TEFCA
What is TEFCA?
TEFCA is the acronym for the Trusted Exchange Framework and Common Agreement put forth by the Office of the National Coordinator. TEFCA seeks to scale health information exchange nationwide and ensure that health information networks (HINs), health care providers, health plans, individuals, and many more stakeholders can access real-time, interoperable health information. The end goal is to establish a single “on-ramp” for data exchange.
TEFCA also will define standards for interoperability as required by the 21st Century Cures Act (signed into law in December 2016.) This Act’s focus on trusted exchange is an important next step toward advancing the establishment of an interoperable health system that:
- Empowers individuals to use their Electronic Health Information to the fullest extent
- Enables providers and communities to deliver smarter, safer, and more efficient care
- Promotes innovation and competition at all levels
In this blog post, we’ll do a quick review of TEFCA, and how it may affect health information exchanges (HIEs) and interoperability going forward.
Background:
In January 2018, ONC released the Trusted Exchange Framework (TEF) Draft 1 for a public comment period. The TEF Draft 1 included two parts: “Part A — Principles for Trusted Exchange”, and “Part B — Minimum Required Terms and Conditions for Trusted Exchange.” ONC received more than 200 public comments from stakeholders across the industry. ONC reviewed the comments and released an updated draft for public comment.
How will TEFCA work?
TEFCA establishes “Qualified Health Information Networks” (QHINs) as a vehicle to help facilitate a standardized methodology for HIE inter-connectivity, along with a new administrative organization, the Recognized Coordinating Entity (RCE).
Three Parts to TEFCA
The modified draft ONC released for public comment on April 19, 2019, is broken into three parts:
(i) The TEF Draft 2: formerly “Part A — Principles for Trusted Exchange”
The TEF Draft 2 supports the Cures Act’s goal of advancing nationwide interoperability and is a key component of the U.S. Department of Health and Human Services (HHS)’ and the Administration’s broader strategy to facilitate nationwide interoperability. HINs must agree on a minimum set of principles that enable trust in order to facilitate interoperability and the exchange of Electronic Health Information (EHI) necessary to support the entire care continuum. The TEF Draft 2 establishes a uniform set of principles that all HINs should adhere to allow for the trusted and secure electronic exchange of health information. Adherence to these principles will help improve the flow of EHI, providing patients with secure access to their information when and where they need it most. This will empower patients to play a more active role in managing and shopping for their care and improve the efficiency and quality of care delivered.
(ii) The Minimum Required Terms and Conditions (MRTCs) Draft 2: formerly “Part B — Minimum Required Terms and Conditions for Trusted Exchange;”
The MRTCs Draft 2 requires support for a minimum set of Exchange Purposes for sending and receiving EHI. The proposed exchange modalities for exchanging EHI include QHIN Targeted Query, QHIN Broadcast Query, and QHIN Message Delivery, which will facilitate core use cases for interoperability, including Individuals’ electronic access to and use of their EHI. Under the MRTCs Draft 2, the Common Agreement will require strong privacy and security protections for all entities who elect to participate, including entities not covered by the Health Insurance Portability and Accountability Act (HIPAA). Establishing baseline privacy and security requirements is important for building and maintaining confidence and trust that EHI shared pursuant to the Common Agreement will be appropriately protected. The Cures Act’s focus on trusted exchange is an important step forward to advance an interoperable health system that empowers individuals to use their EHI to the fullest extent, enables providers and communities to deliver smarter, safer, and more efficient care, and promotes innovation and competition at all levels.
(iii) The QHIN Technical Framework Draft 1
The Qualified Health Information Network (QHIN) Technical Framework (QTF) describes the functional and technical requirements that a Health Information Network needs to fulfill to serve as a QHIN under the Common Agreement. The QTF specifies the technical underpinnings for QHIN-to-QHIN exchange and other responsibilities described in the Common Agreement. While the Recognized Coordinating Entity (RCE) (to be selected by ONC) will establish the final operational and technical means by which QHINs exchange Electronic Health Information (EHI), the QTF Draft 1 provides an initial set of QHIN technical responsibilities for public comment. The QTF also describes high-level functional requirements QHINs must support within their health information networks.
It is important to note that participation in TEFCA is still voluntary at this point according to the published draft.
In the coming blog posts, we will discuss in more detail the three parts of TEFCA and we will try to shed some light on the different challenges and considerations associated with TEFCA including how it may impact pharmacy practice within the health system.
Authors:
Published on behalf of the GetITDone Workgroup for the Clinical Application SAG:
Amanda Bain, Pharm.D., MPH, M.B.A. Director, Pharmacy and Care Management. OSU Health Plan, Inc. Columbus, OH
Beth Prier, Pharm.D., M.S. Director of Clinical Informatics and Managing Advisor. The Robertson Group (TRG). Columbus, OH
Chezka "Mimi" Baker, Pharm.D. Informatics Specialist. Dallas, TX
Hesham Mourad, Pharm.D., BCPS, BCCCP, CPHIMS, Medication Management Informaticist. Mayo Clinic. Jacksonville, FL
Robert (Ben) McDaniel, Pharm.D., BCPS Clinical Pharmacy Informatics Specialist. The University of Texas MD Anderson Cancer Center. Houston, TX
Seth W. Hartman, Pharm.D., M.B.A. Director, Pharmacy Informatics. University of Chicago Medicine. Chicago, IL
Acronyms, references, and links for more information:
-Trusted Exchange Framework and Common Agreement. Retrieved from: https://www.healthit.gov/topic/interoperability/trusted-exchange-framework-and-common-agreement. Accessed 1/28/2020
-TEFCA in a Nutshell. Retrieved from: https://www.impact-advisors.com/regulatory/interoperability/tefca-in-a-nutshell/. Accessed 1/28/2020
- Trusted Exchange Framework and Common Agreement Draft 2. Accessed 1/28/2020
- "A User’s Guide to Understanding the Trusted Exchange Framework and Common Agreement Draft 2". Accessed 1/28/2020
HIN: health information networks.
https://www.healthit.gov/sites/default/files/what-Is-the-nhin--2.pdf Accessed 2/24/2020
HIE: health information exchanges.
https://www.healthit.gov/topic/health-it-and-health-information-exchange-basics/what-hie Accessed 2/24/2020
RCE: Recognized Coordinating Entity
The RCE is the entity selected by ONC that will enter into agreements with HINs that qualify and elect to become Qualified HINs in order to impose, at a minimum, the requirements of the Common Agreement set forth herein on the Qualified HINs and administer such requirements on an ongoing basis as described herein.
https://www.healthit.gov/sites/default/files/draft-guide.pdf Accessed 2/24/2020
EHI: Electronic Health Information
https://www.healthit.gov/sites/default/files/page/2019-02/HITACNPRMPresentation.pdf Accessed 2/24/2020
QHIN: Qualified Health Information Network
A Qualified HIN (QHIN) is a network of organizations working together to share data. QHINs will connect directly to each other to ensure interoperability between the networks they represent.
https://www.healthit.gov/sites/default/files/draft-guide.pdf Accessed 2/24/2020