New TEFCA Framework Brings Some Clarity to Interoperability Push

When the 21st Century Cures Act was signed into law in the waning days of the Obama administration, it was promoted as a revolutionary revision that would help healthcare innovation to flow through the regulatory process. Yet, five years on, one of the most-watched components of the law is still in its early stages. Those provisions called for new interoperability standards to ensure that patient healthcare data could easily and securely be shared across a wide range of healthcare entities.

The law’s implementation was delayed in part by the COVID-19 pandemic. In 2020, HHS’ Office of the National Coordinator for Health Information Technology (ONC) published rules designed to govern interoperability, although those rules raised concerns from some about whether the agency went far enough to protect patients’ privacy.

In January, ONC went a step further, publishing a new set of principles for the exchange of healthcare information. The principles — known as the Trusted Exchange Framework — are a set of voluntary guidelines designed to facilitate secure interoperability. In addition, ONC published a Common Agreement (CA), a contract that health entities can join that sets forth the technical structure and governance for health information exchanges. A portmanteau of their initials, TEFCA (pronounced tef-KA), has been coined.

“Simplified nationwide connectivity for providers, health plans, individuals and public health is finally within reach,” said Micky Tripathi, Ph.D., the national coordinator for health information technology, in a news release.

Now that the framework has been published, ONC said entities will “soon” be able to apply for designation as “qualified health information networks” (QHINs), which will facilitate connections and information exchange between healthcare industry players.

The Sequoia Project, which is implementing TEFCA under ONC’s authority, describes the QHINs as networks that will abide by the common agreement and government structure outlined in TEFCA. Covered entities can choose which QHIN to join based on factors such as services provided and costs. ONC said the design is meant to be flexible enough to work for stakeholders from hospitals to health information networks to patients. In a joint news release announcing TEFCA, ONC and the Sequoia Project said they expect to evaluate QHIN applications and launch information sharing on accepted networks by the end of the year.

Nilesh Chandra, MBA, partner in healthcare strategy at PA Consulting, says TEFCA is a “significant development” because until now there has been no national framework for data sharing. “While the immediate impact may not be obvious, in the long term these frameworks will eventually help drive us to a future where patients’ health data are shared appropriately across care settings, across provider networks, to help every provider get access to all relevant information at the point of care,” comments Chandra.

The TEFCA framework lays out six permitted uses for healthcare data exchange within the networks: treatment, payment, healthcare operations, public health, government benefits determinations and “individual access services,” an umbrella category that includes patient-facing applications.

Along with the TEFCA framework, ONC also published a TEFCA Health Level Seven Fast Healthcare Interoperability Resource (FHIR) Roadmap, which it said is designed to show how TEFCA will accelerate the adoption of FHIR across the industry. FHIR standards are designed, in part, to make it easier to access individual data points within medical records.

Jared Kaltwasser is a freelance writer in Iowa.