National Association for Trusted Exchange (NATE)
Washington, DC 20001 USA
The National Association for Trusted Exchange (NATE) is a not-for-profit membership association focused on enabling trusted exchange among organizations and individuals with differing regulatory environments and exchange preferences. NATE brings the expertise of its membership and other stakeholders together to find common solutions that optimize the appropriate exchange of health information for greater gains in technology adoption and improvement of patient outcomes. Consistent with NATE’s mission to address the legal, policy and technical barriers that inhibit health information exchange between data holders and healthcare consumers, NATE leads and participates in a number of ongoing and emerging projects focused on exchange via multiple modes of transport, including Direct secure messaging and APIs. Working with a broad set of stakeholders through multiple task forces, crowdsourcing and a call for public comment, NATE was proud to make available the first release of NATE’s Blue Button for Consumers (NBB4C) Trust Bundle beginning in 2015. NATE is working to extend the utility of its trust community beyond Direct secure messaging to include other consumer-centric technologies, such as those that leverage APIs or other modes of exchange. Stakeholders interested in participating in the next phase of NATE’s work in consumer mediated exchange should consider NATE membership or subscribe to News from NATE.
NATE Blue Button for Consumers (NBB4C) Trust Bundle
The flagship NATE Blue Button for Consumers (NBB4C) Trust Bundle contains trust anchors of consumer-facing applications (CFAs) that utilize Direct to securely move data from one application to another. The NBB4C Trust Bundle helps relying parties to identify CFAs that meet or exceed criteria considered to be the most important characteristics of a trustworthy steward of consumer health information, while still enabling patients to benefit from the value of having access to their health information.
Participation in the NBB4C Trust Bundle facilitates secure exchange of health information from provider-controlled applications to consumer-controlled applications such as personal health records (PHRs) using Direct secure messaging protocols. Provider organizations that wish to send messages to consumers using one of these recognized applications should load this bundle into their trust stores. In most cases, CFAs that are onboarded to the NBB4C have loaded publicly recognized trust bundles of provider facing applications and Direct Secure messaging should be enabled.
CFAs are welcome to submit an onboarding application and supplementary documentation online by using the NATE Bundles Administrator. Go to https://bundles.nate-trust.org to upload the completed form and supporting documentation. New applicants will be required to create a profile to upload their documents and certificates, and must complete requisite testing by first adding their test trust anchor to the NBB4C staging bundle. See How to Use the NBA for more instruction on how to apply and onboard. Currently, NATE invoices qualified CFAs an administrative fee of $4,000 before being added to the production NBB4C trust bundle.
The NBB4C Staging Bundle is a non-production bundle that is used by candidate consumer-facing applications to conduct the testing required by the NBB4C onboarding process.
This bundle is also used by NATE and the consumer-facing applications in the NBB4C to give demonstrations, such as those offered as part of the HIMSS Interoperability Showcase.
Demonstration Trust Bundle
The Demonstration Trust Bundle is a non-production bundle used by provider-facing applications such as electronic medical records systems when participating with NATE in demonstrations such as the HIMSS Interoperability Showcase.
NATE Blue Button for Consumers (NBB4C)
The following customer-facing organizations have completed the NBB4C onboarding process:
|Organization||List of Trust Anchors||Issuer Name||Expiry Date||Trust Anchors Serial Number|
|Carebox Healthcare Solutions Inc.||carebox.it.der||direct.carebox.it||02/03/2025|| DC EA B5 92 D3
2B FE E5
|GetRealHealth||IPHR-Direct-CA.cer||Instant PHR Direct CA||12/31/2039|| 3A 7F FE 8A 79
CA 37 8E 47 A2
4D AC F6 C9 09
|Humetrix||direct.ibluebutton.com.der||direct.ibluebutton.com||02/22/2033|| 6C 9C 98 D8 E5
5D 2A 6D
|iShare Medical||isharemedicalrecords_com_anchor.cer||iShare Medical Direct Intermediate CA||01/14/2025|| 72 8B E4 E2 D2
35 04 FB 44 BB
6D 7E D2 1B AB
|Medical Informatics Engineering (MIE)||NoMoreClipboard.der||NoMoreClipboard.com||12/09/2023||0|
|MedYear||root.der||Medyear Direct root||02/26/2025|| FF 45 CC 18 92
02 55 65
|Microsoft||Microsoft HealthVault Direct CA.cer||Microsoft HealthVault Direct CA||12/31/2039|| -3 66 B9 3A 93
9B 6B D6 5B 57
EA B9 E2 05 19
|Omedix||root.der||Root for direct.omedix-hisp.com||01/16/2084|| 77 BF 19 C7 8A