 | Important Information about Exchange Transition The Exchange is in transition from under ONC sponsorship to a new, as yet unnamed, organization. By mid-summer 2012, we expect to be able to provide the details concerning the changes and how they will impact organizations that are Onboarding or considering doing so. For now, we know that our current processes and policies are still in effect for the next few months. |
Overview
In 2008, as part of the Nationwide Health Information Network Phase II Trial Implementations, a multi-disciplinary team was assembled to develop a comprehensive agreement that would create a legal framework using existing law for the electronic exchange of health data. This agreement, called the Data Use and Reciprocal Support Agreement or DURSA, was first executed by a number of Federal agencies and non-Federal organizations (the “Participants”) beginning in November 2009.
The executed DURSA contains a provision describing the creation of a Coordinating Committee that is charged with maintaining and evolving this Agreement. Pursuant to that charge, in 2010, the Coordinating Committee established a Task Group to suggest revisions to the Agreement based on the experience gained with the early implementations and to accommodate new opportunities for the promotion and expansion of health information exchange.
This Overview was prepared to facilitate the reader’s understanding of the DURSA, and to place the DURSA into an appropriate context.
Why is a Data Use and Reciprocal Support Agreement (DURSA) Needed?
The DURSA is a legal agreement created to promote and establish trust among the Participants. It codifies a common set of trust expectations into an enforceable legal framework, and eliminates the need for point-to-point agreements.
What is the DURSA?
The DURSA is the legal, multi-party trust agreement that is entered into voluntarily by all entities, organizations and Federal agencies that desire to engage in electronic health information exchange with each other using an agreed upon set of national standards, services and policies developed in coordination with the Office of the National Coordinator for Health IT (ONC) in the U.S. Department of Health and Human Services. (Those who sign the DURSA are known as "Participants.")
The DURSA builds upon the various legal requirements that Participants are already subject to and describes the mutual responsibilities, obligations and expectations of all Participants under the Agreement. All of these responsibilities, obligations and expectations create a framework for safe and secure health information exchange, and are designed to promote trust among Participants and protect the privacy, confidentiality and security of the health data that is shared.
The DURSA is based upon the existing body of law (Federal, state, local) applicable to the privacy and security of health information and is supportive of the current policy framework for health information exchange. The DURSA is intended to be a legally enforceable contract that represents a framework for broad-based information exchange among a set of trusted entities. The Agreement reflects consensus among the state-level, federal and private entities who were involved in the development of the DURSA regarding the following issues:
- Multi-Party Agreement
- Participants Actively Engaged in Health Information Exchange
- Privacy and Security Obligations
- Requests for Information Based on a Permitted Purpose
- Duty to Respond
- Future Use of Data Received from Another Participant
- Respective Duties of Submitting and Receiving Participants
- Autonomy Principle for Access
- Use of Authorizations to Support Requests for Data
- Participant Breach Notification
- Mandatory Non-Binding Dispute Resolution
- Allocation of Liability Risk
Will the DURSA Continue to Evolve?
Yes. An initial group of Participants executed the DURSA in 2009 to support the first set of electronic health information exchange activities in production under the Agreement. Since then, other entities wishing to transact health information electronically using the agreed upon standards, services and policies have executed the DURSA. Additional entities are expected to execute the Agreement over time. (November 2009 version of the DURSA) As a living document, the DURSA is being maintained using the process described in the Agreement. An amended and restated version of the DURSA will be available for execution in 2011.
When the Department of Health and Human Services issues final regulations addressing governance of the nationwide health information network, the Coordinating Committee will likely convene another Task Group to assess how the DURSA might need to be revised to accommodate the new regulations.
Can the DURSA be Used for Other Purposes?
The DURSA was developed for a specific purpose – to establish the legal framework and to support the trust framework for health information exchange using an agreed upon set of standards, services and policies. Others may find this document helpful or informative for other purposes, for instance, when addressing practical issues related to other types of information exchange models. The DURSA is not intended to be used, however, for other purposes outside of the purpose for which it has been created. As a result, entities interested in using this Agreement for other information exchange purposes are encouraged to seek their own legal counsel regarding the applicability and appropriateness of the DURSA to other settings.