- The American Hospital Association (AHA), DirectTrust, and the Electronic Healthcare Network Accreditation Commission (EHNAC) have voiced support for ONC’s efforts to improve health data exchange via the Trusted Exchange Framework and Common Agreement (TEFCA).
After more than six months of development that included several stakeholder meetings, webinars, and comment periods, ONC released the first draft of TEFCA last Friday. The proposed framework is intended to streamline patient health data access and improve interoperability per provisions of the 21st Century Cures Act.
The framework draft is open for public comment until February 18. Already, AHA has expressed its support of ONC’s interest in cultivating a network-of-networks approach to health data exchange.
“Today’s release by ONC is a promising step in creating a more efficient infrastructure for sharing health information that is based on a network-of-networks approach and builds on existing efforts,” said AHA Senior Vice President for Public Policy Analysis and Development Ashley Thompson in a public statement.
“The creation of a nationwide approach to efficient and effective sharing of health information is central to the efforts of hospitals and health systems to provide high-quality coordinated care, support new models of care and engage patients in their health,” she continued.
DirectTrust President and CEO David Kibbe, MD, similarly commended ONC’s work to advance interoperability.
“This is a worthy goal,” stated Kibbe in an emailed statement. “In discharging its duty as published in the ‘Draft Trusted Framework’ document on January 5, 2018, ONC has put forward an ambitious plan to electronically connect the nation's approximately 100 health information exchanges (HIEs) such that any authorized participant or end-user of one HIE would be able to query and access the data and information in any other HIE easily and seamlessly. The requirements for TEFCA, as released for draft, are lengthy and broad, and would almost certainly require HIEs to modify their current contractual relationships in the communities they now serve.”
While DirectTrust generally supports the goals of TEFCA as laid out in the framework draft, he expressed some skepticism that the healthcare industry will be able to achieve its aims according to ONC’s projected timeline.
“Whether any program limited to the nation’s HIEs can be successful achieving all of this is yet to be determined,” Kibbe added. “The TEFCA time frame is also ambitious, with selection of the RCE and release of the final rules by the end of 2018, and full operations in place by the end of 2019.”
As part of TEFCA, HIEs will become qualified health information networks (QHINs). DirectTrust plans to take in feedback from leadership and consumers of its 15 state and regional member HIEs to get an idea of how the new requirements will affect their contracts and operations.
“Specifically, we will be listening carefully to what modifications to existing participation agreements and trust frameworks they think will be necessary to support provisions such as the additional permitted disclosures of health information by the QHINs, and what additional resources they will need in their networks to make upgrades to meet new mandated IT capabilities and align to certain trust and security practices,” he stated.
While DirectTrust members may meet the criteria to become a QHIN, DirectTrust itself does not.
“According to the TEFCA definition, a QHIN must ‘be able to locate and transmit ePHI between multiple persons and/or entities electronically,” Kibbe said.
QHINs must also include record locator and patient matching services, among others.
“DirectTrust offers none of these services and does not store, manage or transmit health information of any kind,” he explained.
EHNAC Executive Director Lee Barrett also weighed in on the framework, emphasizing the importance of supporting existing exchange organizations including DirectTrust and the Sequoia Project, among others.
"Through last week's submission to the public register, the ONC continues to support the healthcare industry's need to strengthen stakeholder trust and assure interoperability across the trust networks,” said Barrett in an emailed statement.
Barrett stated continued federal support of industry initiatives, trust agreements, and common exchange networks will be crucial.
“This includes DirectTrust and the Direct protocol, blockchain, (Empowering People with Privacy and Personalization) EP3 Foundation, Sequoia Project, Carequality and many other industry organizations,” he continued.
Barrett also underscored the need to focus on privacy and security improvements across networks.
“Now is the time for us to work together to identify areas for improvement, close privacy and security gaps across networks, address vulnerabilities across HIPAA compliance, cyber protection and ransomware prevention, address authentication issues, and assure the highest levels of stakeholder trust,” he said.
ONC will continue hearing feedback from these and other stakeholders until the public comment period closes on Feb. 18, 2018.
Following the close of the public comment period, ONC will select an industry-based organization — called a recognized coordinating entity (RCE) — which will further build out the framework and common agreement. ONC expects to publish the final draft of TEFCA toward the end of 2018.