ONC Releases Framework for Improving Health Record Interoperability

WASHINGTON — The newly released framework for health record interoperability is a great opportunity “to build upon existing infrastructure and … to support interoperability nationwide,” Mariann Yeager, CEO of the Sequoia Project, said at a press briefing hosted by the Office of the National Coordinator (ONC) for Health Information Technology.

At the briefing Tuesday, Yeager was referring to the release of the Trusted Exchange Framework and the Common Agreement (TEFCA), an outgrowth of the 21st Century Cures Act, which requires ONC to set forth principles for nationwide health information exchange. “The fact that this framework is really multi-purpose is huge,” said Yeager, whose organization serves as the coordinating entity for TEFCA. “This is really intended to support a multitude of use cases — treatment, payment, and healthcare operations; government benefits determination; and individual access. We hope to really expand this over time.”

The exchange framework, which is voluntary for organizations to abide by, “describes a common set of non-binding principles for policies and practices to facilitate data-sharing among health information networks; according to an ONC email. The principles cover seven areas: standardization; openness and transparency; cooperation and non-discrimination; privacy, security, and safety; access; equity; and public health.

The common agreement, meanwhile, “is a legal contract — a contract that qualifying networks will sign with the Sequoia Project to enable these qualifying networks to exchange [data] with each other so that users can exchange information across networks, regardless of which network they’re in,” ONC head Micky Tripathi, PhD, explained at the briefing.

“Our goals are pretty simple — striking the right balance between …. [bringing] more order to the market to allow it to continue to progress and to serve the country, but not so much order that it suppresses or is brutal to business and technical innovation,” he continued. “We want to be able to create a uniform core of interoperability, so that an authorized user — including individuals — have a baseline expectation of being able to get basic healthcare and medical record information securely and reliably across the network, regardless of where they are geographically, or what their vendors are using or which technology they’re using.”

“We also wanted to enable the ability to locate aggregate information in a patient-centric way, whether that’s the patient themselves, or providers, for example, being able to aggregate your records to be able to provide you with the best possible care,” Tripathi added. “Too many people spend too much time corralling and wrangling data that doesn’t allow them the time to figure out what they want to do with the data, and be able to analyze that data and use it for the improvement of care. And what we want to be able to do is flip that and have TEFCA take that wrangling and corralling as much off the table as possible, so that they can spend all of their time, or close to all of their time, on actually being able to make use of the data to to improve patients’ lives.”

Those entities interested in becoming a qualified health information network (QHIN) under TEFCA will have an opportunity to do so starting in about 3 months, Yeager said. “We do want to give stakeholders time to unpack and understand what we publish, and we’ll be hosting a number of educational forums on that and addressing a number of questions, and then probably in about 90 days, we’ll start accepting applications,” she said. “This is when we anticipate in quarter 2 of 2022 that the initial set of applicants will come forward and express interest in becoming QHINs, and we will work with them through a defined process to verify that they do in fact meet the requirements and expectations” for the designation.

Asked during a question-and-answer session about how many entities she expected to apply for the QHIN designation, Yeager said, “We know that there is significant interest; I doubt there will be 100 [but] certainly more than one … We’re looking forward to seeing who applies.”

As far as the types of entities that might seek the QHIN designation, Tripathi noted that “the health IT [information technology] landscape doesn’t break out in quite the ways that people might think. So for example, you have very active participants in the existing exchanges, like Carequality and CommonWell, and eClinical Works and Athenahealth, two big EHR [electronic health record] vendors — and they primarily serve the small provider market. They have a huge customer base with solo practitioners and small practices, and they have connected their systems for interoperability. We can’t anticipate who’s going to join, but in the active networks today, you do have a lot of connectivity to small practices.”

The Medical Group Management Association (MGMA) expressed cautious optimism about TEFCA’s release. “Back in February 2018, MGMA submitted comments on the proposed TEFCA, encouraging ONC to implement the TEFCA in a transparent and accountable way and to incentivize practices of all sizes to participate,” Claire Ernst, MGMA’s director of government affairs, said in an email (Disclosure: Anders Gilberg, MGMA senior vice president for government affairs, is a member of MedPage Today‘s editorial board).

“If implemented appropriately, this could be a historic opportunity to for medical groups to expand opportunities to share data. However, it’s early days and there is still a ways to go before we can see the full picture of interoperability,” Ernst stated.