The Office of the National Coordinator for Health IT on Friday released a draft Trusted Exchange Framework to enable interoperability across disparate healthcare information networks nationally, as directed by the 21st Century Cures Act.

The draft framework is designed to support nationwide interoperability by outlining a common set of principles, as well as minimum terms and conditions for trusted data exchange. According to ONC, the document focuses on policies, procedures and technical standards that build from existing HIN capabilities and enables them to work together to provide a “single on-ramp” to patient information regardless of the HIT vendor they use or the health information exchange (HIE) with which they contract.

“Currently, there are more than 100 regional HIEs and multiple national level organizations that support exchange use cases,” states ONC’s draft Trusted Exchange Framework. “While these organizations have expanded interoperability within their particular spheres, the connectivity across all or even most of them has not been achieved. This has limited the patient health information that a provider or health system has access to, unless they join multiple networks.”

According to ONC, the proposed Trusted Exchange Framework supports the agency’s goals of achieving nationwide interoperability by—among other capabilities—having “open and accessible application programming interfaces (APIs) to encourage entrepreneurial, user-focused innovation to make health information more accessible and to improve electronic health record (EHR) usability.”

National Coordinator for HIT Donald Rucker says provisions of the Cures Act seek to advance the interoperable exchange of electronic health information, and the agency’s draft Trusted Exchange Framework will help guide the country toward interoperability.

Also See: ONC expects to meet all Cures Act requirements—except one

“It’s a national challenge—it hasn’t been easy,” said Rucker. “Folks have made some great progress, but obviously there’s a lot of work to be done. One of the approaches that ONC is taking is exactly this Trusted Exchange Framework…the very specific request of Congress.”

Genevieve Morris, ONC’s principal deputy national coordinator, said the draft document is in part the product of three public listening sessions with industry stakeholders.

After a 45-day public comment period and refinements to the draft document, a final Trusted Exchange Framework will be implemented by ONC in collaboration with a Recognized Coordinating Entity—to be selected through a competitive process—which will use the policies, procedures, technical standards, principles and goals to develop a single common agreement that qualified health information networks and their participants will voluntarily agree to adopt.

According to Morris, the Recognized Coordinating Entity will be responsible for “oversight” of the qualified HINs that agree to the common agreement. “Which does mean ‘policing,’ ” she commented.

However, Rucker disagreed with Morris’ assessment, adding that he viewed the Recognized Coordinating Entity’s role as “coordinating things rather than the assumption that there’s a lot of policing required here—I don’t think that’s the way that networks tend to work.”

“It’s not necessarily our role to operationalize these things, and industry’s really better in doing that themselves,” added Morris. “We intend, through a cooperative agreement, to work with a Recognized Coordinating Entity—or an RCE—which would be an industry-based organization with some experience in this space that could actually take the minimum required terms and conditions and build that into a full end-to-end common agreement.”

Morris said that a final draft of the combined Trusted Exchange Framework and Common Agreement (TEFCA) is expected to be published by the end of 2018.

“We applaud the efforts by ONC to continue its efforts to assist the healthcare industry to assure stakeholder trust and assure interoperability in the trust networks and technology that continue to evolve already providing a very robust foundational infrastructure,” said Lee Barrett, executive director of the Electronic Healthcare Network Accreditation Commission. “As Dr. Rucker stated in releasing (Trusted Exchange Framework) for public comment in the Federal Register, supporting the efforts already being undertaken by the industry to develop and enhance trust agreements and common exchange networks, we do need to build upon and support these initiatives, including DirectTrust and the Direct protocol, blockchain, (Empowering People with Privacy and Personalization) EP3 Foundation, Sequoia Project and Carequality and many other industry organizations and initiatives underway.”

Barrett added that the healthcare industry needs to “leverage the technology and standards that have and are becoming de facto, identify where we may have gaps, assure privacy and security of the networks address HIPAA and cyber and ransomware vulnerabilities, address authentication issues and provide the highest levels of stakeholder trust.”

The public comment period for the draft Trusted Exchange Framework is open now and ends on February 18. Comments can be submitted to exchangeframework@hhs.gov.

ONC will host a public webinar on January 11 to review the agency’s proposed policies, terms and conditions contained in the draft document. Registration for the online event is available here.

In addition, ONC has released a User’s Guide to Understanding the Trusted Exchange Framework and the US Core Data for Interoperability (USCDI) Glide Path to identify a roadmap for broadening the data that can be exchanged via the TEFCA. The agency is also seeking public comment on the USCDI Glide Path.

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