- An advisory committee thinks the Office of the National Coordinator for Health IT should consider incentives for health information networks to adopt the Trusted Exchange Framework and Common Agreement, a blueprint for fostering interoperability in healthcare.
- At its Tuesday meeting, the TEFCA task force — a subset of the Health IT Advisory Committee — debated multiple incentives, including requiring participation in TEFCA for participation in other federal programs like Medicare, Medicaid or Veteran Community Care, and participation in TEFCA affecting whether an actor is found to be an information blocker.
- "Maybe we don't want to go into that political space, but that's what it could come to for TEFCA to work," task force co-chair John Kansky said.
The 21st Century Cures Act directed ONC to create a trusted exchange framework and common agreement among health information exchanges to foster an on-ramp to nationwide connectivity.
ONC released TEFCA's second draft package in April. It set forth a set of principles for trusted exchange across a broad range of health information networks, introduced the minimum required binding terms and conditions in the Common Agreement and detailed the technical components for data exchange between qualified health information networks.
But since participation in TEFCA is mandated by Cures as voluntary, many parties have expressed concerns about how successful or widespread adoption will be, sparking Tuesday's discussion about whether ONC should bake incentives into the proposal's language.
One option batted around would make participation in federal programs, like those run by CMS and the VA, contingent on participation in TEFCA. Though the federal programs would obviously have to also be on board, CMS' ongoing push for interoperability, which is traditionally in ONC's wheelhouse, suggests this could be a possibility, task force members said.
"The Cures Act says, 'yes, participation is voluntary,' but federal agencies can require it by contract or agreement," Mark Savage, task force member and director of health IT at the National Partnership for Women & Families, said. "That is an option and I personally think that's a good idea."
A less popular idea was making participation in TEFCA impact whether a healthcare company is found guilty of information blocking, a practice targeted by two wide-reaching HHS proposed rules released in February. The idea, in which the government takes TEFCA participation into account when determining if an actor engaged in data blocking, was skewered as a "slippery slope" by one task force member and a "double-edged sword" by another.
Just because an organization is a member of TEFCA that doesn't mean it's a good actor, said Cynthia Fisher, a task force member and managing director at an investment firm. An entity could be in compliance with TEFCA and still be making it difficult for another company to get access to a patient's data.
"The reasoning doesn't play out," Fisher said.
And industry is unlikely to play along with either proposal, as HHS' push for interoperability has been met with a wide swath of provider, payer and health IT opposition. Getting into compliance with the two info blocking regulations will already require significant business modifications and sunk costs for players across the spectrum, the American Hospital Association commented on the rules. And that's without the added burden of TEFCA.
However, the task force members ultimately agreed some incentives were needed to increase industry adoption, and that the government may have to take unpopular moves to entice healthcare companies to make their systems interoperable.
"The less you like the sound of jumping in the pool, the larger the incentive you need to jump in," Kansky said.
The task force's next meeting is Friday, and the group will present its recommendations to HITAC June 19. The public comment period closes Monday.