With the release today of the second draft of the Trusted Exchange Framework and Common Agreement (TEFCA), the Office of the National Coordinator for Health IT is moving another step closer to implementing a framework designed to improve data sharing between health information networks.
The framework (PDF), mandated by the 21st Century Cures Act, 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.
ONC released the first draft of the TEFCA back in January 2018.
Among the key changes in the second draft of the framework is that qualified health information networks (QHINs) would have 18 months to implement the voluntary framework rather than only 12 months. That might not satisfy some healthcare groups as many had called for a phased-in approach and even a three-year implementation plan.
The voluntary framework aims to eliminate the burdens of costly point-to-point interactions that healthcare organizations currently face by creating a common set of practices to allow providers, patients, payers and health IT vendors to securely communicate with one another.
The framework is also an attempt to resolve some of the nagging issues inhibiting data sharing across the industry, including the lack of connection between national networks and local or regional health information exchanges.
In a blog post, Donald Rucker, M.D., national coordinator for health information technology, compared the current state of interoperability of health information to the use of the Internet in the 1990s.
“Many Americans interacted with the Internet through America Online. While this platform was revolutionary, providing users with email services and access to content, it was also a closed network,” Rucker said. “In the healthcare landscape, we still have a similar dynamic today. Both national networks and local or regional health information exchanges provide valuable services to their users; however, these networks are often not connected and offer varied services and use cases.”
In developing TEFCA, ONC is focused on three high-level goals—providing a single “on-ramp” to nationwide connectivity; ensuring electronic information securely follows patients when and where it is needed; and supporting nationwide scalability for network connectivity, ONC officials said.
ONC released Friday three separate but related documents for public comment—a second draft of the Trusted Exchange Framework (TEF); a second draft of the “minimum required terms and conditions” (MRTCs) for trusted exchange; and a first draft of a qualified health information network (QHIN) technical framework.
Collectively, these documents will form the basis of a single data sharing agreement that will create baseline technical and legal requirements for sharing electronic health information on a nationwide scale, according to ONC officials.
The public comment period to submit feedback on the second draft runs until June 17.
“The seamless, interoperable exchange of health information is a key piece of building a health system that empowers patients and providers and delivers better care at a lower cost,” HHS Secretary Alex Azar said in a statement. “The 21st Century Cures Act took an important step toward this goal by promoting a national framework and common agreement for the trusted exchange of health information. We appreciate the comments and input from stakeholders so far and look forward to continued engagement.”
Funding opportunity for coordinating organization
When ONC released the first draft of the framework (PDF), it indicated that it would be shopping out the implementation of the framework—specifically the common agreement—to the private sector.
As expected, ONC on Friday also issued a competitive Funding Opportunity Announcement, allowing industry organizations to compete for a multiyear contract and cooperative agreement. The funding award (PDF) will go to a nonprofit organization to develop, update, implement, and maintain the common agreement and the qualified health network and technical framework.
The cooperative agreement will include requirements for the coordinating organization to demonstrate a commitment to transparent, fair and nondiscriminatory data exchange through organizational policies and governing structures, according to ONC.
Based on the first round of public comments on the first draft TEFCA, there is wide support for a recognized coordinating entity, according to Rucker in his blog post.
Key changes in the second draft
Nationwide interoperability is not a simple undertaking and something as expansive as a final TEFCA requires thoughtful consideration of the issues and challenges, Rucker said. For example, a successful “network of networks” requires that each network that facilitates connectivity agrees to the same mix of technical standards, policies, and legal conditions.
In public comments about the first draft of the framework, industry groups voiced concerns about what they perceived as “aggressive timelines” for implementation as well as the need to strengthen patient matching provisions.
The second draft of the framework includes key changes in response to stakeholder comments, including changes to the draft requirements that health information networks who choose to participate would have to follow.
These changes include updating the purposes for which information can be exchanged, adding a “push” method of data exchange, adding a technical framework for qualified health information networks, and extending timelines for participating entities to implement changes that will be required by the data sharing agreement.
ONC broadened the definition of qualified health information networks to allow more types of stakeholders to apply.
These changes will help improve the flow of information between networks where needed and appropriate, according to ONC.
In public health settings, for example, “reporting from providers is a foundational capability for effective public health action,” Chesley Richards, M.D., deputy director for public health scientific services at the Centers for Disease Control and Prevention, said in a statement.
“The TEFCA will not only strengthen this capability but will create the ability for timely and true bi-directional information sharing that is essential for responding to public health threats and epidemics.”
Rucker said the success of the data-sharing framework depends on coordination with the private sector.
“We expect that the implementation of the Trusted Exchange Framework and the Common Agreement, will bring us all that much closer to achieving the administration’s goals of nationwide interoperability,” he said.