Organizations interested in earning QHIN designation, but questions abound

Some say Qualified Health Information Networks offer great potential opportunity to boost national data exchange if challenges can be overcome.

Much of what will be required of the qualified health information networks that will facilitate nationwide data exchange under the Trusted Exchange Framework and the Common Agreement is still unknown.

But that has not stopped several organizations from expressing interest in applying for the job of running a QHIN.  

TEFCA was created to carry out a requirement under the 21st Century Cures Act to facilitate nationwide interoperability. The QHINs will be the cornerstone of this data exchange, connecting to each other and to their participants and subparticipants.

The QHIN application process is expected to begin in the second quarter, says Mariann Yeager, CEO of the Sequoia Project, the Recognized Coordinating Entity in charge of designating QHINs and providing oversight.

A great opportunity 
Some organizations that are considering applying to launch a QHIN see it as a great opportunity. For example, Health Gorilla believes that starting a QHIN will improve performance for its members, and it plans to apply.

“Becoming a QHIN will expand our ability to enable or facilitate access to health data across the country and help create efficiencies that will deliver greater value to our participants and subparticipants, ensuring interoperability between the networks we represent,” says Steve Yaskin, Health Gorilla’s CEO and co-founder.

Others see running a QHIN it as a chance to be an influential leader in the health IT ecosystem.

“Becoming a QHIN, especially one of the first, would translate into participation in the governance [under the Common Agreement] and therefore give early adopters an opportunity to guide and enhance TEFCA moving forward,” says Paul Wilder, executive director of the CommonWell Health Alliance, which is looking to become one.

The Common Agreement creates a governing council that will review amendments, serve as a resource and provide oversight for the resolution of disputes.

Questions ahead
The potential contenders for QHIN contracts acknowledge, however, that the lack of information about the program raises concerns.

For instance, because providers aren’t currently required to exchange data via the Trusted Exchange Framework, adoption of that framework may not be widespread, notes Jay Nakashima, executive director of eHealth Exchange, which is similarly looking to become a QHIN.

“Since TEF is starting out by tackling modest exchange patterns (treatment and individual access), it may not be differentiated enough to distinguish itself from Carequality, so providers and other healthcare organizations might continue to exchange via Carequality, but not via TEF,” he says.

Carequality is another interoperability framework for connecting health information networks.

Another concern, Yaskin says, is the lack of details regarding QHIN structure and operations, such as automation of workflows and challenges around sharing sensitive information.

More information about QHIN criteria will be available once a new standard operating procedure is released in the coming weeks.

Another pressing concern is uncertainty about QHIN-related costs.

“The biggest challenge in general about TEFCA is that we have a very limited understanding of the financial needs of the RCE [Recognized Coordinator Entity], what, if anything, the ONC [HHS Office of the National Coordinator for Health IT] will fund and how much it will therefore cost QHINs to participate,” Wilder says.  

The potential financial benefits of running a QHIN also are not yet clear.

“QHINs will be able to charge some fees, but it remains to be seen if the market will support that. It’s a large financial risk and responsibility without direct funding. For the model to work, incentives are critical,” says Angie Bass, chief strategy officer for Velatura Public Benefit Corp., parent of USQHIN, a nationwide health information network that is looking to become a QHIN.

Cautious optimism
Organizations considering applying for QHIN status are cautiously optimistic that the program will achieve its goal of enabling national data exchange.  

“It’s really well thought out and a well-organized framework,” Bass says. She believes QHINs will succeed if they are inclusive of all data and apply lessons learned from past networking initiatives that failed.

Wilder adds, “QHINs are what make the TEFCA model work. So, we recognize that eventually becoming a QHIN is one way to support TEFCA, help it become successful and continue to support nationwide interoperability.”

Nakashima also offers an upbeat outlook. “I’m … hopeful that Trusted Exchange Framework can be quickly positioned as the neutral, national public health platform our nation so desperately needs.”

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