The Sequoia Project Posts Draft TEFCA Interoperability Infrastructure

The Sequoia Project, the Office of the National Coordinator for Health IT’s (ONC) Recognized Coordinating Entity (RCE) for implementation of the Trusted Exchange Framework and Common Agreement (TEFCA) interoperability infrastructure, published a draft of the Qualified Health Information Network (QHIN) Technical Framework (QTF) for stakeholder comment.

The technical framework focuses mainly on QHIN-to-QHIN data exchange requirements. QHINS, designated by the RCE, will act as the central connection points within the network-of-networks under the Common Agreement.

“The publication of the draft QTF for feedback is an important milestone as we look to live, in production, exchange under the Common Agreement in 2022,” Micky Tripathi, PhD, national coordinator for health information technology, said in a public statement.

“The QTF will also evolve to support new standards such as FHIR in the future and we welcome industry feedback on a proposed FHIR roadmap which will be released in the near future,” Tripathi continued.

QHINs will route queries, responses, and messages among organizations and patients sharing data through TEFCA interoperability infrastructure.

To serve as a QHIN under the Common Agreement, health information networks must fulfill certain requirements as outlined in the QTF, including strong privacy and security steps, processes to identify and authenticate end-users, patient discovery and identity resolution capabilities, and support for required data exchange protocols.

“Once this QTF is final and in production, that’s just the beginning,” explained Mariann Yeager, CEO of The Sequoia Project. “The RCE will begin immediately developing the next iteration of this living framework, looking to future technological developments and needs, such as adding support for FHIR.”

On Wednesday, August 4 at 1 PM ET, the RCE will host a one-hour webinar to review the framework. Then, on Wednesday, August 18 at 3 PM ET, the RCE will host a two-hour, interactive webinar for more in-depth discussion of essential elements of the QTF. Registration for both events is open on the RCE’s Community Engagement webpage.

Earlier this month, ONC announced TEFCA will go live in the first quarter of 2022.

“The overall goal for TEFCA is to establish a floor of universal interoperability across the country,” Tripathi and Yeager explained in a blog post at the time of the announcement. “We need networks to be seamlessly connected with each other.”

“While the nationwide networks have made considerable progress in this area, cross-network exchange is still not frictionless, and most state/regional HIEs serve only their local markets and many are not connected to any other networks at all,” they wrote.

Experts say the current lack of nationwide interoperability hinders care coordination, as providers often do not have access to a patient’s complete medical history for clinical decision support.

Tripathi and Yeager also noted that while some nationwide networks currently support data exchange among providers for treatment purposes, they exclude other critical use cases including public health reporting, patient access to health information, population health management, payment support, clinical research, and emergency response.

“The COVID-19 pandemic made abundantly clear that our clinical and public health systems live in different interoperability universes,” Tripathi and Yeager wrote.