TEFCA- the “Trusted Exchange Framework and Common Agreement”, is an initiative by the US Government to streamline data exchange by building a network of HIN (Health Information Networks) under the management of ONCHIT.
The aim of the Trusted Exchange Framework and Common Agreement is to expand existing work done by HINs and build a frame work on top of it. The initiative is to bring a common platform and establish a single platform for HIE that will enable providers, hospitals and other healthcare stakeholders to collaborate and exchange data with any HIN.
Need for TEFCA?
- The current health data exchange is more complex and is not cost effective because of scalability issues. Most of the healthcare organizations need to join multiple HINs that do not share data with each other. The complexity of the trusted exchange must be simplified in order to scale this.
- The diversity of restrictions on data sharing cripples the efforts for nation-wide interoperability.
- Due to lack of a Trusted Exchange Framework, the healthcare providers were burdened with heavy costs for point to point interfaces between organizations.
To mitigate these challenges, below are the set of principles and basic terms and conditions proposed in TEFCA:
- Standardization: QHINs must implement the updated federal standards of interoperability in a timely manner and work with RCE to update TEFCA with newer versions of standards as applicable.
- Transparency: ONC and QHINs along with RCE have to make terms, conditions, and contractual agreements that govern the exchange of Electronic Health Information easily and publicly available.
- Cooperation and Non-Discrimination: A stakeholder, being even a business competitor, has to collaborate with other stakeholders across the continuum of care to exchange Electronic Health Information.
- Security and Patient Safety: Ensure that Electronic Health Information is exchanged and used in a manner that promotes patient safety, including consistently and accurately matching Electronic Health Information to an individual.
- Access: Do not impede or put in place any unnecessary barriers to the ability of patients to access and direct their Electronic Health Information to any designated third party.
- Data-driven Accountability: Exchange multiple records for a cohort of patients at one time in accordance with Applicable Law to enable identification and trending of data to lower the cost of care and improve the health of the population.
Common issues submitted on TEFCA:
- Information Blocking: Before ONC goes down the path of implementing TEFCA, several industry stakeholders would like more guidance on this issue.
- Time line challenges for implementing TEFCA: The framework and agreement of TEFCA implementation comes several years after HIE networks and other industry collaboratively have stood up legal agreements, use cases, and business operations.
- Data Privacy and Security: Stakeholders require specific information on how will the TEFCA requirements interact with HIPAA requirements as they govern both QHINs and HIN and specifically how this will affect the future of data exchange.
- Cost burdens: For the Trusted Health Information Exchange and Framework to work, ONC must allow differentiation between state health information exchange models, otherwise, there will be significant financial implications to state economies, infrastructure, and communities.
TEFCA is designed to bridge the gap between providers’ and patients’ information systems and enable interoperability across disparate Health Information Networks by providing a “single on-ramp” to patient information.
Key term to be noted is that TEFCA is voluntary, HINs are not required to become Qualified HINs, however ONC, would clearly like this to be widely adopted. It is recommending that providers, payers and state advocates to include requiring TEFCA connectivity in future legislations.
Despite the fact that the procedures and draft agreements described, if adopted by ONC, would remain completely voluntary, the Act mentions that Federal agencies may require its use in certain circumstances. This may profoundly affect both health agencies and their trading partners.
Regardless, if they don’t consider TEFCA in their planning, it may become a requirement. In the short run, existing HIEs (or HINs) and collaborative activities may not find it convincing to alter their course. Only time will tell if TEFCA will have the impact on interoperability that Congress desires.
To know more about TEFCA, reach out to us at info@nalashaa.com and we would be happy to help you!
Sanjay Patil