TEFCA Interoperability Infrastructure Go-Live Set for Q1 2022

ONC has announced that the Trusted Exchange Framework and Common Agreement (TEFCA) interoperability infrastructure and health information exchange (HIE) standards will be live in the first quarter of 2022.

Drafted by ONC to fulfill the aims of the 21st Century Cures Act, TEFCA is a set of policies, procedures, and standards to support the development of the Common Agreement for nationwide HIE across health information networks (HINs).

“The overall goal for TEFCA is to establish a floor of universal interoperability across the country,” National Coordinator Micky Tripathi and Mariann Yeager, CEO of TEFCA’s Recognized Coordinating Entity (RCE) The Sequoia Project, explained in a blog post. “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.

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.

For instance, public health authorities and individual clinicians cannot easily aggregate data to inform questions related to COVID-19 vaccination acceptance.

Tripathi and Yeager noted that TEFCA aims to build upon the successes of current networks instead of replacing or stifling them.

Health IT infrastructure and services enabled by the Common Agreement will lower the cost of basic data sharing, thereby freeing up resources for more value-added services.

“The Common Agreement will establish the infrastructure model and the governing approach for users in different networks to securely share basic clinical information with each other—all under commonly agreed-to expectations and rules and regardless of which network they happen to be in,” Tripathi and Yeager explained.

Networks that agree to the common terms and conditions of data exchange outlined in the Common Agreement will be certified as Qualified Health Information Networks (QHINs). These networks must agree to the functional and technical requirements for exchange (as specified in the QHIN Technical Framework or QTF).

While the RCE has received considerable market input over the last two years for TEFCA, additional stakeholder input to the Common Agreement and QTF will be considered throughout the remainder of 2021. This includes the reconvening of the Common Agreement Work Group comprised of prospective QHINs and their participants.

Tripathi and Yeager noted that ONC and the RCE welcome input on the TEFCA model including privacy and security policies, required and optional exchange patterns, and incorporation of Health Level Seven (HL7) International Fast Healthcare Interoperability Resources (FHIR) standard in the QTF roadmap.

“This collaborative process will culminate with publication of the Common Agreement V1 Final and QTF V1 Final in Q1 of calendar year 2022, at which point health information networks will be able to apply to become QHINs and, after approval, begin on-boarding on a rolling basis,” Tripathi and Yeager explained.

They also noted that as technology, user requirements, and use cases evolve over time, the Common Agreement and QTF will be updated periodically for optimization.