ONC touts dawn of new era of interoperability with TEFCA

Release of the final framework for the plan to facilitate health information exchange sets timeline as well as a roadmap for achieving easier data accessibility.

The Office of the National Coordinator of Health IT released the final draft of requirements for the Trusted Exchange Framework and Common Agreement this week, launching an era many have waited for since the advent of electronic health records more than 15 years ago.

TEFCA’s purpose is to establish a universal floor of interoperability across the country, according to ONC. It will establish the infrastructure and governance needed for different networks to securely share basic clinical information with each other and will enable patients to more easily access their health information.

“Our goals are pretty simple, and simple is hard,” said ONC National Coordinator Micky Tripathi. ONC hopes its efforts with TEFCA strike a balance between “wanting to have the opportunity to bring more order to the market, to allow it to continue to progress and to serve the country, but not so much order that it suppresses or is brittle to business and technical innovation,” he said.

ONC National Coordinator Micky Tripathi

TEFCA will aim to establish something like a utility for health information interoperability, with larger networks called Qualified Health Information Networks (QHINs), signing legal contracts with ONC’s Recognized Coordinating Entity, The Sequoia Project. QHINs will execute certain corresponding policies within their own networks, reaching down the “last mile” to include smaller entities. Ideally, every healthcare organization will participate, making it a complete network of information. If organizations don’t join, it will lessen the value of the premise TEFCA provides, experts say.

Mariann Yeager, CEO of The Sequoia Project, said she believes networks today will find TEFCA very familiar. “We anticipate as we go through the public feedback process that there will be support that [TEFCA will] really strike the right balance of supporting the trust and policy continuity,” she said.

Tony Sheng, vice president of Interoperability Solutions for ZeOmega, predicts there will be industry buy-in on TEFCA. “Just like today with the member access FHIR APIs and prior auth, some will be ahead of others in adoption. I think there is an incredible opportunity for innovation leaders to leverage this framework and show those on the sidelines how investing and participating in this network can really benefit patients and improve value-based care.”

Sheng says, “existing regulatory drivers, and potentially new ones, will help increase readiness across the board and make it both easier and more rewarding for organizations to participate.”

Lee Barrett, CEO and executive director of the Electronic Healthcare Network Accreditation Commission (EHNAC) is optimistic about TEFCA. Most large groups are already sharing data, and this will only make things easier, he said.  One of the biggest issues with health information networks today is that not all of them really exchange data between HINs. And so, it's a very siloed process for data exchange; it's not even standardized from the standpoint of having any specific standards that are used between them.” TEFCA should improve that, he said. “That’s what interoperability will do.”

Ken Kleinberg, Innovative Technologies Practice Lead, Point-of-Care Partners (POCP) says TEFCA is only the beginning. There is a lot that must play out first. Some stakeholders will see this as competitive, and possibly a threat. Some will have to determine whether they should become a QHIN or not. They will need to assess the risks and the costs. “The burdens are real, but the benefits are real,” he said.

“This idea of a nationwide health information infrastructure has been with us for decades,” Kleinberg says. “We really needed the electronic health records in place first, to build a network. And we've gotten to that point now, over the last years, with the EHR options high enough and interoperability has been there for organizations that had regular exchange with each other,” he said. “So, the real benefit of TEFCA is to widen the ability of organizations to communicate past their regular business partners.”

Jonathan Copley, an interoperability specialist who is working with the HL7’s Da Vinci Project on FHIR, says he is feeling good about TEFCA because he has been preparing for it since it was first released. The work he sees ahead will involve helping providers and national payers to leverage FHIR and OAuth (open authorization).

“Obviously this is complicated stuff, that’s why it’s taken so long,” says Don Rucker, MD, chief strategy officer for 1upHealth, and former ONC National Coordinator. He recognizes TEFCA as “another step; and that alone is good.”

The Sequoia project plans to host a series of webinars to provide further information about TEFCA. Information can be found on their website.

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