The Office of the National Coordinator for Health IT recognizes the first set of qualified health information networks approved to implement a new electronic health data exchange.

HHS Secretary Xavier Becerra speaking at the HHS Event Recognizing QHIN Applicants Feb. 13 in Washington, D.C. Photo Credit: ONC

About 97% of hospitals and 90% of physician offices across the country use electronic health records, making electronic health data exchange essential to effective health care delivery, but there are still gaps to a truly interoperable framework.

To close these gaps, the Office of the National Coordinator for Health IT (ONC) published the Trusted Exchange Framework and Common Agreement (TEFCA) in 2022 to establish a universal technical and legal baseline for information exchange and interoperability across qualified health information networks (QHINs) nationwide, meeting the 21st Century Cures Act mandate, which called on the agency to improve data sharing.

ONC recognized the first set of QHINs on Tuesday, which include CommonWell Health Alliance, eHealth Exchange, Epic TEFCA Interoperability Services, Health Gorilla, Kno2 and KONZA, marking the next step in implementing TEFCA to advance interoperability at scale. TEFCA implementation plans will go live in 10 months.

“The goal of TEFCA is to establish a uniform or baseline of health data interoperability across the country. Its core infrastructure for the healthcare delivery system – like electricity, broadband or water – so the patients and those involved in the care at the individual, population level and focusing on delivering the best possible care, and less on pry data loose from the existing systems,” National Coordinator for Health Information Technology Dr. Micky Tripathi said during the HHS Event Recognizing QHIN Applicants Tuesday.

The digital divide, health agencies’ lack of access to health exchange networks and actionable health data, challenges with payer-provider exchanges, barriers to patient data access and more are a few of the gaps that TEFCA could close, Tripathi said.

“Most importantly – for everyone who has some connection in the health care system – [TEFCA will improve] health and safety. It takes us to the next level,” Department of Health and Human Services (HHS) Secretary Xavier Becerra said. “Part of what defines the 21st century digital health care system is interoperability. Healthcare interoperability is critical if we’re going to talk health care national infrastructure.”

If implemented as intended, TEFCA will provide secure access to data, ensure availability of a core set of data among QHINs, decrease cost and improve efficiency of health care and deliver a common set of privacy and security requirements to protect patient data.

“[TEFCA is] unlocking not just a better course of treatment for one individual, but we’re starting to use the power of the data that’s becoming available to unlock better courses of treatment for thousands – and then ultimately for millions – of people, and this really showing the power scale,” said Dr. Arati Prabhakar, director of the White House’s Office of Science and Technology Policy (OSTP) and assistant to the president for science and technology.

Health agencies envision a more equitable and efficient health care delivery model by leveraging TEFCA. Leaders from the Centers for Disease Control and Prevention (CDC) and the Department of Veterans Affairs (VA) anticipate new improvements to public health emergency response and veteran care following TEFCA implementation.

“We must modernize our public health data and information system,” CDC Director Rochelle Walensky said. “We have to have a nationwide approach to public health interoperability that gets our state, local, tribal, territorial and federal public health professionals the data that they need. And we must take the data that’s available as quickly as possible from our health care providers who are working on the frontlines every single day for the policymakers to feed it back to the state, local, tribal, territorial and federal level and the public.”

CDC has launched several initiatives, such as CDC Moving Forward, to bridge the gaps in the national data infrastructure system and bring modern, scalable and responsive technical and management approaches to public health data.

TEFCA would further enable health departments to focus on intervention and public health rather than data entry, Walensky explained. The network also provides common rules for data sharing, use and governance, a common posture on cybersecurity and greater transparency to guide public health participation.

“CDC and ONC are working with state, tribal, local and territorial communities to identify early adopters and to help forge the path so that the whole public health community can see how much there is to benefit from TEFCA,” Walensky said.  

VA’s Undersecretary for Health Shereef Elnahal explained that TEFCA would enable seamless communication and greater insight into a veteran’s health history both inside and outside VA medical facilities. For example, under the current networks, it takes VA two years to get updated on veteran suicide data.

“Imagine if we were able to get back data in real time, or a month or a quarter. Imagine if we’re able to get overdose deaths for veterans and the general population in a way that doesn’t require us to manually get information from deaths or communities across the country, wait for that data to be uploaded to system after system,” Elnahal said. “This is game changing work that ultimately will reach patients and veterans across the country.”

VA has pioneered new solutions such as the Blue Button to give veterans access to their health information, FHIR APIs and EHR modernization to provide high quality care to veterans. Elnahal said TEFCA will further enable these initiatives, provide greater access to veterans in rural areas and help close the digital divide.

Looking ahead, ONC and QHINs will work together to build trust in TEFCA and recruit more applicants to join the network. 

“Now, we get to the next step, which is a set of six organizations who are now going to implement exchanging with each other. That’s where you start to get that trust and you start to get that deep collaboration,” Tripathi told GovCIO Media & Research in an interview.

ONC aims for TEFCA to go live by the end of the year and will release the standard operating procedures for public health and for payment and healthcare operations in spring 2023. Tripathi said ONC is actively recruiting critical use cases to implement in 2024.

“Interoperable health information technology improves patient care, enables better connection between patients and providers, helps reduce the risk of dangerous medical errors and makes sure that our country is prepared for any future public health care crisis,” Becerra said. “It does that by connecting doctors and patients to more complete and accurate health records and by allowing patients to access the records, which combined, allow patients and their providers to make smarter decisions about care.”


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