What you need to know about the TEFCA

Safe, effective, and efficient care: Every person wants to get it and every healthcare provider wants to give it. 

In order to deliver safe, effective, and efficient care, it’s key that providers have safe, effective, and efficient access to important health information as well.

Unfortunately, for almost two decades now, the health information exchange (HIE) here in the United States has operated in bubbles and silos—working in separate networks, unable to share important clinical information across state lines.

To provide the quality of care they want to deliver, healthcare providers would have to connect to multiple health information networks (HINs) just to get the information they need—and most HINs do not share data with each other!

In fact, according to a survey by the American Hospital Association:

• 78% of hospitals in the US use more than one electronic method to send health records

• 61% of hospitals in the US use more than one electronic method to receive health records

Largely because of technical and legal limitations, healthcare providers here in the US find that a smooth and efficient exchange of health information is just out of reach…until now.

This is where the Trusted Exchange Framework and Common Agreement (TEFCA) comes in.

What is the TEFCA?

The TEFCA is the government’s latest framework in improving nationwide patient data exchange and, ultimately, making healthcare interoperability a reality.

In simple terms, TEFCA was made to simplify the exchange of healthcare data.

Mandated by the 21st Century Cures Act of 2016 and developed by the Office of the National Coordinator for Health IT (ONC), the TEFCA encapsulates a set of policies, terms, conditions, and the technical approach that would enable the nationwide exchange of electronic health information (EHI) across disparate health information networks (HINs).

If successful, the TEFCA can help ensure that HINs, healthcare providers, health plans, individuals, and other stakeholders can get secure access to their EHI whenever and wherever they need it.

The Goals of TEFCA

According to The Sequoia Project, the organization tapped by the ONC to serve as the recognized coordinating entity for the TEFCA, “The ultimate goal…is to enhance provider and consumer access to health information that supports better clinical decision-making, improved outcomes, and lower costs.”

In a joint statement, the ONC’s Micky Tripathi and The Sequoia Project’s Mariann Yeager outlined the three goals for the TEFCA in more specific terms:

• Establish a universal policy and technical floor for nationwide interoperability. Create the baseline technical and legal requirements for nationwide network-to-network sharing of electronic health information.

• Simplify connectivity for organizations to securely exchange information to improve patient care, enhance the welfare of populations, and generate health care value.

• Enable individuals to gather their healthcare information. Allow EHI to securely follow individuals when and where it is needed.

The TEFCA aims to create a network of networks that will grow over time. The ONC recognizes that using a single network for data sharing across the country is not feasible, but a network of data-sharing networks is.

As a remedy to the current interoperability limitations, the TEFCA proposes a two-part solution: A technical framework and a common legal agreement.

The Trusted Exchange Framework (TEF)

The Trusted Exchange Framework is a set of common principles that are designed to facilitate trust and encourage data exchange among health information networks.

These non-binding but foundational principles are:

• Standardization
• Transparency
• Cooperation and Non-discrimination
• Privacy, Security, and Safety
• Access
• Equity
• Public Health
  

The Common Agreement (CA)

If the Trusted Exchange Framework is a set of non-binding but foundational principles for the exchange of health information, the Common Agreement is the contract that advances those principles.

It is a legal data sharing agreement that establishes the technical infrastructure model and governing approach by which HINs and their users can securely share clinical information with each other.

Among the aspects that the Common Agreement establishes and incorporates are:

• Standard Operating Procedures (SOPs). An SOP is a set of written instructions that describes the step-by-step process one must take in order to properly perform an activity. In the case of the TEFCA, SOPs have been developed by The Sequoia Project for topics such as advisory groups, conflicts of interest, dispute resolution process, governing council, QHIN security of TEFCA information, QHIN cybersecurity insurance, and transitional council. Additional SOPs will be made over time.

• QHIN Technical Framework (QTFs). The QTF outlines the technical aspects and components of what is required to participate in the exchange among QHINs, including, but not limited to identity proofing and authentication, and utilization of connectivity services.

• Governing Approach. Under the Common Agreement, QHINS, participants, and sub-participants will have the opportunity to engage in governance. The Common Agreement creates a governing council that:
• Reviews amendments to the Common Agreement, QTF, and SOPs.
• Serves as a resource to the RCE and forum for discussion.
• Provides oversight for resolution of disputes.