- The Office of the National Coordinator for Health Information Technology has released the second draft of the Trusted Exchange Framework and Common Agreement (TEFCA), which would create a technical, nationwide framework for health data sharing across different networks and facilities.
- ONC on Friday offered three new TEFCA documents for public comment that, taken together, form the foundation of a single Common Agreement for health IT providers and users to adopt by introducing a common set of data exchange principles, outlining mandatory terms and conditions and detailing the components of data exchange among qualified health information networks.
- HHS also extended the deadline for comments on its twin interoperability rules by an additional 30 days from the original May 3 limit, bowing to pressure from industry groups complaining they didn't have enough time to analyze the many ramifications the rules could have and draft appropriate comments. Comments are now due June 3.
Most healthcare players agree that interoperability, or the free and unfettered exchange of health information across disparate systems, is important, but continues to grade poorly when it comes to actual execution. A December ONC analysis found one-third of hospitals use four or more different methods to receive information from outside sources. Another fourth have no electronic pathway at all, leading a health IT advisory committee to decry the current state of interoperability as "fragmented and uneven."
The Trump administration's healthcare bodies have been taking strides this year toward facilitating interoperability, with CMS and ONC each proposing a rule in February to prod the industry into line.
The CMS rule would require Medicaid, the Children's Health Insurance Program, Medicare Advantage plans and plans in the federal exchanges to provide their some 125 million patients with electronic access to their personal health information by 2020 at no cost.
Along with urging the industry to adopt standardized application programming interfaces, allowing different computer systems to send and receive requests more smoothly, the ONC rule would enact the information blocking provisions of 2016's bipartisan 21st Century Cures Act. This would define the practice of information blocking and allow regulators to identify any malevolent players and penalize them.
Myriad stakeholders, including health IT groups and provider trade associations, asked HHS for the comment period pushback. In March, 21 IT vendors and trade groups, including the American Medical Association and executive information officer organization CHIME, sent the government a letter requesting a minimum extension of 30 days to allow for more "thoughtful analysis" of the rules and their impact.
Industry leaders reiterated that drive at a Senate HELP panel in March, with LifePoint Health's chief medical informatics officer Christopher Rehm urging policymakers to "strike a balance between their desire to make personal digital health information available and the burdens that these requirements place on health systems under proposed timelines."
TEFCA, a body of documents ONC deemed an "on-ramp" to nationwide connectivity, was first released in January 2018. ONC reviewed more than 200 comments on TEFCA in shaping its second iteration, released last week to bolster the new interoperability rules.
The first proposal mandated patients must be able to easily access their health information electronically, that payers and providers managing population health can receive information allowing them to see trends, outcomes and costs and track progress and that the health IT community should have open and accessible APIs.
The updated TEFCA, which is open for comments until June 17, nixes the population health data sharing stipulation, extends timelines for participating entities to make the required changes, introduces the first draft of a technical framework for qualified health information networks and updates the purposes for which information can be exchanged in an attempt to improve information flow.
For example, TEFCA should strengthen reporting from providers in public health settings, according to Chesley Richards, CDC's deputy director for public health scientific services, and "create the ability for timely and true bi-directional information sharing that is essential for responding to public health threats."
HHS is also funding a nonprofit organization, the Recognized Coordinating Entity, to develop, update, implement and maintain the new Common Agreement under ONC's guidance.