The technical attributes and common requirements of the Health Information Environment include:

The detailed design principles of the Health Information Environment are:

1. Decentralized. Data stays where captured: The U.S. healthcare system is fragmented. Many types of institutions are part of the current healthcare network, from giant hospital systems to individual practices, with all manner of specialists, clinics, and agencies in between. The decentralized approach reflects the legal and market realities of healthcare. The Health Information Environment facilitates the transfer of selected information from one end-point system to another (not necessarily the source system), as is required for providing care and supporting informed patient participation in care. The decentralized approach obviates the need for storing identifiable data in a central database, but builds on existing aggregates of data where available or necessary. The infrastructure facilitates information access by authorized end-point systems, or proxies for them, to improve the delivery of patient care and to further other health-related goals. Even though the infrastructure is decentralized, it supports and facilitates authorized aggregation for public health, quality management and other functions.
2. Federated. To maintain the local autonomy of decentralization, a common set of policies, procedures, and standards to facilitate reliable, efficient sharing of health information among authorized users is required. These standards or practices specify when patient information can be shared, which information can be shared, and how the information can be used. That is, the participating members of the health network must belong to and comply with agreements of a federation. Federation, in this view, is a response to the organizational difficulties presented by the fact of decentralization. Formal federation with clear agreements allows participants to access information that has been authorized to share.
3. Private and Secure. All of the activities of the Health Information Environment, including the delivery of care and the conduct of research and public health reporting, must be conducted in an environment of trust, consistent with appropriate requirements for patient privacy, security, confidentiality, integrity, audit and informed consent. All those that generate health information for patients are its stewards. Patients control access, in partnership with their providers.
4. Accurate. Accuracy in identifying both a patient and his or her records with little tolerance for error is an essential element of the Health Information Environment design. The Health Information Environment must also create feedback mechanisms to help organizations to fix or "clean" their data in the event that errors are discovered.
5. Reliable. Assurance of a uniform minimum degree of system service quality (e.g., reliability, dependability, etc.) in addition to backup mechanisms, so that stakeholders can count on the availability of the overall system.
6. Fast. Near real-time information access is crucial, not only for routine clinician and patient needs, but also for particularly time-sensitive specialties such as emergency medicine and monitoring of disease outbreak, bioterrorism, or contamination of the food supply.
7. Interoperable and built on a Common Framework. The interoperability of the Health Information Environment is premised on conformance to a Common Framework, which consists of the essential technical and policy requirements to enable the interoperation of standard interfaces and transactions at the local, regional and national level. The technical standards address secure transport over the Internet and other networks, and provide the essential components required for the infrastructure including secure connectivity, reliable authentication and a suite of defined interchange formats for health care data. The policy standards address the privacy, use and access policies for the exchange of health information. The Common Framework also provides a uniform methodology for the identification of users. The modular character of the Common Framework permits rapid attainment of an interoperable information environment using essential requirements but also scales to a more complete structured data interchange for enhanced performance. The suite of interoperability standards will be enhanced over time. The Common Framework is the basis of all subsequent use cases that require specific, uniform interoperable standards to support information exchange. Use cases and accompanying information standards will be specified for each of the myriad of health information exchange requirements and will be supported by detailed implementation guides. The participants in sub-networks will determine which profiles are appropriate to address the requirements established by their stakeholders. The Common Framework, and mechanisms to enforce compliance with it, ensures the creation, interoperability, scalability, efficiency and ongoing evolution of this environment. The Common Framework should be required across all health communities, including the clinical research community, public health, etc. The Common Framework is further described in subsequent sections.
8. Designed to Respect and Serve Patients (in addition to the Health System and the Public). The Health Information Environment is premised on a model of patient authorization and control. Patients must be able to: choose whether or not to participate in sharing personally identifiable information; exercise their rights under HIPAA; control who has access to their records (whether in whole or in part); see who has accessed their information; review, contribute to and amend their records (without unreasonable fees); receive paper or electronic copies of their information; and reliably and securely share all or portions of their records among institutions. Once patient consent has been granted for a certain type of information access, however, information should be able to be accessed freely in a trusted environment.
9. Flexible. The Health Information Environment is flexible in several ways. First, it is heterogeneous with regard to the types of technology and function of the sub-networks and other entities that use it, providing that all of them adhere to the Common Framework. This enables users of varying levels of technical and functional sophistication to use it for a variety of processes. Second, it is flexible in that it facilitates communication among end-point systems at varying levels of sophistication in the structured and coded representation of data and supports the evolution of systems in this regard. For example, while some might use the Health Information Environment to locate records and request them by telephone, others may draw on it to support the full electronic exchange of highly structured data for sophisticated data analysis and decision support. This is necessary because health information will continue to be a mix of unstructured and structured and coded data. The Common Framework provides standards and procedures that allow two systems that support highly coded data to exchange it without loss of data, a system that supports less or little coding to receive information from comparable and from highly structured systems, and a system that supports a high level of coding to receive, file, and make use of lightly coded data when this comes from another system. Lastly, the Health Information Environment is flexible also in that it is able to evolve over time to address the changing needs of users and to increase in scale as the numbers of users and their transactions grow; it supports a reasonable level of variation and innovation in response to local needs.

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