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Designing a Technical Infrastructure for
Health Information Exchange in California

In 2009, the California Health and Human Services Agency (CHHSA) engaged Sujansky & Associates to facilitate the design of a technical architecture for enabling health information exchange in California.  The process entailed managing a technical advisory committee and a working group comprised of executives and technical experts representing key California healthcare industry stakeholders.

Based on a "straw man" design proposed by Sujansky & Associates, these groups developed an architecture for the secure, directed, “push” messaging of protected health information among organizations of various sizes in all regions of the state.  The design included certain elements that were also adopted by the federal DIRECT Project for health information exchange.

Sujansky & Associates documented the consensus technical architecture, which was submitted to the federal government as part of California's Operational Plan under the HIE Cooperative Agreement Program. Sujansky & Associates subsequently developed a set of detailed functional requirements and technical specifications for this architecture, which have informed the state’s planning and design efforts since that time.

Relevant documents:

Technical Infrastructure for HIE in California (PDF)

Functional Requirements and Technical Specifications for Core HIE  
Services in California

Sujansky & Associates' role in this project included:

  • Design of a "straw man" architecture for HIE services in California, which were largely incorporated into the Technical Infrastructure submitted to ONC

  • Management of a Technical Advisory Committee and Technical Working Group that each met weekly and included 15 - 25 stakeholder representatives

  • Research and preparation of a "gap analysis" of California's existing infrastructure for HIE relative to the requirements of HIE for meaningful use.

  • Development of detailed Functional Requirements and Technical Specifications for the core HIE technical infrastructure proposed by CHHSA.



The proposed technical infrastructure creates a "trust framework" enabling secure HIE transactions between any two healthcare organizations in California. The framework consists of a set of "core" shared services that provide identity management, authentication, and directory services for participating organizations.

The infrastructure accommodates additional "non-core" services to provide value-added functions, such as a service to facilitate lab-result routing and standardization.

The Technical Architecture design document was delivered to CHHSA on schedule, integrated into the state's Operational Plan, and submitted to the Office of the National Coordinator for Health IT.