The Trusted Exchange Framework and Common Agreement (TEFCA) is now available establishing a new era of electronic health information exchange in the US. Within the health information technology (HIT) world, few things have been as elusive as a governance framework for nationwide health information exchange.
When the Office of the National Coordinator for Health Information Technology (ONC) was formed in 2004, the concept of a nationwide health information network, where your information could be located across the country in a click, was a big picture vision that drove the federal government’s early health IT infrastructure, standards, policy actions, and investments.
What’s followed as a result of two laws (HITECH Act and 21st Century Cures Act) and continuity across four administrations has been steady growth, maturity, and investment from both the public and private sectors. Most healthcare providers use electronic health records. Many are connected to and engage in at least one form of electronic health information exchange. And health information networks are now dotted across the US map supporting communities with a wide range of services.
The goals for the TEFCA are:
- Goal 1: Establish a universal policy and technical floor for nationwide interoperability.
- Goal 2: Simplify connectivity for organizations to securely exchange information to improve patient care, enhance the welfare of populations, and generate healthcare value.
- Goal 3: Enable individuals to gather their health care information.
The Trusted Exchange Framework is a set of non-binding principles to facilitate data-sharing among health information networks. The Common Agreement will operationalize simplified electronic health information exchange for many across the US and will provide easier ways for individuals and organizations to securely connect. Most notably, the Common Agreement sets a new baseline for the exchange purposes that need to be supported—a common source of friction across networks today. The Common Agreement includes support for treatment, payment, healthcare operations, individual access services, public health, and government benefits determination.
The Common Agreement is a new legal contract that ONC’s Recognized Coordinating Entity (RCE), The Sequoia Project, will sign with each Qualified Health Information Network (QHIN). QHINs will then execute certain corresponding policies within their own networks. Published in tandem is the QHIN Technical Framework, which sets the functional and technical requirements that QHINs need to support to make this new connectivity come online.
While road-tested production standards are being used at the start, we are also actively working with the RCE to develop a TEFCA Health Level Seven (HL7) Fast Healthcare Interoperability Resource (FHIR) Roadmap (TEFCA FHIR Roadmap) to outline how FHIR will also become an established part of TEFCA-based exchange over time.