Five years in the making, the nation's top health IT agency released Tuesday the Trusted Exchange Framework and Common Agreement, a critical step in establishing a nationwide data-sharing network.
The long-awaited interoperability framework (PDF), called TEFCA, was mandated by the 21st Century Cures Act back in 2016 and was designed to improve data sharing between health information networks.
The Office of the National Coordinator for Health, within HHS, released the first draft of the TEFCA back in January 2018. The framework provides the policies, procedures and technical standards necessary to exchange patient records and health information between providers, state and regional health information exchanges and federal agencies.
"Today’s milestone marks the beginning of a new era of electronic health information exchange in the US. That world we wanted to see back in 2004—it’s here—and now it’s time to put what we’ve built to use," wrote National Coordinator for Health IT Micky Tripathi and Mariann Yeager, CEO of The Sequoia Project, in a blog post.
When ONC was formed in 2004, the concept of a nationwide health information network—where your information could be located across the country in a click—was a big picture vision that drove the federal government’s early health IT infrastructure, standards, policy actions, and investments, Tripathi and Yeager wrote.
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With the release of TEFCA, healthcare entities will soon be able to apply to be qualified health information networks (QHINs). These networks will connect to one another to support health information exchange nationwide.
The Trusted Exchange Framework is a set of non-binding but foundational health information exchange principles, while The Common Agreement sets up the technical infrastructure and governing approach to support data exchange—all under commonly agreed-to rules-of-the-road. The Common Agreement includes support for treatment, payment, health care operations, individual access services, public health and government benefits determination.
The Common Agreement's flexible structure allows stakeholders—such as health information networks, ambulatory practices, hospitals, health centers, federal government agencies, public health agencies, and payers—to benefit from TEFCA through improved access to health information. Patients will also be able to benefit from TEFCA and seek access to their health information through entities that offer individual access services, according to the agency.
Published in tandem is the QHIN Technical Framework, which sets the functional and technical requirements that qualified health information networks need to support to make this new connectivity come online, according to the blog post.
"Goal 1: Establish a universal policy and technical floor for nationwide interoperability." We are excited about how TEFCA will reduce the number of connections that individuals, care providers, and other stakeholders need to make to get the health information they seek. #TEFCA https://t.co/MNXntJIB6T
— John Rancourt (@johnrancourt) January 18, 2022
ONC also released today the TEFCA Health Level Seven (HL7) Fast Healthcare Interoperability Resource (FHIR) Roadmap (TEFCA FHIR Roadmap), which outlines how TEFCA will accelerate the adoption of FHIR-based exchange across the industry.
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“Operationalizing TEFCA within the Biden Administration’s first year was a top priority for ONC and is critical to realizing the 21st Century Cures Act’s goal of a secure, nationwide health information exchange infrastructure,” Tripathi said in a press release. “Simplified nationwide connectivity for providers, health plans, individuals, and public health is finally within reach."
In 2019, ONC tapped the Sequoia Project to serve as the recognized coordinating entity (RCE) for TEFCA. The organization is charged with developing, updating, implementing, and maintaining the Common Agreement, stewarding the QHIN technical framework as well as designating, onboarding and providing oversight of QHINs.
“The release of TEFCA today marks the beginning of the implementation phase,” Yeager said in a statement. “This is a very exciting milestone that reflects the thoughtful feedback of public and private stakeholders throughout the process. We look forward to supporting everyone as they review the Common Agreement and identify their role in this new public-private paradigm advancing health information exchange nationwide.”
The Sequoia Project plans to host a series of public engagement webinars to provide further information about TEFCA. It is expected that initial QHINs will onboard to the network-of-networks to begin sharing data with one another this year.