Industry perspectives on TEFCA one year post-go-live
TEFCA facilitated the exchange of 7.8 million documents in its first year, but additional efforts are needed to expand use cases across public health and payer-provider exchange.
As the country looks toward health data interoperability, TEFCA could be the missing piece for national health information exchange.
TEFCA aims to facilitate nationwide interoperability for a variety of use cases through a network of networks approach. Born from the 21st Century Cures Act, the framework became operational in December 2023 with the HHS designation of five initial qualified health information networks (QHINs).
Just over a year since it went live, TEFCA has added two additional QHINs and supported the exchange of 7.8 million documents, according to The Sequoia Project, TEFCA's recognized coordinating entity.
At a session during the 2024 Assistant Secretary for Technology Policy (ASTP) Annual Meeting, Mariann Yeager, CEO of The Sequoia Project, spoke with stakeholders about TEFCA's implementation progress across various use cases.
Progress for public health data exchange
Public health data exchange has long been fraught by data silos and incompatible systems. However, TEFCA is a critical step toward modernization, according to Michelle Meigs, managing director of informatics at the Association of Public Health Laboratories (APHL), a nonprofit membership organization.
"Public health informatics is on the cusp of a renaissance, and part of that renaissance is TEFCA," Meigs said.
APHL has connected to the eHealth Exchange QHIN to support electronic case reporting (eCR) for its members, building upon a successful eCR initiative for COVID-19 with the health information network.
"We were able to leverage TEFCA because we had existing trust and relationships with eHealth Exchange," Meigs explained.
APHL sees TEFCA as a critical tool for bridging health information exchange (HIE) gaps between public health and the broader healthcare ecosystem.
"What APHL is trying to do with TEFCA is to build new technical partnerships and streamline this for public health agencies so that they can focus their attention on figuring out how to use these data in the correct way," Meigs said.
Meigs noted that by alleviating the burden of managing TEFCA connections for eCR, public health agencies can think more strategically about how TEFCA can support their daily operations and long-term goals.
Potential for payer-provider interoperability
Michael Westover, vice president of data partnerships and informatics at Providence, emphasized the role that TEFCA could have in connecting siloed data systems across the care continuum.
"We live in a fragmented healthcare world with often fiercely independent contributors and competitors around us, and because we live in this fragmented healthcare environment, interoperability and liquid data exchange are foundational to success," Westover said.
We live in a fragmented healthcare world with often fiercely independent contributors and competitors around us, and because we live in this fragmented healthcare environment, interoperability and liquid data exchange are foundational to success.
Michael WestoverVice president of data partnerships and informatics, Providence
"How do you overcome the weight of history between providers and payers?" he asked. "I know I'm biased, but through my experience, part of the answer is interoperability and data exchange. Data is an excellent way that you can form a partnership."
"We've started off with the clinical data exchange, which is fantastic, but we also need that operational and financial data so that we can know where to invest and how we can best take care of patients," Westover underscored.
Incremental progress and trust-building
Matthew Eisenberg, associate chief medical information officer at Stanford Health Care, said that TEFCA participation for treatment purposes was a natural extension of the health system's interoperability efforts.
"Many of us have been engaging in health information exchange for the purpose of treatment in a standard way for a long time," Eisenberg said.
However, Eisenberg mentioned that implementing TEFCA for additional HIE use cases, like public health reporting, will require sustained collaboration and trust.
"You have to establish that trust by knowing who you're exchanging with down to the participants, subparticipants, et cetera," Eisenberg said. "That has to be baked into the technology at the level of the directory, at the level of the transactions."
Cait Riccobono, Esq., general counsel for the eHealth Exchange and senior counsel for interoperability and technology policy at CRISP Shared Services, echoed the critical role of trust in TEFCA's progress.
She emphasized that while legal agreements and terms are an important foundation for trust, building relationships and fostering collaboration among stakeholders are also critical.
Riccobono praised the efforts of The Sequoia Project and the ASTP in fostering collaboration across the industry through TEFCA and highlighted the importance of incremental progress in TEFCA's first year.
"Incrementality with progress is important, and I think we've seen so much of that over the past year and I'm really excited to keep seeing more of that," Riccobono said.
She mentioned ongoing progress in onboarding new HIEs and expanding partnerships with public health agencies.
"Continuing to bring additional HIEs on and having them bringing on additional public health agencies is where we're really focused," Riccobono said. "We're really hoping to make strides in that over the coming year."
As TEFCA participation grows, trust and collaboration will be key to unlocking the framework's potential for HIE.
Hannah Nelson has been covering news related to health information technology and health data interoperability since 2020.
