Most Health Information Exchanges in Strong Position for TEFCA

Most state and local health information exchanges (HIEs) are supporting a vast number of services and are developing connections to each other and national networks in preparation for the Trusted Exchange Framework and Common Agreement (TEFCA), according to a study published in Health Affairs.

HIEs are overcoming financial issues to fulfill the role of supporting patient data exchange to fulfill the goals of TEFCA. Additionally, HIEs that can offer increased services will be in a stronger position to compete with national HIE networks under TEFCA, the study authors wrote.

Drafted by the Office of the National Coordinator for Health IT (ONC) to fulfill the aims of the 21st Century Cures Act, TEFCA is a set of policies and standards to support the development of the Common Agreement. Ultimately, this should help support nationwide electronic patient data exchange across health information networks (HINs).

TEFCA aims to ensure that HINs, healthcare providers, health plans, individuals, and stakeholders have secure access to electronic health information when needed. Although it intends to create new potential opportunities, it also creates challenges for local and statewide HIEs.

In 2019, the study authors conducted an HIE survey across the country to dissect the current state of HIEs and examine TEFCA-based responses.

Survey respondents revealed 89 active local and statewide HIEs, 17 fewer than a similar survey from 2014 identified. The 2019 survey also revealed 45 states, including Washington DC, leveraged at least one HIE, and 32 percent of health service areas in the country had more than one HIE. Roughly half of the respondents reported financial struggles.

Fifty-seven percent of HIEs connected to other HIEs in the same state and 53 percent to other states. Sixty-seven percent leverage eHealth Exchange, 46 percent connect to DirectTrust, and 38 percent leverage SHIEC Patient Centered Data Home (PCDH).

Ninety percent of HIEs exchanged medications, 87 percent exchanged problems, 84 percent exchanged laboratory results, and 83 percent exchanged immunizations.

Looking forward, 56 percent of HIEs planned to participate in TEFCA, while 41 percent were unsure at the time. Furthermore, 90 percent of HINs that plan to join in TEFCA already connect to at least one national network, and 64 percent connect to HIEs in different states. Thus, those HINs already have prior experience in connecting to outside networks, the researchers noted.

“Given this, it is encouraging that more than half of operational HIOs plan to participate in TEFCA,” wrote the study authors.

On the other hand, 44 percent of HIEs are unsure about participating or do not plan to participate in TEFCA, and those networks had less connecting experience.

“For these HIOs, committing to TEFCA likely depends, at least in part, on the finalized set of applicable conditions and requirements included in the Common Agreement and flow-down clauses, which are under development,” the study authors wrote.

It will be crucial for ONC to identify critical benefits for HINs to engage in TEFCA, the study authors stressed.

“With TEFCA, HIOs can connect to a variety of networks in a more seamless fashion, enabling their end users (for example, hospitals and physician practices) to limit the number of different networks in which they need to participate to exchange with others.”

TEFCA will also provide several services, such as query-based exchange services, that could overlap with what local HIEs offer, the authors cautioned. 

“To offer value and remain financially viable, HIOs that do not already do so will likely need to provide services that go beyond facilitating the transmission of clinical data,” the authors recommended. 

For example, HIEs could offer quality measurement and analytics. The HIE organizations could also leverage the new federal funding to boost immunization information sharing. 

However, the study authors said it is not clear what HIE networks should provide to their respective customers. 

“By offering a broader set of services to a more diverse set of participants than other types of networks and doing so across many different EHR vendors, HIOs can play an important role in the HIE ecosystem, and their participation in TEFCA is important so that their current participants reap the benefits of national connectivity,” the study authors wrote. 

To make this happen, HIEs should make it easier for providers to access data by decreasing the number of point-to-point interfaces, the study authors recommended. The HIEs that were unsure of participating in TEFCA could improve connectivity to other networks with improved health IT assistance, lowered participation barriers, and a viable set of benefits. 

“Our national survey data reveal that the majority of HIOs have achieved a robust level of maturity and scale alongside markedly lower levels of reported technical challenges compared with five years prior,” concluded the researchers.

“A subset appears particularly well positioned to take advantage of new opportunities under TEFCA the Trusted Exchange Framework and Common Agreement, based on their experience with network-to-network connectivity and by offering a breadth of services to attract new participants.”