Trusted Exchange Framework and Common Agreement (TEFCA)

On January 19, 2022, the office of the National Coordinator for Health Information Technology (ONC) introduced version 1 of the Trusted Exchange Framework and Common Agreement (TEFCA) and Qualified Health Information Networks (QHIN) technical framework. TEFCA is like a catalyst for the ONC’s Final Rule, where ONC’s Final Rule focuses on streamlining the exchange and access to health information.

Through this article, you will be able to explore:

• Aims of TEFCA (Trusted Exchange Framework and Common Agreement)
• Functions of HINs (Health Information Networks)
• Qualified HIN (QHIN) and Connectivity Broker
• The Sequoia Project
• Purpose of RCE (Recognized Coordinating Entity)

Aims of TEFCA (Trusted Exchange Framework and Common Agreement)

One of the main aims of the Trusted Exchange Framework and Common Agreement (TEFCA) is to bring together the best-learned practices by establishing a framework for Qualified Health Information Networks (QHINs). QHINs would be able to share all the information with each other and accomplish interoperability. In order to achieve this, TEFCA emphasized bringing different Health Information Networks (HINs) together under one umbrella and called it a Recognized Coordinating Entity (RCE). These different health networks would connect with each other to share and exchange information, thereby facilitating the process of accessing and exchanging health information.

The commercial payers and the government would offer incentives to the providers so that they participate in a QHIN. It would be more of a form of encouragement for the providers rather than a mandate. Health plans might also just decide to contact only those providers who could connect with a QHIN. Patients would be another driver. People have a tendency to want to manage their own information about health. This is a trend that has grown since the COVID-19 pandemic. Some patients, especially those from rural areas, need to travel a long way outside their care communities. Hence it is important for them to gain full access to their medical records.

The Trusted Exchange Framework focuses on creating governance and technical infrastructure that connects the HINs together through a Qualified Health Information Networks (QHIN) core.

Functions of HINs (Health Information Networks)

The functions of Health Information Networks (HINs) include the following:

1. Determining oversees or administers agreements and policies that define technical, operational, or other requirements or conditions. It enables exchange, access, or Electronic Health Information (EHI) use between two or more unaffiliated entities or individuals.
    
2. Manage, control, and provides any service or technology that would facilitate or enable EHI exchange between two or more unaffiliated entities or individuals.
    
3. Exercising substantial control or influence on the exchange, access, or Electronic Health Information (EHI) use between two or more unaffiliated entities or individuals.

Qualified HIN (QHIN) and Connectivity Broker

The HIN that would be considered under TEFCA is referred to as Qualified HIN. It would be providing a service called - Connectivity Broker.

The functions of Connectivity Broker involve:

• Master Patient Index or MPI (The MPI helps in listing the medical records or identification numbers that are associated with the name. It must contain demographic data that is enough to identify a patient and his/her record readily)
   
• Record Locator Service (It is an electronic index of patient identifying information that directs providers in a health information exchange to the location of patient health records held by providers and group purchasers)
   
• Broadcast and Directed Queries
   
• Electronic Protected Health Information (EHI)

The QHIN would have sub-participants and participants affiliated with them, and they would in turn connect with each other through QHIN to access other organizations and cfcheck whether or not it is included in their QHIN. Participants include HINs, EHR vendors, and other types of organizations.

The Sequoia Project

In August 2019, the Sequoia Project was awarded by the ONC as the RCE. The Sequoia published a draft of the QHIN Onboarding and Designation Standard Operating Procedure on May 16, 2022, and the RCE sought feedback on this draft upon its release. Virtual events, individuals, and organizations chose to submit written feedback to the RCE, apart from additionally engaging the RCE through the public.

Purpose of RCE (Recognized Coordinating Entity)

The single umbrella under which all the HINs would be brought together, i.e., RCE or Recognized Coordinating Entity, would coordinate with ONC for the following purposes:

• Appointing and monitoring Qualified Health Information Networks (QHINs)
• Modifying and updating an accompanying QHIN Technical Framework
• Identifying and monitoring QHINs that would agree to sign and adopt the Common Agreement voluntarily
• Engaging with public stakeholders through sessions of virtual public listening
• Making a formal judgment on the noncompliance disputed matter with the Common Agreement
• Proposing, maintaining, and strategizing certain RCE levels so that it benefits the RCE in continuing to support TEFCA through the QHIN connectivity at the term expiration of the Common Agreement.

The program would be funded at $900,000 for the first year, with additional funding in the years to come. This would be contingent upon the fund availability and how satisfactorily the milestones are reached.

TEFCA aims in scaling interoperability both procedurally and technologically. The thoughts and efforts put behind this agreement are both laudable and impressive. However, it must be kept in mind that healthcare leaders must stay updated with the TEFCA developments. They should keep focusing on long-term goals as well as the positive outcomes of TEFCA participation, such as lowering care costs, eliminating care gaps, and delivering the optimum care for patients.