- Thirty health IT companies part of the Electronic Health Record Association (EHRA) recently requested ONC make its health data exchange framework voluntary and build on existing standards to improve interoperability.
EHRA’s comments came after ONC issued a request for comment following the first stakeholder meeting to establish a Trusted Exchange Framework and Common Agreement on July 24.
Specifically, the association—which includes vendors such as Epic, Cerner, and Allscripts—constructed their commentary around four main points:
1. Our support for secure exchange and non-discrimination in data-sharing.
2. Urging ONC to build upon the important investments and progress that have been made by stakeholders, versus introducing major mid-course changes which would lead to disruption.
3. Emphasizing that participation in the trust framework should be voluntary.
4. Noting that some comment areas proposed by ONC seem to extend beyond Cures requirements; these should be clearly stated as ONC policy goals, as opposed to statutory requirements. Thank you for this opportunity to comment.
In addition, EHRA issued feedback specific to each of the 6 comment areas outlined by ONC.
First, the association commented on standardization. ONC stated the framework should adhere to industry and federally recognized technical standards, policies, best practices, and procedures.
EHRA highlighted the importance of not undermining the work and investments made by health IT developers, HIEs, providers, payers, and other stakeholders in establishing technical exchange standards and approaches for interoperability.
The association cited the move by HHS to invest in the EHR certification program—both 2014 edition and 2015 edition—as one example of an investment in HL7 as a standard promoting interoperability.
“This standard, which has been undergoing periodic revision based on community feedback, can be applicable for many use cases including provider-to-provider transitions, public health use cases, patient access to health information (VDT), and bulk extracts for EHR conversions or other purposes,” stated EHRA.
In total, EHRA offered 7 comments regarding ways ONC can use existing standards in developing trusted exchange framework.
Next, the association issued comments about the need for further transparency in data exchange. EHRA agreed, but stated participating in the trusted exchange framework should be voluntary.
“Failure to adhere should not be considered de facto information blocking when other methods are used to exchange information,” stated the association. “Additionally, ONC should avoid conflating a trust agreement with specific service agreements or network agreements and not seek to draft such detailed agreements. Rather, its focus should be on core principles that various Trust Frameworks should support to enable essential consistency across networks.”
The third comment area focused on the importance of cooperation and non-discrimination.
EHRA supported the general principle proposed by stakeholder groups, but noted that providers and exchange partners may seek to negotiate provisions for purposes beyond treatment for direct patient care.
Fourth, EHRA stated its agreement for all provisions regarding security and patient safety.
In the fifth comment area about data access, EHRA agreed all patients and caregivers should have easy access to electronic health information. However, undersigned health IT companies clarified that not all exchange frameworks are focused on patients or caregivers.
“Additionally, we see a need to clarify “caregiver” in this context: a patient’s clinician, a family member or friend, or both?” wrote EHRA.
In the sixth and final comment area about data-driven choice, EHRA also sought further clarification.
“We seek clarification on the statutory basis for this approach, and how it may relate to initiatives already in place through quality measures and enabling access to certain claims data that is already progressing in this space,” wrote the association.
Additionally, EHRA requested this stipulation not be a requirement for all networks.
At the conclusion of the letter, the association submitted general comments pointing out the comment areas seemed to diverge a bit from the initial aims laid out in the Cures Act.
“It will be important to distinguish between statutory requirements and ONC policy goals,” they advised.