HHS Plans for ‘Nationwide Interoperability’


Posted April 23, 2019

The Department of Health and Human Services (HHS) has updated its plan to support “the full, network-to-network exchange of health information nationally.” The second draft of its Trusted Exchange Framework and Common Agreement (TEFCA) is intended to help ensure that healthcare providers, health plans, and individuals have secure access to their electronic health information (EHI) when and where they need it.

“Nationwide interoperability is not a simple undertaking, and something as expansive as a final TEFCA requires thoughtful consideration of the issues and challenges,” said Donald Rucker, national coordinator for health information technology (ONC), in a blog post. “The challenge before us … is to work as efficiently as we can to advance towards nationwide interoperability, which will inject competition and transparency into healthcare to empower patients and drive down costs.”

The TEFCA report and its associated documents establish the technical and legal requirements for sharing EHI on a nationwide scale, with the goal of allowing healthcare providers, healthcare plans, and patients real-time access to data. The framework, which was required by the 21st Century Cures Act, focuses on three goals:

  1. Creating a single “on-ramp” to nationwide connectivity by providing access to a network that would in turn be able to access different networks within the healthcare system.
  2. Ensuring EHI securely follows patients so it is available when and where it is needed, allowing patients to work across healthcare providers in a secure way.
  3. Supporting nationwide scalability for network connectivity through the establishment of technical and legal requirements, establishing the “rules of the road” for such a system.

“A single network that comprehensively addresses all use cases for all users is not feasible for a variety of reasons, including technical limitations, security concerns, variations in use cases, and resource limitations,” the TEFCA report reads. “However, establishing a Common Agreement that enables existing and future networks to share EHI with each other without having to join multiple networks is feasible and achievable.”

The second draft of the TEFCA incorporates feedback from more than 200 commenters and includes substantial changes, such as separating the Trusted Exchange Framework and Common Agreement into two documents; broadening the definition of Qualified Health Information Networks (QHINs); and including greater privacy and security guidelines, more data exchange methods, and longer implementation timeframes for participating QHINs.

ONC is seeking feedback on the TEFCA and related documents until June 17. In addition, ONC has announced a funding opportunity, also due June 17, for a nonprofit, industry-based entity to develop, update, implement, and maintain a future Common Agreement.