Key Resources

 

Additional Resources

The Markle Common Framework helps health information networks to share information among their members and nationwide while protecting privacy and allowing for local autonomy and innovation. It consists of a set of 17 mutually-reinforcing technical documents and specifications, testing interfaces, code, privacy and security policies, and model contract language.

It was developed by experts in information technology, health privacy law, and policy. It has been tested since mid-2005 by Markle Connecting for Health prototype teams in three states: California, Indiana, and Massachusetts. Each of the three prototype communities has made available its source code and testing interface.

Click on the document titles below to download a PDF of information for a specific item.

  • Markle Common Framework: Overview and Principles

    This paper is an introduction to the Markle Common Framework that puts it into context. It tells you how the Markle Common Framework evolved from the Roadmap report and a set of policy and technology principles, and how it has been tested in three communities via a Markle Connecting for Health prototype. Download the paper below.

    • Policy Guides: How Information is Protected
      • P1 The Architecture for Privacy in a Networked Health Information Environment

        A foundational policy architecture for privacy and health information technology in a networked environment, based on nine principles. The Markle Connecting for Health approach dictates that these nine principles be balanced together and considered as part of one package - elevating certain principles over others will weaken any overall architectural solution to privacy protection in a networked health information environment.

      • P2 Model Privacy Policies and Procedures for Health Information Exchange

        Model privacy policies designed as a starting point for those working to establish sub-network organizations that will utilize a Record Locator Service. The policies establish baseline privacy protections designed to apply to all individuals receiving care from an institution participating in a SNO. The model policies and procedures are intended to accompany and complement the "Model Contract for Health Information Exchange." Issues addressed in the document include, inter alia, policies regarding acceptable uses and disclosures of individual health care information, ensuring individual participation in and control of their health information, and how to handle individual health information that may be subject to special protections.

      • P3 Notification and Consent When Using a Record Locator Service

        Recommended policies for what an institution or provider participating in the Record Locator Service should be required to do to inform patients and give them the ability to decide not to be listed in the index, consistent with the privacy principles articulated in "The Markle Connecting for Health Architecture for Privacy in a Networked Health Information Environment."

      • P4 Correctly Matching Patients with Their Records

        A review of methods for optimizing the likelihood of finding as many of a patient's records as possible through the Record Locator Service, while minimizing false matches. False matches, in which records associated with one patient are erroneously linked to another patient, can result in "incidental disclosures" of information, which compromise patient privacy. The policies addressed also include whether and how such incidental disclosures should be handled under the Markle Connecting for Health Common Framework.

      • P5 Authentication of System Users

        Recommended approaches for SNO participants to establish user identity for the purpose of access to health information.

      • P6 Patients' Access to Their Own Health Information

        The discussion includes a review of the state of the current law on individuals' access to their own health care information and then makes recommendations regarding such policies in the context of a Record Locator Service and a health information sharing environment.

      • P7 Auditing Access to and Use of a Health Information Exchange

        The advantages and disadvantages of audit logs, some criteria for successful audit logs, and issues that sub-network organizations should consider in implementing successful audit systems.

      • P8 Breaches of Confidential Health Information

        Recommended policies for addressing breaches in confidentiality of personal health information.

      • P9 A Markle Common Framework for Networked Personal Health Information

        Explains why consumer participation can be transformative, why networked PHRs empower consumers, and how policies can guide an emerging industry; also presents how Consumer Access Services can fit within the Markle Connecting for Health approach for health information sharing efforts.

      • Future Policy Guides
    • Technology Guides: How Information is Exchanged
      • T1 The Markle Common Framework: Technical Issues and Requirements for Implementation

        A high-level description of the technical philosophy embodied in the Markle Connecting for Health Prototype. This document discusses the basic design principles adopted by Markle Connecting for Health, the technical constraints governing the work, what subsequent choices were made, and why those choices were made.

      • T2 Health Information Exchange: Architecture Implementation Guide

        The core technical document, governing the message standards required for exchange of Markle Common Framework-compliant messages between participating entities within a SNO, and exchange of messages between entities in different SNOs. This document covers the design of the standard messages used in network communication, as well as the operation names used to invoke the required services, and the design of the Patient Identification segment used in queries for patient data. In addition, access to the technical code and test servers created for the prototype are available here.

      • T3 Medication History Standards

        The standards for expressing a patient's medication history. The exchange of medication history was one of two use cases tested in the prototype; we adopted a version of the NCPDP-proposed standard. There is considerable work on medication history standards, and we anticipate that there will be future changes to this standard in the near term. Because the Markle Common Framework maintains a separation between data description and transport, updates to the medication history standard will not require re-engineering the network to accommodate the new standard.

      • T4 Laboratory Results Standards

        Describes desired future changes to the Laboratory Results Standard to make it more compatible with a multi-use networked environment. Includes a web link to the Laboratory Results Standard used in exchanges of data in the prototype test (proposed ELINCS 2.0 standard). There is considerable work on lab results standards, and we anticipate that there will be future changes to this standard in the near term. Because the Markle Common Framework maintains a separation between data description and transport, updates to the lab results standard will not require re-engineering the network to accommodate the new standard.

      • T5 Background Issues on Data Quality

        A review of the issues raised by dirty, incomplete, and inaccurate healthcare data, and mechanisms that could be developed and implemented to address these issues. This framework also describes the importance of establishing accountability among those responsible for the reliability of data.

      • T6 Record Locator Service: Technical Background from the Massachusetts Prototype Community

        Discussion of the technical and design issues of the Record Locator Service, as constructed in Massachusetts. Provides background on the initial technical conversations; the current state of the architecture is documented in "The Markle Common Framework: Technical Issues and Requirements for Implementation" and "Health Information Exchange: Architecture Implementation Guide."

      • T7 Consumer Authentication for Networked Personal Health Information

        Republished as CT2: Authentication of Consumers for the Markle Common Framework for Networked Personal Health Information, which provides a framework for establishing and confirming the identity of individual consumers so that they may participate on a network.

      • Future Technical Guides
  • Model Contractual Language
    • M1 Key Topics in a Model Contract for Health Information Exchange

      A brief overview of the elements covered in the full "Model Contract for Health Information." It is intended to provide a general approach to the issues that health information sharing networks must address to increase the likelihood of success of their own electronic health information exchanges.

    • M2 A Model Contract for Health Information Exchange

      A model contractual agreement containing sample language and descriptive notes regarding issues that both regional and affinity-based networks must address to increase the likelihood of success of their own electronic health information exchanges. The Model addresses such contractual topics as the implementation of user agreements, general disclaimers, insurance requirements, and enforcement requirements.

      The Model is intended to assist in the organization of a SNO by providing a basis upon which to begin drafting that SNO's Terms and Conditions. All language provided in the Model is intended for illustrative purposes only. Each SNO will have to draft its Terms and Conditions based upon its own organization, operations, system and services, regulatory environment, etc. Some of the Model's terms will be inapplicable to some SNOs. The Model shows where some of these variations might be expected to occur.

 

©2006-2011, Markle Foundation

These works were originally published as part of the Markle Connecting for Health Common Framework: Resources for Implementing Private and Secure Health Information Exchange. They are made available free of charge, but subject to the terms of a License. You may make copies of these works; however, by copying or exercising any other rights to the works, you accept and agree to be bound by the terms of the License. All copies of these works must reproduce this copyright information and notice.