A critical component of California’s strategy for statewide HIE is health information exchange among community HIOs, enterprise HIOs, and HIE service providers. The California Trusted Exchange Network (CTEN) combines the California Data Use and Reciprocal Support Agreement (CalDURSA), a common set of policies and procedures, and a lightweight technical infrastructure to create a trust environment for California HIOs to safely and securely exchange health information.

Health information exchange on the CTEN currently utilizes both the Direct and Exchange specifications. However, the California Interoperability Committee (CIC) is currently expanding the framework for CTEN’s technical specifications, policies for exchange, and on-boarding and testing procedures to make the CTEN independent of specific transaction standards, to be more broadly applicable to stakeholder needs in California, and to reduce redundancy with existing successful national network initiatives. These changes should be finalized by the CIC in 2017.

CTEN Participants

All Participants have executed the CalDURSA and have been on-boarded for and participate in transaction patterns that share health information statewide through the CTEN.

Organization Direct Messaging Query-Based Exchange Participant Since
Axesson yes 1 Aug 2014
Connect Healthcare yes 20 Nov 2015
Manifest MedEx yes 11 Nov 2015
OCPRHIO yes  yes 1 Aug 2014
RAIN Live Oak HIE and Telemedicine Network yes 1 Aug 2014
San Diego Health Connect yes yes 1 Aug 2014
San Joaquin Community HIE yes 18 Mar 2016
Santa Cruz HIE yes yes 1 Aug 2014

The California Data Use and Reciprocal Support Agreement (CalDURSA) is a multi-party data sharing agreement which allows all parties who have signed it to interoperate using recognized standards. It is a separate agreement from the federal DURSA that calls out the policies, procedures, and operational practices necessary for trusted statewide health information sharing in California. The CalDURSA is an important aspect of the California governance of inter-HIO data exchange over the CTEN, and is maintained and administered by the California Interoperability Committee (CIC), a committee of the CTEN participants.

CalDURSA version 1.0.2 approved 24 July 2014

The Sequoia Project maintains a federal version of the DURSA to support nationwide exchange among HIOs and federal agencies. The CalDURSA is compatible with the federal DURSA, allowing organizations to be members both of the CTEN and eHealth Exchange. It is the intent of CAHIE and the California Interoperability Committee to track important changes made to the federal DURSA and maintain compatibility with it.

The CalDURSA is also designed to work well with the Model Modular Participants Agreement (MMPA), a model agreement between HIOs and their exchange participants used by several California HIOs, including several CAHIE members. If you are interested in adopting or developing a participant agreement that is compatible with the CalDURSA, consider starting with the MMPA.

Signatories to the CalDURSA

The following organizations have executed the CalDURSA.

  1. Axesson
  2. California Association of Health Information Exchanges
  3. ConnectHealthcare
  4. Dignity Health
  5. Manifest MedEx
  6. North Coast Health Information Network
  8. RAIN – Live Oak HIE and Telemedicine Network
  9. Redwood MedNet
  10. San Diego Health Connect
  11. Santa Cruz Health Information Exchange
  12. San Joaquin Community Health Information Exchange
  13. Sutter Health

Onboarding to CTEN

Any organization can utilize Direct and Exchange specifications to share health information with organizations they trust and with whom they have data sharing agreements. CAHIE, through the CTEN, provides a framework to make statewide trust and data-sharing efficient, and to ready organizations for sharing health information nationally. Organizations interested in participating in exchange using the CTEN should follow these steps to get started:

  1. Review the goals and activities of CAHIE, become a member, and participate in CAHIE activities as they benefit your organization.
  2. Become familiar with the California Data Use and Reciprocal Support Agreement (CalDURSA), and verify that your organization can satisfy the provisions in the agreement.
  3. Identify the message transaction patterns and related specifications applicable to your organization, and ensure your system(s) satisfy the technical requirements for participation in the CTEN.
  4. Review the Exchange Policy and Procedure (EPP) documents for the transaction(s) of interest to your organization, and ensure that your organization and your system(s) satisfy the business processes for participation in the CTEN.
  5. Sign and submit the CalDURSA Joinder Agreement to cic@ca-hie.org.
  6. Complete and submit the application form(s) for the transaction(s) of interest to your organization to cic@ca-hie.org, attesting to and providing evidence for your adherence to business process requirements and your eligibility to participate in that transaction on the CTEN.
  7. Complete and submit the testing form(s) for the transaction(s) of interest to your organization to cic@ca-hie.org, documenting your adherence to the technical specifications for that transaction.
Cost for Participation

Onboarding to the CTEN is applicable to those organizations that are responsible for creating and/or enforcing information exchange policies, through agreements such as Participant Agreements, with participating users. On-boarding fees are due each time an organization submits new applications to on-board for one or more additional transaction patterns more than 12 months after their last full application.

  • On-boarding to CTEN for CAHIE Members – $4,000 for organizations using the MMPA, $5,000 for organizations not using the MMPA
  • On-boarding to CTEN for non-Members – $10,000

CAHIE currently bears the cost of operating the CTEN. Beginning January 1, 2018, participation fees to offset the costs of operating the CTEN will be $250 quarterly for CTEN Participants that are also CAHIE Members, $500 quarterly for non-Members. At that time, participation fees will be applicable for each on-boarded organization, independent of whether they receive their technical services from another organization or service provider already on-boarded.

Onboarding Forms

CIC Meetings

The California Interoperability Committee (CIC) is authorized by participants of the CTEN under the CalDURSA to provide oversight, facilitation, and support for exchange over the CTEN by:

  • Determining which transaction patterns and specifications will be used on the CTEN;
  • Maintaining the CalDURSA, and the policies and procedures governing CIC and CTEN operation; and
  • Determining whether to admit a new participant, and managing suspensions and disputes.

The CIC meets monthly or as deemed necessary by its members. All meetings are open to the public.  Upcoming meeting information is available on our Events page.