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Policy Primer Part 2: What will TEFCA do?

October 20, 2018 | Author: HealthTech Solutions

Recently, we wrote a high-level overview of the Trusted Exchange Framework and Common Agreement (TEFCA) and the interoperability challenges it will address. In this post, we will explain more about the challenges in the current health data exchange landscape and the goals of TEFCA. This post is the second part of the TEFCA primer. For more detailed information, please see the U.S. Department of Health and Human Services (HHS) Office of the National Coordinator for Health IT (ONC) TEFCA User Guide and the full draft proposal


Current interoperability landscape


Image credit to the ONC


The current landscape of health information exchange is due to data use inconsistency, the nature of market competition, and lack of trust. Many clinical data exchange entities compete with one another for business and it is not in their business interest to share data. Furthermore, due to inconsistent technology and privacy practices, there is a lack of trust between some of the entities and stakeholders exchanging the clinical data.


In order to assure complete information for their patient cohorts, many providers have to join multiple data exchange arrangements. This is duplicative and costly for providers, as well as creating workflow, technology, and legal burden.


In solving these challenges, TEFCA has five goals:


Goal 1 Build on and extend the work being done by the industry

  • Broaden the exchange of data
  • Build trust frameworks
  • Develop participation agreements that enable providers to exchange data across organizational boundaries
Goal 2 Provide a single on-ramp to interoperability for all

stakeholders to join any health information network they choose and be able to participate in nationwide exchange regardless of what health IT developer they use, health information exchange or network they contract with, or where the patients’ records are located.

Goal 3 Be scalable to support the entire nation

both technologically and procedurally, by defining a floor, which will enable stakeholders to access, exchange, and use relevant electronic health information across disparate networks and sharing arrangements

Goal 4 Build a competitive market allowing all to compete on data services

Easing the flow of data will allow new and innovative technologies to enter the market and build competitive, invaluable services that make use of the data.

Goal 5 Achieve long-term sustainability

By providing a single “onramp” to nationwide interoperability while also allowing for variation around a broader set of use cases, the TEFCA ensures the long-term sustainability of its participants and end users.



Future interoperability landscape


The purpose of TEFCA is to create efficiencies and trust within the current infrastructure. The TEFCA proposes a governance and exchange structure whereby a Recognized Coordinating Entity (RCE) will be selected to develop criteria by which Qualified Health Information Networks (QHINs) are evaluated on an ongoing basis. These QHINs will be on-ramps for health data exchange, creating interoperability.


Image credit to the ONC


The ONC will procure and select the RCE to provide governance to QHINs. QHINs will meet interoperability requirements and be limited to certain permitted purposes of data exchange, which will facilitate expedient data use agreements. Participants and end-users will submit the electronic health record (EHR) clinical data — including lab and imaging results — to the QHINs. Patients and providers can then request records through QHINs, which will handle the queries. 


Considerations for states and health data exchange entities



  • Would you become a QHIN or a HIN? How do your current participants and stakeholders fit into this proposed arrangement?
  • What is your readiness to meet new qualifications and how will you pay for this? Do you have an opportunity to request money from the state or federal government? Can you charge your services differently if participants only need to join one QHIN? Will you lose business?