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What is the Data Exchange Framework?

Every Californian, no matter where we live, should be able to walk into a doctor’s office, a county social service agency, or an emergency room and be assured health and human services providers can access the information they need to provide safe, effective, whole person care—while keeping our data private and secure. 

This is the goal of California’s Health and Human Services Data Exchange Framework, a first-ever, statewide data sharing agreement that will accelerate and expand the exchange of health information among health care entities, government agencies, and social service programs beginning in 2024.

The data exchange framework is not a new technology or centralized data repository; instead, it’s an agreement across health and human services systems and providers to share information safely. That means every health care provider can access the information they need to treat you quickly and safely; health care, behavioral health and social services agencies can connect to each other to deliver what Californians need to be healthy; and our public health system can better assess how to address the needs of all communities.

Hundreds of experts and members of the public have spent the last year shaping a framework that delivers on these principles. On this website, learn more about the progress toward seamless data exchange that will improve Californians’ experience of health care, support California’s whole-person care transformation, and put consumers in the drivers’ seat with our health data.

On July 5, 2022, CalHHS released the Data Exchange Framework, Data Sharing Agreement, and initial set of Policies and Procedures. Please see the Data Exchange Framework section for more information. View the Executive Summary.

Take Action

The Data Exchange Framework (DxF) is an opportunity to create equitable and affordable health information exchange, so that patients, providers, and other healthcare entities can access the health information they need, wherever they are and whenever they need it.

The DxF DSA Signing Portal is now open for providers and healthcare entities to take the first step for better health information exchange. The DSA is a signed agreement between hospitals, physician organizations and medical groups, skilled nursing facilities, health plans and disability insurers, clinical laboratories, and acute psychiatric hospitals to share patient information safely.

California Health and Safety code requires most providers and healthcare entities to sign the DSA by January 31, 2023.

Take the first step today. Visit the CalHHS Data Sharing Agreement Signing Portal to sign the DSA. 

In the News

Health facilities to start sharing patient data with each other

  • Hospitals, public health agencies and other providers have no systematic way to share patient data among themselves, limiting their ability to monitor trends and work efficiently. Under the state’s new data-sharing requirement, a doctor or case worker could get immediate access to a patient’s full medical history, and patients could view their own records easily. Read more in this article from CalMatters.

A secure, trusted system of data exchange

  • “California has long been a leader in transforming health care, expanding coverage and improving access to care and social services for its residents. But to be successful, all of these initiatives require a reliable, secure, trusted system of data exchange so patients and providers can access the health information they need, wherever they are and whenever they need it.” Read more in this San Francisco Chronicle op-ed from Dr. Sandra Hernádez, CEO of the California Health Care foundation and HHS Data Exchange Framework Stakeholder Advisory Group Member.

Supporting whole-person care, health equity 

  • At the core of the data exchange vision is an “emphasis on health equity and center our health information efforts on the needs of Californians.” Read more in this California Health Care Foundation blog from John Ohanian, chief data officer and director for the Center for Data Insights and Innovation Office.
  • “This framework will be a pillar of support to our health system’s transition to providing whole-person care that addresses social determinants of health. It will be essential to the success of the state’s expansion of integrated care in Medi-Cal, to our major new homelessness initiatives, and to dozens of programs aimed at connecting health and social services, from the Cradle-to-Career California Data System to the Master Plan for Aging.” – Read more in this California Health Care Foundation blog from John Ohanian, chief data officer and director for the Center for Data Insights and Innovation Office.

Expert stakeholder advisory group 

  • News release announcing the formation of the Data Exchange Framework Stakeholder Advisory Group

Timeline

Initial Data Exchange Framework

By July 1, 2022, the state will establish a single Data Sharing Agreement and common set of policies and procedures that will govern and require the exchange of health information among health care entities and government agencies in California. This effort will be guided by a Stakeholder Advisory Group, which will provide information and advice to CalHHS.

Public health/social services integration

By January 31, 2023, CalHHS and the California State Association of Counties will encourage as many county health, public health, and social services providers to connect to the Data Exchange Framework—with all state and local public health agencies exchanging health information in real time with participating health care entities.

Data Sharing Agreement

By January, 31, 2023, the Data Exchange Framework data sharing agreement will be executed by the following entities: General acute care hospitals, physician organizations and medical groups, skilled nursing facilities, health service plans and disability insurers, Medi-Cal managed care plans, clinical laboratories, and acute psychiatric hospitals.

Data Exchange Framework Grant Program

The Data Exchange Framework (DxF) Grant Program launched in October 2022 to help health and human services providers and other healthcare entities understand and implement DxF requirements. There are three core grant opportunities to address areas where resources are required to support broad DxF implementation.

Full implementation

By January 31, 2024, all participating entities will exchange health information or provide access to health information to and from every other entity in real time for treatment, payment, or health care operations.

Context

While parts of California’s health care system rely on coordinated, interoperable electronic systems, other parts rely on decentralized, manual, and siloed systems of clinical and administrative data exchange that is voluntary in many situations. This voluntary patchwork imposes burdens on providers and patients, limits the health care ecosystem from making material advances in equity and quality, and functionally inhibits patient access to personalized, longitudinal health records. Further, a lack of clear policies and requirements to share data between payers, providers, hospitals, and public health systems is a significant hindrance to addressing public health crises, as demonstrated by challenges inherent to the COVID-19 pandemic.

Despite the widespread availability of secure electronic data transfer, a small but important minority of Californians’ medical information is stored or shared on paper. When that medical information is shared between providers, much of it happens by mail, fax, or, most likely, by the patients themselves, who frequently carry their records from appointment to appointment. While electronic health information exchange cannot replace provider-patient communication, it can greatly improve the completeness of patient records, which has a significant effect on health and wellness outcomes, as past history, current medications, and other information are jointly reviewed during appointments.

Social and economic factors distinct from medical care are powerful predictors of health outcomes and disease burden throughout a person’s life. From a population health perspective, this means that evidence-based policies that affect the broader conditions in which people are born, grow, and live can exert a powerful influence on health and well-being. From an operational perspective, data-driven efforts to better coordinate human and social supports with the medical and health care sectors provide opportunities to deliver services that are more client centered, efficient, effective, and tailored.

Data Exchange Framework

 

On July 5, 2022, CalHHS released the Data Exchange Framework, Data Sharing Agreement, and initial set of Policies and Procedures. Documents can be found in the respective tabs of this section. More information for signatories of the Data Sharing Agreement, including information on agreement execution, will be available on this webpage later this year (2022).

 

The Data Exchange Framework (DxF) Grant Program launched in October 2022 to help health and human services providers and other healthcare entities understand and implement DxF requirements. There are three core grant opportunities to address areas where resources are required to support broad DxF implementation.

Public Comment

 

The CalHHS Center for Data Insights and Innovation (CDII) has released four new draft Policies and Procedures (P&Ps) and one modified P&P for the Data Exchange Framework’s (DxF) Data Sharing Agreement (DSA) for public comment:

  • [New] California Information Blocking Prohibitions
  • [New] Technical Requirements for Exchange
  • [New] Real-Time Exchange
  • [New] Early Exchange
  • [Amended] Privacy Standards and Security Safeguards

Earlier drafts of these P&Ps were discussed at CalHHS DxF Implementation Advisory Committee (IAC) and DSA P&P Subcommittee meetings, where feedback was received and incorporated from committee members and the public. CDII is now seeking broader public comment on the draft P&Ps by Tuesday, February 14, 2023.

CDII is additionally releasing a list of questions for public input to accompany the release of the P&Ps for public comment. CDII seeks public input on the listed questions to inform future version(s) of the P&Ps. Please note that CDII appreciates all comments and recommendations and invites comments on other components of the P&Ps not addressed by the questions listed in this document. Please note, for the amended Privacy Standards and Security Safeguards P&P, CDII is only soliciting comments on the highlighted sections which indicate changes made to the version released in July 2022.

The DxF Comment Template is CDII’s preferred method for the creation and submission of your comments. Additional details with guidance on how to prepare and transmit comments are provided below.

CDII asks that comments delivered in alternative formats meet Web Content Accessibility Guidelines. Specifically, CDII requests that commenters refrain from submitting comments in tracked-changes format or as a document with in-text comments. The California Department of Rehabilitation has created Web Accessibility Toolkit to serve as a resource for meeting accessibility guidelines.

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1. Structure of the Comment Template
The DxF Comment Template contains six worksheets that include “locked” cells shaded in grey with instructions and “open” cells shared in green for your comments on the applicable DxF documents.

Each worksheet has a header row with instructions and examples in the third row shaded in grey. Additional information on the worksheets and their contents is provided below.

  •  “Commenter Information” Worksheet: This worksheet includes “open” cells shaded in green for: your name, your organization, the date you prepared your comments, and the name of the file.
      •  The “Commenter Information” worksheet also includes a table that tracks the presence of comments on the DxF documents contained in the subsequent worksheet—this is for CalHHS staff use only, please do not edit it.
  • Worksheets for each of the five draft P&Ps released for public comment: These worksheets include “open” cells shaded in light green to enumerate and track your specific comments for each of the draft P&Ps. To aid us in tracking your comments, the worksheet includes:
      • an “open” cell in column A for you to enumerate your specific comment
      • a drop-down menu in column B (shaded in yellow) for the applicable document version
      • an “open” cell in column C for you to paste the relevant document text
      • an “open” cell in column D for you to identify the relevant page number(s)
      • an “open” cell in column E for you to provide a brief title or high-level summary of your specific comment
      • an “open” cell in column F for you to provide the full text of your comment

2. Transmission of the Comment Template
To assist us with processing of your comments, please name your completed Excel file as follows:
[Your Organization Name]_[Your Last Name]_[Date Prepared] and transmit the file attached in an email to CDII@chhs.ca.gov.

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Implementation Advisory Committee

 

Implementation Advisory Committee Meeting #4 (2/2/2023, 9:00 am – 11:30 am)

Clifford L. Allenby Building, 1215 O Street, Sacramento, CA 95814
Sacramento 1181 Conference Room (11th Floor)

Join by smart phone, tablet or computer
To call in (listen only): 888 788 0099 (Toll Free)
Webinar ID: 979 4305 1559

Implementation Advisory Committee Meeting #5 (3/16/2023, 9:00 am – 11:30 am)

      • Chair
        • John Ohanian, Chief Data Officer, CalHHS and Director, CDII
      • Members
        • Norlyn Asprec, County Health Executives Association of California
        • Andrew Bindman, Kaiser Permanente
        • Joe Diaz, California Association of Health Facilities
        • David Ford, California Medical Association
        • Aaron Goodale, MedPoint Management
        • Lori Hack, California Association of Health Information Exchanges
        • Cameron Kaiser, County of San Diego
        • Troy Kaji, Contra Costa Regional Medical Center and Health Centers
        • Andrew Kiefer, Blue Shield of California
        • Paul Kimsey, California Department of Public Health
        • Linnea Koopmans, Local Health Plans of California
        • Matt Legé, Service Employees International Union California
        • DeeAnne McCallin, California Primary Care Association
        • Amie Miller, California Mental Health Services Authority
        • Ali Modaressi, Los Angeles Network for Enhanced Services
        • Jonathan Russell, Bay Area Community Services
        • Cary Sanders (2022 delegate for Kiran Savage-Sangwan), California Pan-Ethnic Health Network
        • Cathy Senderling-McDonald, County Welfare Directors Association
        • Ryan Sommers, Common Spirit Health
        • Felix Su, Manifest MedEx

Data Sharing Agreement and Policies & Procedures Subcommittee

 

Data Sharing Agreement Policies and Procedures Subcommittee Meeting #4 (1/26/2023, 9:00 am – 10:30 am)

Meeting Attendance Options
*This meeting will be held virtually.

To join by smart phone, tablet or computer
To call in (listen only): 888 788 0099 (Toll Free)
Webinar ID: 933 0500 5362

Data Sharing Agreement Policies and Procedures Subcommittee Meeting #5 (3/9/2023, 9:00 am – 11:30 am)

Meeting Attendance Options
*This meeting will be held virtually.

To join by smart phone, tablet or computer
To call in (listen only): 888 788 0099 (Toll Free)
Webinar ID: 933 0500 5362

    • Chair
      • Courtney Hansen, Assistant Chief Counsel, CDII
    • Members
      • Ashish Atreja, UC Davis Health
      • William (Bill) Barcellona, America’s Physician Groups
      • Michelle (Shelley) Brown, Private Practice
      • Jason Buckner, Manifest MedEx
      • Jackie Nordhoff, PointClickCare
      • Louis Cretaro, County Welfare Directors Association of California
      • Matthew Eisenberg, Stanford Health
      • Elaine Ekpo, CA Dept. of State Hospitals
      • John Helvey, SacValley MedShare
      • Sanjay Jain, Health Net
      • Bryan Johnson, CA Dept. of Developmental Services
      • Diana Kaempfer-Tong, CA Dept. of Public Health
      • Helen Kim, Kaiser Permanente
      • Steven Lane, Health Gorilla
      • Lisa Matsubara, Planned Parenthood Affiliates of California
      • Deven McGraw, Invitae
      • Leo Pak, Los Angeles Network for Enhanced Services
      • Eric Raffin, San Francisco Department of Public Health
      • Mark Savage, Savage & Savage LLC
      • Tom Schwaninger, LA Care
      • Morgan Staines, CA Dept. of Health Care Services
      • Elizabeth Steffen, Plumas District Hospital
      • Lee Tien, Electronic Frontier Foundation
      • Belinda Waltman, Los Angeles County Department of Health Services
      • Terry Wilcox, Health Center Partners

Data Exchange Framework Grants Listening Sessions

The DxF Grants Listening Sessions were offered twice – once on October 4th, and once on October 17th – and were designed to gather input from participants on DxF implementation challenges, technical assistance opportunities to address those challenges, and the administration of the grant program. During the sessions, participants had the opportunity to provide feedback in writing and verbally.

Organizations that will sign the DSA were encouraged to participate in one of these Listening Sessions.

DxF Grants Listening Session #1 (10/4/2022, 9:30 am – 11:00 am) 

DxF Grants Listening Session #2 (10/17/2022, 3:30 pm – 5:00 pm) 

Data Exchange Framework Public Webinars

 

DxF Webinar 6 (2/21/2023, 10:00 AM – 11:00 AM PT)

DxF Webinar 7 (3/23/2023, 9:30 AM – 10:30 AM PT)

DxF Webinar 8 (4/18/2023, 10:00 AM – 11:00 AM PT)

DxF Webinar 9 (5/16/2023, 10:00 AM – 11:00 AM PT)

DxF Webinar 10 (6/22/2023, 1:00 PM – 2:00 PM PT)

DxF Webinar 11 (7/25/2023, 10:00 AM – 11:00 AM PT)

DxF Webinar 12 (8/24/2023, 1:30 PM – 2:30 PM PT)

The Impact of Data Exchange Under the DxF & Key Program Update (1/19/2023, 9:00 AM – 10:00 AM PT)

DxF DSA Signing Portal Town Hall (1/6/2023)

What is a QHIO? How do I sign the DSA? And other DxF Program Updates (12/13/2022, 2:00 PM – 3:00 PM PT)

DxF Grant Program Overview & DSA Signature Portal Demonstration (11/22/2022, 11:30 AM – 12:30 PM PT)

The DxF DSA and P&Ps: An Overview (10/24/2022, 2:00 PM – 3:00 PM PT)

 What is the Data Exchange Framework? (9/13/2022)

Archived Meeting Information and Materials

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