Trusted Exchange Framework and Common Agreement (TEFCA)

See the following -

AHRQ Releases Draft Guide for Registry Interoperability: Does Public Health Have a Role?

On January 11, 2019, the Agency for Healthcare Research and Quality (AHRQ) released a draft Addendum to the Third Edition of Registries for Evaluating Patient Outcomes: A User's Guide called Tool and Technologies for Registry Interoperability. AHRQ has long written about registries - largely from a research standpoint - and I have been following this from afar for some time. This new guide is focused on helping those who both create and use registries understand the issue surrounding leveraging external data to improve registry completeness, accuracy, and usefulness. This report covers lots of ground and does a good job of summarizing important subtopics. Each chapter is overflowing with footnotes and sources.

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An interoperability update: Do we need more carrots and sticks?

Earlier this year, the ONC released the Trusted Exchange Framework and Common Agreement (TEFCA), which responds to a mandate included in 2016’s 21st Century Cures Act and lays out principles, terms and conditions on which to base an interoperability framework that healthcare organizations can embrace. “This means patients who have received care from multiple doctors and hospitals should have their medical history electronically accessible on demand by any other treating provider in a network that signed the Common Agreement,” said National Coordinator for Health IT Donald Rucker in a recent blog post. To achieve that goal, TEFCA is divided into parts A, the principles, and B, the terms and conditions, which is also where the rubber meets the road for many who live in the healthcare IT world...

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HHS Releases Landmark Report: Reforming America's Healthcare System

On December 3, 2018, the Department of Health and Human Services (HHS) released an extensive, 120-page report on the administration's proposals to reform the healthcare system. The report, titled Reforming America's Healthcare System Through Choice and Competition, is divided into four major sections. The report that government policy of the last few years has suppressed competition, increased prices for healthcare, and limited choices for consumers. Though rich in detail as it tries to prove each of these points, the more than fifty recommendations are often broad and aspirational rather than practical. Since I am not a health economist, I will leave the market issues to others to discuss (many of the ideas in this report have been vetted and discussed by others previously). But there are two sections of the report which make direct mention of Health IT.

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Major Interoperability Initiative Launched During the Annual Meeting of The Sequoia Project

On December 5, 2019, HLN Consulting, LLC participated in The Sequoia Project's day long annual meeting which was held just outside of Washington, D.C. at the Gaylord National Resort & Convention Center. As a leading healthcare informatics consulting company HLN monitors developments in healthcare interoperability nationally with particular emphasis on the impact to public health agencies and their stakeholders. This conference represented a good opportunity to participate in the start of a major interoperability initiative that will play out over the next several years. In addition to this report, the Sequoia Project posted the proceedings of the meeting online, including the recorded discussions as well as the slides from the presentations. Read More »

ONC Gets It Mostly Right with TEFCA 2.0

On April 17, 2019 the Office of the National Coordinator for Health Information Technology (ONC) released the second draft of its Trusted Exchange Framework and Common Agreement (TEFCA) for comment. The initial version was released more than a year ago in January 2018 (see my original blog). As before, this is in response to a requirement imposed by Congress in the 21 Century Cures Act. After a somewhat lengthy (but well written) introduction, the document contains three parts (compared to just two parts the first time around)...

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ONC Tech Forum 2020: An Attendee's Perspective

I attended the ONC summer Tech Forum in August 2020 which brought together over 1,500 industry experts and Federal partners to discuss technical innovations in health information technology and their potential impacts on the healthcare ecosystem...One of the most interesting parts of the conversation was focused on the efforts made by Honk Kong to develop an open source digital health platform. Over the past 20+ years, Hong Kong has been pursuing a "one system, one record" policy primarily built on open source components. Though they had little money to invest at the beginning, for them open source is more about retaining control than about controlling cost (though the lower price tag certainly got them started down this path)...

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ONC's 3rd Interoperability Forum: Not Much to Report

On August 21 and 22, 2019 the Office of the National Coordinator for Health Information Technology (ONC) held its third Interoperability Forum in Washington, DC. More than 600 individuals participated in person with many others viewing the general sessions via webinar. The conference began and ended with half-day plenary sessions while providing five tracks with smaller sessions in between. I attended the Health Information Exchange (HIE)/Community-based Information Exchange (CIE) breakout session on both days. The plenaries...focused on the current state and the future state of interoperability.

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ONC's Trusted Exchange: A Public Health Perspective

In January 2018 the Office of the National Coordinator for Health Information Technology (ONC) issued a draft Trusted Exchange Framework and Common Agreement (TEFCA), and related supporting documents, in response to a requirement imposed by Congress in the 21st Century Cures Act. The Act says that the TEF may include a common method for authenticating users, a common set of rules, enabling policies, and a process for managing non-compliance. Nowhere does the Act instruct ONC to determine an actual technical architecture in this process, though such a step is not precluded either. The primary document is in two parts: Part 1 is a set of principles that set the foundation for Part 2 which is a set if minimum terms and conditions for trusted exchange.

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The Evolving Landscape of Health Information Exchange

The original vision for nationwide health information exchange was a “network of networks” model where local HIEs would interact HIE-to-HIE to form a virtual national network. But notice that many of the new initiatives are essentially solving a different problem: they are enabling point-to-point connections across a wider geography and set of clinical sites. This seems more like a large, single national network rather than leverage of more distributed organizations or implementations. Only time will tell if these private sector initiatives will collaborate, converge or compete. And only time will tell of the limitations of ONC’s ability to influence and provide leadership will creates gaps or provide new opportunities for innovation.

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The Strengths and Weaknesses of the HL7 FHIR Messaging Standard

It has been several years since we reviewed the progress of the HL7 FHIR standards adoption rate. Health Level Seven's (HL7) Fast Healthcare Interoperability Resources (FHIR) is an emerging standard that has rapidly captured the mind-share of the Health Information Technology (HIT) standards community. FHIR is a standard that enables healthcare data sharing between systems in a manner that is more easily implemented and more expressive than previous HL7 standards such as HL7 Version 2, 3 and Clinical Document Architecture (CDA). Regardless of the version of HL7 standard used, the purpose of these standards is to send clinical data in messages, whether to a party inside or outside your organization. HL7 devises flexible message formats so the receiver of the message can open it up, know who sent it and why, and break it down into understandable segments and data fields.

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