ONC Expects to Open TEFCA Interoperability Network Applications Q2

ONC and its Recognized Coordinating Entity (RCE), The Sequoia Project, Inc., recently announced the publication of the Trusted Exchange Framework and the Common Agreement (TEFCA) interoperability framework.

The Trusted Exchange Framework is a set of non-binding but foundational health information exchange (HIE) principles, while The Common Agreement establishes the technical infrastructure and governing approach to support data exchange.

Ultimately, ONC intends for TEFCA to connect Qualified Health Information Networks (QHINs) to one another to support health information exchange nationwide. QHINS will sign contracts with the RCE to agree on policy and technical terms to enable data exchange across networks.

“We want to create a uniform for interoperability so that every authorized user, including individuals, have a baseline expectation of being able to get basic medical record information securely and reliably across the network, regardless of where they are geographically or which vendor or technology they're using,” Mickey Tripathi, national coordinator for health IT, said in a recent press briefing.

Tripathi also noted that ONC wants to simplify network connectivity through TEFCA.

“Right now, it's pretty hard for the networks when they connect to get their systems to work together,” he explained. “It takes a lot of work to get their contracts aligned so that they have the same data use principles across those networks.”

Additionally, TEFCA sets out to allow patients and providers to aggregate information in a patient-centric way, Tripathi said.

“Too many people spend too much time corralling and wrangling data, which doesn't allow them the time to analyze that data and use it for the improvement of care,” he said. “What we want to be able to do is flip that and have TEFCA take wrangling and corralling as much off the table as possible so that they can spend their time on actually being able to make use of the data to improve patients' lives.”

“If we can change that dynamic, then I think we'll have done our job with TEFCA,” Tripathi added.

Maryanne Yeager, CEO of The Sequoia Project, said that QHINs will be high-performing, high-security networks that currently connect other healthcare organizations such as other networks, provider organizations, and health systems.

Yeager predicted that ONC and The Sequoia Project will begin taking applications for QHINs during Q2 of 2022.

“We know that we need at least 90 days following the release date to make sure that we're doing education outreach and helping organizations prepare,” she explained. “We want folks to have an opportunity to have their questions answered, so by the time they do apply, they're ready and understand what they need to do.”

Yeager said while The Sequoia Project knows there is significant interest in TEFCA, the RCE does not have specific predictions of how many networks will apply to be QHINs.

“I doubt there will be a hundred applicants, and certainly more than one, but I think that there's going to be a solid interest,” she said. “We're looking forward to seeing who applies.”

The timeframe for the RCE to certify applicants as QHINS will largely depend on their preparedness around technical testing, Yeager explained.

“Some organizations go through technical testing readily because they have pretty mature capabilities and they've tested before,” she said. “The earliest point in which we anticipate seeing QHINS in production would be Q4 of 2022, but it really depends on them.”

When asked about the potential for TEFCA participation incentives, Tripathi said that there is nothing concrete in the works.

“It's certainly too early to talk about carrots or sticks related to TEFCA participation,” he said. “It is voluntary, but we also are working with federal agency partners about how they may have use cases that would benefit from being able to be TEFCA-enabled.

“We think there's a tremendous amount of benefit for the public at large and for the federal government and making the federal government more efficient,” Tripathi added.

For instance, TEFCA could help support CDC’s public health efforts, he said.

ONC also released the TEFCA Health Level Seven (HL7) Fast Healthcare Interoperability Resource (FHIR) Roadmap on January 18, 2022 which outlines how TEFCA will accelerate the adoption of FHIR-based interoperability across the industry.

The roadmap follows an incremental adoption approach for FHIR over time because the data standard is currently not at a point of maturity for network enablement, Tripathi explained.

Stage one of the roadmap represents the exchange of FHIR content, which is mostly done today through application programming interfaces (APIs).

Stage two of the roadmap is facilitated exchange, which Tripathi said is focused on streamlining direct point-to-point FHIR API exchange through network infrastructure.

Stage three of the roadmap outlines FHIR as a part of QHIN-to-QHIN exchange.