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February 13, 2023 Headlines 8 Comments

Building TEFCA

HHS, ONC, and The Sequoia Project recognize CommonWell Health Alliance, EHealth Exchange, Epic Trusted Exchange Framework and Common Agreement Interoperability Services, Health Gorilla, Kno2, and Konza as the first set of networks to be approved to implement TEFCA as prospective Qualified Health Information Networks.

Top Senator Says Modernizing VA’s EHR ‘Is Not Optional’

Senate Veterans’ Affairs Committee Chairman Jon Tester (D-MT) says the VA’s EHR Modernization Program must move forward, pointing out that issues with the new Oracle Cerner system do not outweigh the fact that the department’s legacy VistA system needs to be updated.

Johns Hopkins Winds Down Pioneering Pandemic Data Tracking

Three years after launching, Johns Hopkins University & Medicine’s Coronavirus Resource Center announces it will stop collecting and reporting COVID-19 data on March 10.



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Currently there are "8 comments" on this Article:

  1. TEFCA and QHIN: Waiting for an Axios Pro article to explain to me in under five minutes in simple language as to why this matters and if this is useful to anyone outside of the professional interop consulting circles!

    • In case it’s helpful…

      – TEFCA (Trusted Exchange Framework and Common Agreement)
      TEFCA is a requirement imposed by Congress. The 21st Century Cures Act (passed in 2016) directed HHS to create TEFCA in order to promote greater, more efficient data exchange throughout the country.

      – Breaking down the parts
      The TEF part is a set of non-binding principles that health information networks should follow to achieve that goal of strong, efficient interoperability. To make an analogy, in sports it is common practice to shake hands after a match, and if you are wearing a hat or helmet, to remove your head covering before shaking hands. Neither action is required in the rule books, but these are shared principles that make for good sportsmanship and build a sense of respect among competitors. Likewise, the TEF encourages HINs to follow certain best practices (e.g., use and prioritize industry standards rather than proprietary ones, make their privacy policies publicly accessible) for the sake of strong, efficient interoperability.

      The CA part is a legal agreement, so it is more detailed and is legally binding. Think of this like the rule book in a sport. When a player decides to participate in a sports league, they are agreeing to follow this set of rules, and there are consequences if they break any rules. The CA and its associated standard operating procedures outline rules that HINs must follow (e.g., only exchange data for a valid purpose like treatment-payment-operations, carry a minimum amount of cybersecurity insurance) to ensure they are participating in TEFCA correctly and fairly.

      – Why does it matter (for anyone besides consultants)?
      Today, exchanging data in healthcare is very fragmented, and you often have to establish point-to-point connections with individual providers, payers, etc. There is variation in how you establish those connections, what information you must provide to get the data you seek, and for what purposes you are allowed to request data.

      Imagine a world with professional football teams but no NFL or standardized rule book. When the Titans play the Chiefs in Week 1, they must negotiate over things like the length of each quarter, how many players are allowed on each team, how many timeouts each team gets, etc. Then when the Titans play the Eagles in Week 2, they must negotiate again over the same things, and the rules for this second game may differ from the first one’s.

      Granted, not all healthcare data exchange is like this. There are health information exchanges and other entities that aggregate large amounts of data across an entire population, so you can get a more comprehensive set of data this way. But these entities don’t necessarily talk to each other well, so if the data you need lives with two different HIEs, you have to establish separate connections and conform to separate rules. In the NFL, this would be like if the AFC and NFC had different rules, so playing a team within your conference is a lot easier than playing one without.

      Instead, the NFL says “No matter where your team is located or which conference it is in, here are the rules every team will follow.” TEFCA aims to do the same thing, with the hope that standardizing the rules for data exchange will make it easier for patients, providers, researchers, and others to request and retrieve medical information, to improve care delivery, and to make us healthier.

      – QHIN (Qualified Health Information Network)
      A QHIN is simply a health information network (i.e., a repository of health data across a large population) that has signed the Common Agreement and is participating in TEFCA.

      – What does The Sequoia Project have to do with this?
      The Sequoia Project is the Recognized Coordinating Entity for TEFCA. Essentially, they were chosen by the federal government to manage and support several aspects of TEFCA. You can think of them kind of like the commissioner of a sports league, establishing the rules for the league’s teams, onboarding new teams into the league, and making sure things are running smoothly.

      • Thank you! Much more helpful than anything else that ONC has put out. Given the NFL metaphor, any bets on which QHIN participant will be embroiled in “deflategate”? 🙂

  2. Cyrus your explanation was helpful, but the level of complexity and lack of requirements are some of the leading reasons that healthcare records aren’t universally available to providers. A unique universal patient identifier would help as well.

    I have worked in healthcare for over 30 years, and the challenges of efficiently and effectively sharing health records between providers that have received appropriate permission from the patient is still amazing to me. I recently saw a HCA ambulatory provider that utilizes EPIC, I was seen earlier in the year by a provider in the community employed by the second largest health system in the area that utilizes eClinicalWorks for ambulatory office based care. The best option to get records to my HCA provider was for me, the patient, to print the records out of the Portal, and have the practice scan into EPIC. I also did the same for a provider seen in the past the utilized Allscripts Touchworks. The records were unstructured, incomplete, and duplicative, As a country we need to do better. Exports of CCD documents are challenged due in part of loose standards, FHIR was going to save the day a few years ago, and it has helped, but not enough. TEFCA might be a move in the right direction, but I fear that since RHIO, and US Nationwide Health Information Network (NHIN).really never took off (lot of money spent), and HIEs are fragmented at best and sorely missing in major parts of the country, we really need a solution that is standards based, and mandatory. I don’t use the word mandatory lightly, but most other options have simply fallen short.

    These are my views and not necessarily those of my employer Medical Advantage.

    • I share this skepticism, borne of our history.

      When I heard that implementing TEFCA merely makes you a “prospective Qualified Health Information Networks”, I asked why? Why prospective? It feels tentative and unnecessary.

      Honestly, at this point? I’d welcome a de-facto, vendor-driven standard. Sure it’s not ideal, but how long are we going to throw ourselves ineffectively at the problem?

      I’m sure the people behind TEFCA mean well. So did the people behind HL7, FHIR, CCD, HIE, Blue Button, and all the rest. Somehow, routine, easy and secure data sharing remains out of reach.

      I’ll continue to support efforts in that direction. But you have to be naïve in the extreme not to see the multiplicity of ways in which our efforts have fallen short.

      • A “prospective QHIN” is a QHIN whose application has been approved. This is where we are today with the first six prospective QHINs. A QHIN becomes a designated QHIN once it signs the Common Agreement and completes the onboarding process. After that, it completes a final production test before being a full implementer of TEFCA and able to perform production data exchange. https://rce.sequoiaproject.org/qhin-process/ has some good details.







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