSI in accordance with federal and state law, the Data Sharing Agreement, and its Policies and Procedures. This includes any Individual consent requirements and an Individual’s right to request restrictions on how their information is Used and Disclosed that are applicable under federal and state law. The DxF does not change or supersede a Participant’s responsibility to comply with an Individual’s rights under Applicable Law or a Participant’s requirements to obtain an Individual’s consent to Access or Exchange HSSI when required by Applicable Law. If an Individual’s consent is required under Applicable Law for a Participant to share the Individual’s data, the Individual can refuse to provide such consent. Similarly, if an Individual has the right under Applicable Law to require a Participant not to share their information, the Individual can work with the Participant to exercise that right by reaching out to the Participants who Maintain their HSSI to make that request. Each Participant is responsible for ensuring all HSSI that the Participant shares through the DxF complies with Applicable Law.
Health and Safety Code section 130290 does not allow required entities listed in Health and Safety Code section 130290(f) to opt out of signing the DxF DSA.