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Vision V of V · Five Visions for the Future of HIEs

Project National Quality Mesh

A federated intelligence network, so no exchange faces the platform era alone.

Timeline12–48 monthsKey enablerInter-HIE protocol + governanceBuiltwith HIEs, for HIEs
The problem

Every HIE alone against the platform era

Each exchange today vets the same applications, benchmarks in isolation, negotiates alone with vendors many times its size, and rebuilds analyses its peers finished last quarter. The organisations that taught rivals to cooperate locally have no equivalent fabric among themselves nationally.

As consumer platforms and national networks consolidate, fragmentation becomes strategic weakness: individually, no HIE has the leverage its collective footprint would command.

The vision

What changes

The National Quality Mesh is a federated intelligence network connecting America's HIEs: shared benchmarking, shared PHA vetting, federated research, and collective bargaining, built on an inter-HIE protocol with governance the members control.

It is federation, not centralisation: each HIE keeps its data, its governance and its community accountability, while gaining the intelligence and leverage of the whole network.

The architecture

How it works

01

Share the vetting once

A PHA vetted anywhere in the mesh is vetted everywhere, with findings and compliance history shared under common standards.

02

Benchmark across the network

Quality, performance and access metrics become comparable across exchanges, so every HIE knows where it stands and what good looks like.

03

Federate research

Studies run across the mesh without records moving between HIEs, multiplying the value of every member's data while honouring every member's governance.

04

Bargain collectively

EHR vendors, identity providers and regulators meet an organised counterweight: the combined footprint of the connected exchanges.

The return

What HIEs gain

Network effects for members

Every HIE that joins increases the intelligence and leverage available to every other, the same flywheel that built the exchanges locally.

Cost collapse on duplicated work

Vetting, benchmarking and analysis are done once for the network rather than once per exchange.

Research revenue

Federated studies open income streams no single exchange could offer at credible scale.

A seat at the national table

Collective representation before ONC, CMS and Congress, proportionate to what HIEs actually carry.

Cures Gateway's role

The connected Gateway network and its trust fabric are the mesh's foundation, and the HIE Advisory Council is its governance seed. Agentic's commitment is explicit: the mesh is governed with HIEs, never over them.