Imagine you arrive at an emergency room unconscious. The attending physician is prepared to treat you but needs your medical history—your allergies, any recent surgeries, and what medications you take. How does your important health information follow you safely and securely?
Right now, many hospitals can only see the information in their own systems or in systems they partner with. There is no national information “highway system” connecting doctors, hospitals, insurers, and public health agencies. At best, information in our nation’s health system operates like parallel roads that don’t intersect. What is needed is a single on-ramp for each “driver” to get on the highway and connect to any other destination. And, by the way, those drivers should include more than just doctors, hospitals, and insurers; they should also include consumers who have been largely left out of the loop.
Earlier this year, the federal Office of the National Coordinator for Health Information Technology (ONC) published its first version of the Trusted Exchange Framework and Common Agreement (TEFCA). The goal of TEFCA is to achieve seamless and efficient nationwide exchange of digitized health information to improve the health and care of U.S. consumers. You may be familiar with the existing Health Information Exchanges or “HIEs” that operate in some regions. What makes TEFCA different – and important – is that for the first time the U.S. is poised to realize nationwide exchange of health data. Basically, the technological magic behind the curtain will put critical information at the fingertips of doctors and others across the country to facilitate the best care possible.
You might ask, why isn’t the country there yet? After all, we have been able to use debit cards in ATMs across the nation for decades. Yet our complex health care system has a number of challenges. It is fragmented, has a lot of players, technology is expensive, and data is a valuable commodity in today’s society.
TEFCA is intended to kick-start a national information network through federal funding for the initial infrastructure. In tandem, the ONC Cures Act final rule is intended to prevent so called “information blocking” by providers and ensure that the data requests are answered. Complexity will remain a challenge for years to come, but through TEFCA, the roads are being built.
ONC also established a cooperative agreement with The Sequoia Project that will serve as the “Recognized Coordinating Entity” or “RCE” that will oversee the governance, compliance, and business operations of TEFCA. Once launched, the RCE will enter into the “Common Agreement” with a handful of “Qualified Health Information Networks” or “QHINs” that establishes a minimum set of expectations like what types of data they have to make available and what privacy and security standards they will meet. In turn, the QHINs will offer services under consistent terms to providers, payers and other entities (called “Participants” and “Subparticipants”) to facilitate the electronic processes and legal framework.
For consumers, this means that there will be new ways to access their health information safely and securely. For example, after meeting the requirements of the Common Agreement, third-party applications or “apps” can join a QHIN. Thus, an individual who wears a fitness tracker can choose to have that information shared with a health care provider or health insurance provider to track progress on exercise goals for reducing diabetic complications. Or likewise, the app could request information on test results or office notes from the health care provider or health insurance provider on behalf of the consumer as value-added services. These are just two examples, and more benefits will be available once the system is up-and-running.
From a health insurance provider’s viewpoint, TEFCA holds the promise of providing better services to enrollees through broader and easier access to provider information. For example, future iterations are expected to include the sharing of digital quality information, helping to eliminate the burdensome and costly chart pulls and flat file exchanges of old. Or, as another example, plans in federal programs will soon need to share certain claims data with each other. Rather than having to build connections and enter into agreements with each and every plan nationwide, a single connection and agreement would suffice to access all of the other participating payers. Ultimately, TEFCA may provide an important means by which health insurance plans can utilize data to better coordinate care, monitor outcomes, and work toward improving overall quality, equity, and affordability of services.
From a societal standpoint, TEFCA could serve as a catalyst for truly transforming health care. Think about having to answer a question once, with the data being shared with all relevant parties. Think about having more robust and real-time sharing of public health surveillance data. Think about harnessing data to better understand the impact of systemic racism on disparities in care and using that data to devise methods for reversing those effects. And think about how data can drive new innovations to improve outcomes and care. Look at what we have accomplished as a fragmented health care in the U.S. and think about what we could accomplish with a digitally interconnected system leveraging its parts to create a stronger whole.
Despite all these benefits, many questions remain. How many QHINs will come to the table? What services will they offer? What will their fee structure look like? Will there be sufficient participation by the existing HIEs? How long will it be before insurance use cases such as payment, operations, and quality measurement (it is starting with treatment and consumer access) are integrated? ONC is putting the pedal to the metal to get this stood up by year’s end—at least on paper.
Ultimately the goal of TEFCA is to use technology and the safe and secure sharing of information to achieve the best possible care and outcomes for patients at the lowest cost. Health insurance providers share that goal and are committed to ensuring all Americans can thrive in good health.