HHS moves forward with plans to transform data exchange

The second draft of the Trusted Exchange Framework and Common Agreement is intended to enable widespread data exchange, working as a set of principles between health industry participants.

On Friday, HHS through the Office of the National Coordinator for Health IT issued a second draft of the Trusted Exchange Framework and Common Agreement (TEFCA), among other steps to promote easier exchange of health information. It’s now seeking comments on the draft.

“The seamless, interoperable exchange of health information is a key piece of building a health system that empowers patients and providers and delivers better care at a lower cost,” says HHS Secretary Alex Azar. “The 21st Century Cures Act took an important step toward this goal by promoting a national framework and common agreement for the trusted exchange of health information. We appreciate the comments and input from stakeholders so far, and we look forward to continued engagement.”

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Alex Azar, secretary of Health and Human Services (HHS), speaks during a press briefing at the White House after an event on lowering drug prices with U.S. President Donald Trump, not pictured, in Washington, D.C., U.S., on Friday, May 11, 2018. Trump is proposing a sweeping effort to bring down U.S. drug prices in a long-awaited plan meant to fulfill a promise he has been pushing since his bid for the White House. Photographer: Andrew Harrer/Bloomberg

Also See: HHS offers second draft of TEFCA, extends reg comment period

In the 21st Century Cures Act, Congress sought a single trusted way to exchange information because many providers, insurers, vendors, public health departments and individuals lack a core exchange mechanism, as do federal, state, tribal and local governments.

“The updated Trusted Exchange Framework and Common Agreement … considered the more than 200 comments we received on our previous draft and reflects extensive work with our federal partners,” says Don Rucker, MD, national coordinator for health information technology. “The future Common Agreement … will provide the governance necessary to meet the interoperability demands of diverse stakeholders, including patients, healthcare providers and health plans.”

The drafts released Friday respond to stakeholder comments by making key changes to the draft requirements that health information networks that choose to participate would have to follow. These changes include updating the purposes for which information can be exchanged, adding a “push” method of data exchange, adding a technical framework for quality health information networks, and extending timelines for participating entities to implement changes that will be required by the Common Agreement.

Trusted exchange, HHS contends, must be simplified to scale. Currently, industry stakeholders must use multiple exchange methods to communicate. Only a few hospitals use one interoperability method, while the majority requires three or four methods, and about three in 10 use five or more methods. It is an expensive approach because the organizations are building many point-to-point interfaces between each other.

Health information networks (HINs) are entities that administer policies and agreements defining business, operational, technical or other requirements for enabling access, exchange or use of electronic heath information between unaffiliated individuals or entities; controls for technology or services enabling exchange; or controls to support access, exchange or use of electronic health information among unaffiliated individuals or entities.

“The Trusted Exchange Framework will significantly reduce the need for individual interfaces, which are costly, complex to create and maintain, and an inefficient use of provider and health IT developer resources,” according to HHS.

A HHS survey of about 70 hospitals found interoperability is minimal, with 63 percent of surveyed hospitals saying they had no or little interoperability, 17 percent reporting some interoperability and only 19 percent largely or fully interoperable.

HHS has developed five clear goals to achieve trusted exchange:

  • Build on and extend existing work done by the industry.
  • Provide a single “on-ramp” to interoperability for all.
  • Scale the approach to support the entire nation.
  • Build a competitive market to enable all entities to compete on data services.
  • Achieve long-term sustainability.

Also See: Why patience for data exchange has run out for healthcare

Technical controls for a HIN include being able to locate and transmit electronic protected health information between multiple persons and entities; audit entities; adopt a connectivity broker service; be a neutral participant; and have participants actively exchanging data in a live clinical setting.

For qualified HINs, the Trusted Exchange Framework will give them and their provider participants’ access to more data on patients they serve, enhancing care coordination and care delivery use cases, HHS expects. The framework ensures there is no limitation to the aggregation of data exchanged among participants, although appropriate business associate agreements must be in place.

Other provisions covered under the Trusted Exchange Framework include breach notifications and controlled unclassified information.

The framework also offers benefits to patients and their caregivers, enabling them to find all of their health information from across the care continuum, even if they don’t remember the name of the provider they saw. This further enables patients and caregivers to participate in their care and manage their health information, according to HHS.

More information is available here.

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