California’s Data Exchange Framework

Santa Cruz County CalAIM PATH Collaborative

July 30, 2025

Agenda

Agenda

Understand the basics of the California Data Exchange Framework (DxF) and Data Sharing Agreement (DSA)

Review how the DxF relates to CalAIM and the impact of participating

Learn more about a data sharing activity to engage stakeholders in identifying priority use cases

Today’s Objectives

1

2

3

Data Exchange to Enhance Care Delivery

Facilitates Referrals and Service Coordination

Promotes Continuity of Care

Enables Timely and Informed Care Decisions

Ensure not only connections are made to needed health and social services, but adequately tracked and completed

Ensure all providers have up-to-date information to reduce gaps and promote seamless transitions across care team

Provide real-time access to client data to respond to changing client needs

Data sharing is critical to improve and integrate care delivery ensuring coordinated, timely, and long-term support.

The Vision for Data Exchange in California

The DxF is California’s first-ever statewide Data Sharing Agreement (DSA) that requires the secure and appropriate exchange of health and human services information to enable providers to work together and improve an individual’s health and wellbeing.

About the California Data Exchange Framework

• The DxF provides the rules of the road to bring existing siloed health systems, providers, and social services together

​

• The DxF is a technology-agnostic collection of organizations that are required to share health information using national standards and a common set of policies

​

• Signing the DSA is the first step of the DxF implementation process.

What the DxF is

• The DxF is not a technology system or a single repository of data.

What the DxF isn’t

What is the Data Sharing Agreement (DSA)?

AB 133 required the establishment of a single data sharing agreement and a common set of policies and procedures that govern and require the exchange of health information.

The DSA & P&Ps were developed to align with an build upon existing state and federal data exchange laws, regulations, and initiatives where possible (e.g., HIPAA, TEFCA, CalDURSA).

DxF Data Sharing Agreement (DSA)

Policies & Procedures (P&Ps)

A legal agreement that a broad spectrum of health organizations are required to execute by January 31, 2023

​

​

• Streamlined document that focuses on the key legal requirements

Rules and guidance to support “on the ground” implementation

​

• Detailed implementation requirements
• Will evolve and be refined over time through a participatory governance process involving stakeholders

DxF Participants & Timeline for Exchange

Required to sign the DSA by January 31, 2023, and required to begin exchanging information or provide access by January 31, 2024

Required to sign the DSA by January 31, 2023, and are required to begin exchanging information or provide access by

January 31, 2026

Voluntary Signatories: not required to sign the DSA, but if they do, are required to begin exchanging information or provide access by January 31, 2026

• General acute care hospitals
• Acute psychiatric hospitals (100+ beds)
• Physician organizations (e.g., Independent Practice Associations that exchange health information) and medical groups (with 25+ physicians)
• Skilled nursing facilities that currently maintain electronic records or electronic health information
• Health care service plans and disability insurers
• Clinical laboratories regulated by CDPH

• Physician organizations and medical groups with <25 physicians and any nonprofit clinic with <10 health care providers

• Governmental organizations (such as Counties)
• Social services organizations and community-based organizations

What is a Qualified Health Information Organization (QHIO)?

A QHIO is a DxF designated intermediary that meets the requirements for secure data exchange and other criteria

These intermediaries offer services and functions to help DxF Participants share HSSI and meet their DSA requirements.

DxF Participants may choose to use a QHIO or another intermediary to meet some or all of their DSA requirements.

What is a QHIO?

Manifest MedEx

Cozeva

Health Gorilla

San Diego Health Connect

LongHealth

Los Angeles Network for Enhanced Services (LANES)

SacValley MedShare

Serving Communities Health Information Organization (SCHIO)

Orange County Partners in Health (OCPH)

9 organizations designated as qualified health information organizations (QHIOs) to assist Participants in meeting their DxF obligations:

DxF Participants in Santa Cruz

• Central California Alliance for Health - Health Plan
• CommonSpirit Health - Ambulatory Care Setting
• Dominican Hospital - Acute Care Setting
• Ehritt Hearing Services - Ambulatory Care Setting
• Health Projects Center - Community-Based Organization
• Nalu Partners - Ambulatory Care Setting
• PACS Post Acute - Subacute Care Facility
• Hearts & Hands Post-Acute Care and Rehab Center - Subacute Care Facility
• Serving Communities Health Information Organization (SCHIO) - QHIO
• Sutter Health - Acute Care Setting
• Teen Kitchen Project - Community-Based Organization

Download the full list of DSA Signatories here

​

Why Sign the DSA (as a Voluntary Signatory)?

Requirement to Exchange Data

Access to Real-Time Information for Care Delivery

Streamline Data Sharing Agreements

When you participate by signing the DSA, all other organizations who have also signed are required to share HSSI for treatment, payment, healthcare operations and public health activities. Under other national frameworks, exchange is optional

Gain access to real-time information about clients from health care entities and health plans including clinical data, encounter data, claims data, and more to improve care delivery

Reduce administrative burden of maintaining multiple Memorandum of Understanding (MOU) and/or Business Associate Agreements (BAAs) to exchange data

Data Sharing for CalAIM Use Cases

ECM Enrollee identification, review, and authorization for ECM and Community Supports

ECM Assignment and Enrollee Engagement

Care Coordination and Referral Management

Billing and Encounter Reporting Practices

MCPs identify ECM populations by compiling and analyzing administrative, physical, behavioral, dental and social service data and information received from DHCS, counties, Providers, Enrollee, and others

MCPs assign Enrollees to an ECM Provider based on their previous provider relationships, health needs, and known preferences, and ECM Providers use available information to reach out to and engage with Enrollees qualifying for the ECM benefit

Providers support care coordination and care transitions for engaged Enrollees, including supporting referrals across the MCP’s community, county, social services and Community Supports Provider networks

Providers submit claims/invoices to MCPs for services rendered, and MCPs report complete and accurate encounters of all services provided to DHCS

Source: CalAIM Data Sharing Authorization Guidance

Questions?

Activity: Determining a CalAIM Use Case for Improved Data Sharing

Defining a Use Case

A use case defines the functional requirements and technical specifications for a technology solution

It specifically defines the interactions between the user and the system and the transactions between the senders and receivers of data

A use case allows you to communicate what a technical solution needs to do without knowing whether it will be custom built or acquired

User A

User B

System A

System B

Sending Data

Use Case 1 Example

Receiving Data

Components of a Use Case

Components of a Use Case

Define the Use Case as a Business Need

“A system is not the sum of the behavior of its parts; it’s the product of their interactions.”

Russell Ackoff

whether it be to solve an organizational pain point, comply with a new regulation, or take advantage of a market opportunity.

A use case addresses a clear business need

• Network (understanding interconnections)
• Process (understanding interdependencies), or
• Problem Map (understanding root causes)

The business need can be defined as a systems challenge:

Use Case Approach: Let’s Start with the Why

WHAT

HOW

WHY

Most of our time is spent explaining the ‘what’ and the ‘how’ of our ideas.

What is a care coordination problem you need to solve? What data infrastructure is needed to support it?

How are referrals managed?

While most ideas get spread because of the ‘why’

What is the driving purpose of electronic data exchange? Why is it important to you? Why should we care?

Use Case Approach: Let’s Start with Why

DxF Community Design Studio Use Case Library

​

​

Use Case Approach: Let’s Start with Why

Completed Use Cases Available in the Design Studio Library

• DxF Community Sandbox Minimum Viable Product (MVP) Use Case developed in partnership with industry subject matter experts and interoperability stakeholders
• Estella falls and is admitted to an emergency department and being referred into necessary services post-discharge

• Developed in collaboration with an ECM Provider in Los Angeles County alongside a QHIO, IPA, and MCP
• Mei experiences a complication with her diabetes and after receiving care at a hospital, she is enrolled into ECM and Community Supports to stabilize her housing situation and prevent future re-admission

​

​

Estella Ruiz

Mei Lin

John Lee

• Developed in Sacramento with a hospital, CBO, MCP, and housing agency
• John is unhoused and falls leaving him with lacerations. A street medicine provider supports him in getting enrolled in ECM
• John transitions from living unhoused to temporary housing, then to recuperative care and finally permanent housing

Where can your data exchange be improved?

Where can your data exchange be improved?

Identify two to three areas to better meet the needs of your clients through data exchange

1. Notification of Admit, Discharge or Transfer from a hospital emergency department or inpatient facility.
2. Information delivery, including orders and/or referrals and the resulting documentation after the order and/or referral are completed.
3. Request for HSSI Information for a person you are working with.

Examples

You are an ECM (Enhanced Care Management) provider, and would like to see a client’s medical history to better understand the care they are receiving for their chronic condition to help you serve them better.

You are a Community-based Organization (CBO) and would like to automate the referrals between the local community clinic and your organization.

You are a CBO and would like to be notified when one of your clients is admitted to the hospital

How to get to your why?

How to Get to Your “Why”

STEP 1. What are the problematic qualities of the current state of the system? What problem are you trying to solve? What undesirable outcomes does the current system produce?

STEP 2. What are the ideal dynamics of the future state of the system? What outcomes do you aspire to see? Who are you working in service of?

Examples:

• Mostly manual process of receiving referrals is time consuming and leads to incomplete communication between providers
• Delayed notification of discharge medications leads to medication adherence issues and other complications.

Examples:

• Automatic, closed-loop referrals between all partners.
• Patients feel well cared for because all providers and organizations know what the care plan is.

How to get to your why?

How to Get to Your “Why”

STEP 3. Plug in your answers from the previous two steps to get to your “How Might We?” question. This represents your current understanding of the systems challenge. You should write several versions BEFORE settling on the one you find most generative and compelling.

​

How might we move from a system that ________ to a system that _________ ?

Example: How might we move from a system with mostly manual communication to one where partners and patients have access to the status of a referral and other care?

​

​

Write Your “How Might We” Question

System Mapping

System Mapping

Network Map Development

1. Centralize focal point. Place focal point at the center of the map and write a one-line sentence at the top that describes your chosen frame. �e.g., a patient, a provider, a transition from one setting to another.
2. Brainstorm Stakeholders/ Partners. Identify all stakeholders you think interact within the network.
3. Sort Stakeholders/Partners into categories. �e.g., health system, clinical provider, MCP administrator
4. Arrange Stakeholders by category.

Group A

Group B

Group C

Tips

• Avoid identifying stakeholders who are most visible in a system–those with more power, influence, or ‘expertise’.
• Identify the people directly or indirectly impacted by the decisions being made, but who hold less decision-making power and may be underrepresented

Network Map Development

Network Map Development

Network Map Development

5. Draw the connections between stakeholders that illustrate how they relate to one another. E.g., how aligned are they? What is current effectiveness of communication? Who has influence over who? Where is the value created or delivered?

EXAMPLE: Communications Lens

​

• Green line = strong communication

​

• Blue line = average communication

​

• Yellow line = weak communication

​

• Red line = broken communication

​

• No line = no communication

Focal Point

74-year-old woman, living in a Single Room Occupancy in Oakland. She has limited mobility and her only income is social security. Enrolled in ECM. No close family nearby, but has neighbors who check in on her. She recently experienced a fall.

Neighbors

Primary Care Provider

Emergency Department (post-fall)

ECM

Lead Care Manager

Average Communication

Weak Communication

Legend

​

• Green line = strong communication
• Blue line = average communication
• Yellow line = weak communication
• Red line = broken communication
• No line = no communication

Data Sharing Priority Use Case Activity

June 2025

Legend

​

• Green line = strong communication
• Blue line = average communication
• Yellow line = weak communication
• Red line = broken communication
• No line = no communication

Data Sharing Priority Use Case Activity Template

​

Write the Use Case Story

Write the Use Case Story

Resources: CalHHS CDII DxF Scenarios, CalAIM Data Sharing Authorization Guidance

In writing a short use case story, specify each partner involved in the process and what steps they perform to move the person along in their journey in the best way possible.

Writing the Use Case Story

A use case typically outlines a patient journey as they resolve a particular issue. The issue you identified above may just be one step on that journey. Looking at the questions above, what is the larger arc of the person’s journey that will form the basis of this use case?

Post-Discharge Follow-up Example

An older male is discharged from the hospital after a fall at home with new medications and a referral to install new grab bars in his home. The ECM provider coordinates with a DME company to install the grab bars and confirms with his pharmacy his new medications.

Process Map Example

Data Sharing Example​​​​​

Mei Lin recently immigrated from China in search of better opportunities and a fresh start. She experienced unforeseen challenges including language barriers and a lack of social support. She is currently staying with an acquaintance in a cramped apartment. Her diabetes has been difficult to manage due to unstable housing and limited access to health care. She frequently experiences complications with managing her diabetes, leading to repeated visits to the ED.

1. The hospital Mei Lin went to for a recent ED visit shares information about the visit with the network.
2. Isabella, the ECM Care Coordinator, logs into the Network to find information about Mei Lin’s past health history
3. Through reading the hospital notes, she finds out that Mei Lin has new contact details
4. She reaches out to Mei Lin and is able to help her with the ED visit discharge instructions she received.

Isabella Gomez

ECM Care Coordinator

Hospital

Network

ECM Organization

Mei Lin

Hospital EHR

Network Portal

1

Message of discharge

Discharged

2

3

4

DxF Community Sandbox

Find and Filter DxF Participants in your Region

The Sandbox enables DxF Participants to

Access the Sandbox Platform

• Use visualization tools to identify neighboring organizations and learn how they are sharing data
• Explore available use cases to further your organization’s data sharing practices - with more coming soon!
• Simulate data exchange and test use cases with organizations that have onboarded to the Sandbox

Access Connecting for Better Health Materials

For any questions or inquiries, please contact: info@connectingforbetterhealth.com

​

www.connectingforbetterhealth.com

​

​

Thank You!

​