As more providers, payers, and other stakeholders take advantage of electronic and digitized support, care delivery is entering its most sophisticated state, finally catching up to peers in industries like finance and logistics.
But while technology has introduced valuable infrastructure like electronic health records (EHRs), imaging systems, laboratory information systems, health information exchanges (HIEs), plus remote monitoring systems — this change has presented a new challenge: getting these systems to communicate with each other for effective care delivery.
The Office of the National Coordinator for Health Information Technology (ONC) introduced the Trusted Exchange Framework and Common Agreement (TEFCA) to push healthcare further as an interoperable ecosystem.
TEFCA is the compounded result of everything learned from past interoperability initiatives like Meaningful Use, Consolidated CDA (C-CDA), and the different versions of Health Level Seven (HL7). With added innovations, this document sets out to create a nationwide system for sharing health information across care settings, and is on the way to achieving this.
TEFCA aims to lay a standardized framework that supports data exchange between operating systems. This document puts its value where its name is — by creating a Trusted Exchange Framework of common principles and conditions for systems looking to exchange health information.
Since 2016, after the release of The Cures Act, providers, payers, and other stakeholders have heard whispers about TEFCA, but it wasn’t until January 2022 that the TEFCA document, in its third draft, was finally released.
While previous interoperability measures used incentives and rules to promote compliance, TEFCA takes it further by introducing a single Common Agreement that every participating IT vendor becomes bound by. This agreement means participating vendors and players have to play nice and by the same rules to prevent common data blocks and enhance information exchange.
TEFCA's requirements span privacy protections, data quality, plus uniform technical standards. Technology systems operating under this agreement will require similar protocols like APIs using Health Level Seven (HL7) standards, plus consistent datasets to achieve seamless exchange.
For providers, payers, and IT developers participating in this framework, players in the form of a Recognized Coordinating Entity (RCE), and Qualified Health Information Networks (QHINs) help provide a structure to enforce the Trusted Exchange Framework and Common Agreement.
If everything goes according to plan, TEFCA’s interoperability approach could be the go-to standard adopted across healthcare networks. To put this plan into place, the TEFCA landscape has key participants to take note of. These are:
Because the ONC recognizes the potential impact of the TEFCA, in 2019 this body designated a RCE specially to develop, implement, and maintain the Common Agreement portion of the document.
The Sequoia Project currently holds this position, and its responsibilities include:
QHINs are a network of provider organizations that make patient data exchange possible. These serve as a network of networks, but should not be confused with simple Health Information Networks (HINs).
For starters, QHINs work hard to earn the “qualified” status from the RCE, so while every participant (more on this shortly) may be a HIN or a Health Information Exchange (HIE) — not every exchange system will be considered a QHIN.
Also, while other exchanges may have similar standards but individual rules, QHINs play by different, standardized rules that govern information exchange.
To earn this status, QHIN applicants must satisfy that they meet applicable federal and state law, plus operate an existing network with participants exchanging data in a healthcare setting, and must submit a plan to meet QHIN requirements.
Under TEFCA, these qualified networks are permitted to carry out six information exchange purposes:
QHINs are also projected to feature improved technical support, with capabilities like a Master Patient Index, and record location for participants.
In February 2023, the ONC approved the first QHINs under TEFCA. Included in these initial QHINs was CommonWell Health Alliance, which has a network spanning thousands of hospitals and providers, providing a robust database of patient records available through services like Metriport's Medical API.
A participant is a person or entity that enters into an agreement to transmit or receive information through QHIN exchange. These participants may be EHRs, Health Information Exchanges, IT developers, payers, or even a federal agency.
Sub-participants operate under the umbrella of a participant and are typically bound by the participant’s agreements and compliance demands under the TEFCA. For context, where HIEs make up a QHIN, this information exchange is considered a participant of the network. Providers and other players that send and receive patient information using this same HIE, however, are indirect, sub-participants of a QUIN. Sometimes, QHIN structures permit individual users like patients to relate with the QHIN, participant, or sub-participant directly.
As the technical floor for nationwide interoperability, TEFCA has elevated the stage for improved data exchange across care settings. This agreement will broaden access to clinical data, with patients free to move across the country, safe in the knowledge that their health information and history are readily accessible, regardless of operating systems or data storage locations.
Through TEFCA, providers can seamlessly obtain complete patient records, enhancing clinical decision-making, reducing duplicative tests, and other administrative burdens caused by compromised data-sharing structures. In addition to patients and providers, other beneficiaries like public health organizations, health plans, and payers can take advantage of TEFCA’s offerings to close care gaps and stimulate care coordination.
TEFCA’s impact can be summed up as improved trust felt across healthcare systems. A patient moving cities can do so with no worries about care continuity. This initiative promotes collaboration such that a participating hospital in Texas can readily access complete patient information contained in structures across pharmacies, hospitals, or patient portals in New York without fear of tampered data or quality. As the technical floor for nationwide interoperability, this agreement has elevated the stage for improved data exchange across care settings.
TEFCA has the potential to broaden access to clinical data, with patients free to move across the country, safe in the knowledge that their health information and history is readily accessible, regardless of the systems or storage locations. Through this agreement, providers can seamlessly access complete patient records, enhancing clinic decision-making, reducing duplicative tests, and other administrative burdens caused by compromised data-sharing structures. Other beneficiaries include public health organizations, health plans, and payers who will utilize the information available to close care gaps and stimulate care coordination.
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