As a cooperative agreement, as opposed to a grant, this award instrument of financial assistance ensures substantial involvement between the Office of the National Coordinator for Health Information Technology (ONC) and the recipients during the performance of the project.ONC had previously considered proposing the establishment of a voluntary accreditation process for the governance of health information exchange through a rulemaking process. A Request for Information (RFI) solicited feedback on whether ONC should establish this voluntary program and on the specific rules of the road that exchange entities should follow. Several of the responses to the RFI pointed out that there are already organizations engaged in health information exchange governance activities, and that ONC should work with these entities rather than set up a new process and program. Based on these and many other comments received, ONC decided not to pursue a governance approach through rulemaking at this time. Instead ONC is establishing a robust framework of leadership, guidance, engagement, listening and learning, and monitoring. • We will identify and shine light on good practices that support robust, secure and interoperable exchange. • We will actively engage with entities currently serving in governance/oversight roles to promote emerging good governance practices. • We will continue to use our existing authorities and convening powers to create consensus and provide guidance and tools to address specific barriers to interoperability and exchange. • We will continue to evaluate how and what consumer protections can be appropriately applied to health information exchange through existing regulatory frameworks. • We will continue to monitor and learn from the wide range of activities occurring. This FOA will enable ONC to work collaboratively through the cooperative agreement process with existing entities undertaking governance activities for the electronic exchange of health information to encourage them to develop and adopt scalable national policies, interoperability requirements and business practice requirements that reduce the cost and complexity of exchange, obviates the need for cumbersome legal agreements and reduces the cost and complexity of health information exchange, . The FOA is focused on working with existing governance entities to expand their rules of the road (i.e. policies, interoperability requirements and business practice requirements) for participating organizations. This work will support and advance the efforts of existing governance entities which will benefit consumers and providers by allowing health information to flow securely between unaffiliated healthcare organizations. The cooperative agreement will provide funding to selected governance organizations to collaborate with ONC to:• Develop and implement policies, interoperability requirements and business practice requirements that will facilitate directed “push” and/or query-based exchange and address operational challenges that are slowing adoption and use of either model of exchange • Identify potential opportunities to incorporate these solutions in national policy through certification of electronic health records, nationally adopted standards, incorporation into federal policy or additional governance activities