Rhapsody Health Solutions Team

TEFCA Panelists Answer Looming Questions About the Trusted Exchange Framework and Common Agreement

As I do most Sundays, I recently pulled up my week’s calendar and lamented that I couldn’t have made a career out of being a ski bum.  

But when I reviewed my calendar on Sunday, October 18, 2021, there were two shining bright spots that stoked my enthusiasm for the week: the start of the NBA season and the Connect/21 panel on the Trusted Exchange Framework and Common Agreement (TEFCA).  

(Need a refresher on TEFCA? Read Everything Healthcare Organizations Need to Know About TEFCA.) 

Now, casual reader, I can understand your confusion as to how these things are at all related. Let me tell you.  

The Connect user group conference has always offered a great glimpse into the future of healthcare interoperability. Rhapsody, formed out of the merger of the Corepoint and Rhapsody interoperability platforms, has several decades of history in this space.

You can rely on the Connect conferences to lay out directionally how data exchange standards are evolving, the best technical implementations for common and obscure interoperability problems, and more.

There are winds blowing nationally in the public policy space that are poised to have a significant impact on healthcare interoperability moving forward.  

The biggest of these national policy initiatives that has, potentially, the greatest impact on healthcare, and the most ambiguity surrounding it, is the TEFCA Draft Technical Framework.  

This framework is a Common Agreement (the CA of TEFCA) in which all nationally Qualified Health Information Networks (QHINs) agree to exchange data among all QHINs when needed. This network of networks aims to be a unified exchange paradigm that will allow patients to have access to their clinical history regardless of their point of care.   

Rhapsody has been following these swirling winds for some time. But at our core, we are a healthcare technology company, not a healthcare policy thinktank. 

So, what do we do to ensure our customers know how this framework will affect them?  

We recruit an all-star group of industry leading subject matter expertise across health information exchange (HIE) leadership, federal healthcare policy, and healthcare data security to join a panel discussion on the topic of TEFCA.

Similar to how Lebron James recruited the best-in-class, complementary role players — thereby creating the 2021-2022 legendary Lakers roster — at Rhapsody, we feel we’ve done the same with this panel.

Leading up to the panel discussion, I’d been closely following the proposed TEFCA framework, but I still had some big questions, like How will the framework be implemented? What will the incentive structures look like?  

I’m happy to report that all my outstanding questions were answered during the panel. Here are some of the questions I had, along with the answers I gathered during the panel.

Why would an HIE want to become a Qualified Health Information Network (QHIN)? 

TEFCA is an optional participation network, and the certification process for becoming a QHIN is quite a rigorous and time-consuming journey. So, why would any organization take focus away from their core business of an HIE/QHIN? Why not just focus on growing their influence regionally irrespective of the TEFCA framework?  

Tim Pletcher, Executive Director, Michigan Health Information Network, made the great point that most, if not all, the organizations nationally that’ll be striving for QHIN designation are already technical leaders in the HIE space.  

They have facilitated connections across multiple state boundaries and have already had an impact in the region. But in Pletcher’s view, the best reason to become a QHIN is that it gives the organization a differentiated position in their region, and more importantly, a seat at the national table related to interoperability and the evolution of TEFCA.   

I love this answer because it not only creates a strong value-prop for joining TEFCA, it also allows the QHINs to inform the evolution of healthcare interoperability over the coming years. I agree that having a role in influencing the future of these rules as a QHIN is valuable, as the TEFCA roadmap will be the defining characteristic that, in my opinion, will make or break the value of the network. 

Read: How State HIEs Are Advancing Interoperability

What is the Sequoia Project, and what is the Recognized Coordinating Entity’s (RCE) role? 

We’re all adults and all want better interoperability, right? So why do we need a Recognized Coordinating Entity to tell us what to do?  

David Muntz answered this question, leaning on this experience as the Former Principal Deputy National Coordinator at ONC. Muntz outlined in clear terms that we’ll need an unbiased arbiter to help navigate all of the competing interests related to the creation and evolution of the TEFCA framework.

Another important role of the RCE is to field feedback from interested parties and incorporate that feedback into the final TEFCA exchange framework.   

This is a labor-intensive and complex job, and to be honest, it may be a thankless one. Regardless of the final TEFCA framework, some stakeholders will be disgruntled, as there are truly vested, competing interests related to the technical nature of data exchange.

I have a renewed appreciation for The Sequoia Project’s role and position in this large, national conversation around healthcare interoperability.   

Learn more about how TEFCA will work, and get insight into the RCE and The Sequoia Project

Who pays? 

This is where my cynical mind gets me in trouble.  

We’re all interested in this utopian vision of a totally free national interoperability framework — where your healthcare data follows you around, showing up where and when you need it, instantly and securely.  

Sadly, any organization that’s looking to facilitate any subset of these complex integration workflows will need industry-leading healthcare interoperability tools; large, capable staff; and an often-costly IT infrastructure.

So how will the QHINs/HIEs stay in business?  

Like most HIEs today, member organizations (hospitals and health systems) will pay a fee to their regional QHIN, which will unlock the national network for those organizations.  

So, for both entities, the value-proposition makes sense. The health system can drive down costs, leveraging a much more complete set of clinically relevant data about their patients, while the QHINs can have a consistent and stable income stream through which they can plan capital expenditures.  

It’s a rare win-win. 

What’s next? 

For just a second, let’s suspend judgment and assume over the next five years that we arrive at a true national interoperability ecosystem with total data portability. What’s next for QHINs/HIEs?  

As someone who enjoys looking at issues with a lens to the future, this question is particularly interesting to me.  

My takeaways on this question came from the contributions of several panelists. The long-term value of HIEs/QHINs is connecting to ancillary facilities — outside of the traditional care settings, such as corrections facilities, schools, universities, and job sites — as these sites may store niche clinical data that, when aggregated, paint a much different picture than would be painted in the absence of such data.

Connecting non-traditional care settings to traditional data sources (payer systems, EMRs) is not only how we’ll get the richest clinical insights, but also how we’ll truly understand the social determinants of health (SDOH) of a particular population.  

In my estimation, this last-mile challenge in healthcare interoperability will be with us for quite some time—especially since the pandemic has accelerated the decentralization of care delivery in America.  

One last anecdote that resonated with me came from Laura McCray, President and CEO of KONZA.  

McCrary pointed out that since the pandemic, the overcrowding of some hospitals has forced people to travel greater distances than ever to access care. It’s critically important to ensure that medical records can cross state lines and travel to any care site in the nation. 

Thank you to Rhapsody and the panelists at our TEFCA session:  

I found the panel incredibly informative and instructive for Rhapsody long-term investments and support of our customers who are onboarding onto the emerging TEFCA framework. And while I have clarity on the future of TEFCA, I’ll have to wait and see if the Lakers super team can stay healthy and build a season record commensurate with their roster talent!  

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