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TEFCA inches forward by tapping The Sequoia Project

TEFCA is aimed mostly at health information exchanges, but AMIA's Jeffery Smith said healthcare CIOs can't ignore its progress.

A nonprofit organization will develop the legal and technical requirements for a framework that could pave the way to better data sharing among health information networks. 

The Office of the National Coordinator for Health IT (ONC) recently named The Sequoia Project, a nonprofit created in 2012 to advance interoperable nationwide health information exchange, as a significant player in moving the Trusted Exchange Framework and Common Agreement (TEFCA) forward.

TEFCA is a two-part document that outlines principles, terms, conditions and a technical framework for sharing data on a national scale. It is part of the 21st Century Cures Act, a bill that funds the modernization of the U.S. health system and interoperability efforts. A part of the act stipulates naming a Recognized Coordinating Entity or RCE to oversee the common agreement portion of TEFCA. The Sequoia Project has been tapped to be the RCE.

The goal of the framework is to remove barriers that impede data exchange, and it aims to make sharing data between organizations that don't have an existing relationship easier, said Jeffery Smith, vice president of public policy for the American Medical Informatics Association. TEFCA is often referred to as "a network of networks," he said.

Jeffery Smith, vice president of public policy, American Medical Informatics AssociationJeffery Smith

"Ideally what you have is a way to connect networks of hospitals and physicians to other networks of hospitals and physicians," Smith said.

TEFCA has the potential to foster greater transparency around data sharing. It could help healthcare organizations create a more complete picture of a patient by being able to query not only their health information network, but a national network of electronic health information, Smith said. But keeping TEFCA aligned with where EHRs are going in terms of sharing data could be a "tough juggling act to pull off" for ONC, Smith said.

Ideally what you have is a way to connect networks of hospitals and physicians to other networks of hospitals and physicians.
Jeffery SmithVice president of public policy, American Medical Informatics Association

Regardless, healthcare CIOs should make sure their health information exchanges are staying on top of what's happening at the federal level with TEFCA, Smith said.

What is TEFCA?

According to ONC, the goal of TEFCA is to scale the sharing of electronic health information to a national level, thereby ensuring providers, health plans and patients have access to electronic health information "when and where it is needed."

TEFCA is made up of two parts: the trusted exchange framework and the common agreement.

The trusted exchange framework is "a common set of principles" used to establish trust between health information networks (HINs). All HINs are obligated to follow the common set of principles or rules that are the foundational element guiding the development of the common agreement, which outlines terms and conditions the networks agree to follow. It also details the technical components of exchanging data.

John Rancourt, director of the interoperability division with the office of policy at ONC, said that while health systems have been digitized, they don't necessarily talk to each other, which makes sharing data between providers, payers and patients cumbersome. TEFCA's goal is to make that conversation to happen, which would make care coordination easier by making information available at the point of care, he said.

John Rancourt,  director of the interoperability division with the office of policy, ONCJohn Rancourt

"What we're trying to do is create a common agreement, which would be a contract that would be signed by those entities that are participating that would include nationwide networks, but flowing down to entities like hospitals," he said. "This would be a contract that would define the baseline legal and technical requirements for that network-to-network sharing of information."

The Sequoia Project will develop the common agreement, which includes granting what ONC calls "qualified health information network" status to an HIN. The common agreement is ultimately the governance needed for scaling a system of connected QHINs, according to ONC.

The goal of TEFCA is for an individual hospital to connect to a network and query not just the state health information exchange, but the entire nation. That way, the hospital can quickly pull together a complete record of a patient.

Rancourt said one interoperability concern healthcare organizations have raised is redundancy of technology. Hospitals use multiple interoperability methods to send and receive data, which adds additional cost and complexity to the healthcare system, according to Rancourt. TEFCA aims to create a "single on-ramp" to nationwide connectivity, he said.

Where TEFCA stands today

The federal agency released its first draft of the trusted exchange framework in January 2018. It recently closed the comment period on the second draft. The Sequoia Project will be responsible for releasing the first draft of the common agreement.

AMIA's Smith said it is critical to note that TEFCA is a voluntary program, but the federal government is looking at ways to incentivize HINs and health systems to participate.

ONC is now looking at comments on the second draft of the trusted exchange framework, but Smith doubts the agency will propose a final version before the end of the year. He believes there are still areas within the draft that need fine-tuning, such as the technical components for a nationally-scaled information exchange.  

What healthcare CIOs should know

The bulk of the regulatory and technical heavy lifting for TEFCA won't fall to CIOs, Smith said. Yet the health IT leaders will share some responsibility when it comes to enabling data exchange.

The most important step healthcare CIOs can take now is to get in touch with their HINs, according to Smith. He said it's also important to pay attention to what the federal government is doing so that CIOs can start thinking about and planning how their organization can make use of TEFCA.

By staying involved and paying attention, Smith believes there will be "ample opportunity" for CIOs to help shape the way TEFCA evolves.

"The least helpful thing would be to look at this as a voluntary program that your individual hospital isn't going to be participating in, therefore you don't need to pay attention," he said. "That would be the exact wrong thing to do."

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