National Coordinator for HIT gives country C- grade on interoperability

Health information exchange remains ‘highly patchy’ on a national level, says Donald Rucker, MD.

Health information exchange nationwide has been patchy at best, according to National Coordinator for HIT Donald Rucker, MD, who gives the country a C-minus grade when it comes to interoperability.

In his testimony on Tuesday before the House Energy and Commerce Subcommittee on Health, Rucker commented that HIE is “highly patchy” on a national level, with “A students and F students” in different regions—that, in his estimation, “averages out to a C-minus” overall.

“There are more than 100 regional networks and multiple national-level organizations that support health information exchange,” testified Rucker. “While these organizations have made significant progress to expand interoperability, connectivity across networks has been limited due to variations and gaps in technical specifications, and in the participation and data use agreements that govern the secure exchange of health information.”

Also See: CommonWell, Carequality link seen as basis for nationwide interoperability

To address this shortfall, Rucker told lawmakers that under the 21st Century Cures Act, ONC this past January released the first draft of the Trusted Exchange Framework and the Common Agreement (TEFCA), which seeks to expand HIE nationwide and ensure that patients, providers, community and social services, and payers can access real-time healthcare data.

According to Rucker, the draft TEFCA—which generated more than 200 public comments—outlines the minimum set of principles, terms and conditions to support the development of a full common agreement that would enable HIE among disparate networks.

“We will release an updated draft for further public comment” in the coming months, he said.

Part A of the TEFCA, the principles for trusted exchange, provides a set of core principles by which qualified health information networks—as well as all HINs—and data sharing arrangements for data exchange should abide. Part B aligns to and builds on these principles to address a minimum set of terms and conditions to enable network-to-network exchange of electronic health information.

Part B includes the minimum required terms and conditions for trusted exchange that a Recognized Coordinating Entity (RCE)—selected through a competitive process—will use to develop a single common agreement that qualified health information networks and their participants will voluntarily agree to adopt.

“The Cures Act’s focus on trusted exchange is an important step for advancing an interoperable health system,” Rucker added. “Together, the Trusted Exchange Framework and Common Agreement will provide the governance necessary to scale a functioning system of connected health information networks that can grow over time to meet the demands of consumers, healthcare providers, health plans and other stakeholders.”

However, in a statement for the record sent to the House subcommittee for Tuesday’s hearing, the College of Healthcare Information Management Executives noted that providers have concerns about being able to put into practice what was outlined under ONC’s draft TEFCA.

“The feasibility of revising all data exchange agreements on such a tight timeline, as proposed, is problematic,” according to CHIME. “The complexity and aggressive timeframes could discourage some organizations from participating in TEFCA, at least initially. Also, the critical mass of TEFCA participation necessary for benefit to outweigh burden for most participants has not been discussed, nor has ONC shared any projections for TEFCA uptake.”

In addition, the group called for clarification from ONC as to the consequences to an organization for not participating in TEFCA.

“For example, could choosing not to participate be construed as data blocking?” asked CHIME. “ONC must clarify how they envision the interface between TEFCA participation and data blocking regulations during the comment period on the data blocking rule. Also, we are unclear about what the impact to providers will be if some HIEs in their region join TEFCA while others do not. ONC must clarify this as well.”

ONC’s proposed information blocking rule, which has yet to be made public, has been under review at the Office of Management and Budget since September.

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