HHS ushered in the first group of TEFCA's Qualified Health Information Networks

The Department of Health and Human Services celebrated the inaugural cohort of companies approved to begin onboarding as Qualified Health Information Networks, or QHIN, within the Trusted Exchange Framework and Common Agreement (TEFCA).

QHIN is a new federal designation to mark networks interconnected to increase national health information exchanges. The six companies recognized will not be designated as QHINs until after pre-production testing process and project plan completion, according to the Office of the National Coordinator for Health IT.

TEFCA will function as a national floor for interoperability in healthcare. QHIN entities have agreed to the Common Agreement, adhering to a model that will allow for the secure sharing of basic clinical information with one another. The Trusted Exchange Framework creates a non-binding set of common policies and practices to allow exchange between QHINs.

HHS Secretary Xavier Becerra cheered on the inaugural companies, which he says will create a new standard of interoperability that will ultimately save lives.

“While most Americans probably won't recognize that you scored some real touchdowns in the last several months of work, at some point, it's going to click that something is changed, that all of a sudden, that specialists instantly got the information that was needed to keep them alive,” Becerra said at the Feb. 13 recognition event. “At some point, the synapses will click and they'll realize something has changed in the way we do health care.”

TEFCA, which was mandated by the 21st Century Cures Act in 2016, will now be followed by six organizations in the “network of networks”: CommonWell Health Alliance, eHealth Exchange, Epic, Health Gorilla, Kno2 and KONZA National Network. All six networks applied to join the cohort and passed through a stringent process to ensure compliance with TEFCA regulations. 

The first draft of the TEFCA was released in January 2018 by the ONC, within HHS. The framework’s goal is to ease the burden of interactions between healthcare organizations and to free patient information from silos that slow care.

The framework outlines security measures and technical standards necessary to share patient records and health information between providers, state and regional health information exchanges and federal agencies. “Similar to the way that wireless networks and ATM networks connect to create the experience of a single seamless network,” said ONC head Micky Tripathi at the recognition event.

The Sequoia Project functioned as a coordinating entity for the six participating organizations and HHS. All six groups volunteered to meet the stringent requirements without immediate reward or acknowledgment aside from an HHS certificate.

However, through data exchange, interoperability of data and ease of care, it is expected that current and future participating organizations with reap longitudinal benefits.

Epic will bring data from almost 2,000 hospitals and 45,000 clinics that are tied together through the electronic health record provider’s Care Everywhere platform. According to the company, the platform is used every day to exchange over 11 million patient charts, comprised of millions of actionable, standards-based documents. Half of those connections are passed between organizations that use different IT systems, Epic says.

“I think that one of the great opportunities now is to build on top of what the private sector has done and really bring a partnership between the public and private sector together,” said Matt Doyle, head of the Epic research and development team at the recognition event. “A large number of hospitals are on the sidelines. TEFCA’s big opportunity is to encourage those folks that come off the interoperability sidelines, to join, to build on the success that we've seen before. TEFCA can help to set that expectation nationwide.”

Doyle used the analogy of the telephone and how without the widespread use of technology, advances can fall flat: “The only way it works is if everyone in your community has one.” He sees the earning of faith in the system as being necessary to integrate provider data. One way he sees this trust being built is through the TEFCA stipulation that third-party apps that aren't HIPAA-covered entities still have to follow the HIPAA Privacy and Security rules.

“We need to help people understand how this is going to help them, how this is going to help their patients, how this is going to help public health, how this is going to help us as a nation to be stronger and better at health care,” Doyle said.

On top of improving overall health outcomes, interoperability has been shown to ease the patient burden of repeating health information, an experience 83% of patients report having. Tedium laid on nurses and clinicians to translate patient health information between siloed systems can also be eased by interoperability. The remedy of repeated and incorrect information is often also pointed to as an advantage of increased interoperability.

Dave Cassel, senior vice president of customer success and operations at Health Gorilla, emphasized that through partnering with the federal government, further opportunities are opened. He suggested that federal incentives could increase private participation in TEFCA.

“There’s already been a rigorous process just to be part of this and raising the floor on trust, which encompasses security,” Cassel said at the recognition event. “Raising that floor, I think, is what gives the federal agencies the level of comfort that they need in order to really dive in fully and bring that level of success that I think we’ll see with TEFCA.”

Interoperability has been a privilege, with patients of a lower socioeconomic class being less likely to gather and utilize their health data, Health Gorilla said in a press release. Without standardized data, information like social determinants of health may not be easily accessible to providers.  

ONC was formed in 2004 with the moonshot of a nationwide health information network in mind. While there is still no mandated requirement to join the “network of networks,” ONC is hoping that ushering in the first cohort will inspire others to follow.

Editor's note: This story has been updated with a statement from the Office of the National Coordinator for Health IT.