How TEFCA and QHINs Will Benefit Patients, Providers, Payers, and Public Health

To create a healthcare system with effective health information exchange, healthcare organizations need more than a series of connections between each other. They need assurance that the data being exchanged is secure, actionable, and to know it will be delivered when and where they need it.

While health information exchange has made tremendous strides over the last few years, unreliable patient data identifiers, information blocking, and disparate systems continue to cause various challenges. These, paired with varying data standards, have created a healthcare environment that is disconnected and difficult for patients to navigate.  

In the 21st Century Cures Act, which President Obama signed in 2016, Congress called on the Office of the National Coordinator for Health Information Technology (ONC) to solve these issues by developing or supporting "the trusted exchange framework, including a common agreement among health information networks nationally."

When fully implemented, the Trusted Exchange Framework and Common Agreement, or TEFCA, will create a single on-ramp for Health Information Networks to send healthcare information, ensure that electronic health information follows an individual regardless of where they travel or move, and promote national scalability. TEFCA will also decrease the healthcare industry's administrative burdens and improve organizational security by closing network privacy gaps and addressing security vulnerabilities.

And while these improvements will enhance the entire healthcare ecosystem, there are specific benefits that particular actors will experience once TEFCA is fully implemented and Qualified Health Information Networks (QHINs), the designated entities responsible for facilitating the national exchange of health information, are established.

Read on to see how TEFCA will enhance data exchange for state governments, patients, payers, and healthcare providers.

Benefits for Patients

Many people are surprised to find out how difficult it is to access their complete medical information. It seems obvious that a patient would be able to easily access their historical records and share them with a provider. But, the reality is that their information is dispersed across various systems that do not readily exchange information with each other.

For patients to access their complete medical history today, they would have to log in to each of their previous provider portals or health plans and download each of their previous records, which requires a significant amount of time and energy.

With the release of TEFCA version 1 (TEFCA V1) earlier this year and the QHIN application process starting in quarter two, the process has begun to create the national interoperability framework for patients to have the ability to access, control, and share all of their health information electronically. Allowing this type of access should give patients peace of mind that their providers have their most up-to-date information along with their medical history and will enable them to have more engaged relationships with their physicians.

The ability for patients to easily access more complete medical records will also:

  • Decrease the need for duplicative and costly tests.
  • Make moving throughout the United States and changing providers much easier.
  • Reduce the number of questions patients are required to answer when seeking urgent or emergency care.
  • Ensure that information insurers need is readily available to patients needing prior approval for treatment or second opinions.
  • Make sure clinical data is available when patients are displaced during natural disasters and other emergencies.

Benefits for Providers

The network based on TEFCA will establish a set of technical, data access, and security requirements to create the trust needed for providers to confidently send and receive clinical information across a national health information network. Pairing that increased confidence with the "network of networks" approach will enable providers to efficiently access more complete clinical records, allowing them to make more informed decisions, reduce the number of duplicative tests administered, and increase care coordination. Participating in TEFCA will also ensure that primary care providers are notified when their patients are admitted to the hospital or discharged and when they receive care in other settings, allowing them to stay updated on any care administered outside of their practice.

TEFCA's new data-sharing structure will also reduce the burden on providers when sharing data with public health agencies. Providers are required to communicate with various public health organizations, which often have unique reporting requirements and connection methods. But as TEFCA becomes implemented and public health organizations connect to the network, providers will be able to implement bi-directional exchanges with public health agencies, easing the process when reporting to multiple jurisdictions and across state lines.

Benefits for State Governments and Public Health

TEFCA's "network of networks" approach benefits state governments and public health agencies in various ways. Decreasing the data exchange burdens for state and regional Health Information Exchanges (HIEs) should increase the types of providers participating in their networks and encourage new actors to join their HIEs. More structured and well-ordered connections across Health Information Networks (HINS) will also increase the amount of information available to their network and ease communication across state lines.

Adding new healthcare and health information entities and simplifying data sharing will improve the population data available to state governments and public health organizations, decrease their need to build one-off connections to public health reporting systems, and reduce the burdens associated with onboarding providers – all of which support their efforts to promote population health.

Medicaid organizations that choose to participate in TEFCA will have access to more complete clinical information, which should improve decision-making, enhance care coordination, and increase participation in value-based care initiatives. It will also enable care management organizations to easily access the data they need for case management, quality measurement, and reporting activities, enhancing their ability to identify and close care gaps.

Benefits for the Health Plans and Payers

Reliable information sharing will give health plans a more holistic view of an enrollee's medical history, supporting the industry's shift towards value-based care. Additional health information will also allow health plans the information needed to identify and close care gaps and offer case management services to enrollees needing extra care.

Enabling easier access to clinical and administrative information will also allow payers and health plans to support patients needing prior authorization and other activities that ensure care recommendations are appropriate, affordable, and safe.

The COVID-19 pandemic has shown how important it is for public health agencies to have reliable and efficient access to clinical records at an individual and population level. TEFCA will create a network that allows public health organizations to share and receive data from health plans, which will enable them to manage future pandemic outbreaks and public health emergencies in a more efficient and collaborative manner. Information exchanged may include immunization records and recommendations on how to treat new conditions.

What’s Next for Health Gorilla?

Our team at Health Gorilla was very excited to see the release of TEFCA Version 1 earlier this year. We have built our FHIR-native Health Interoperability Platform through the lens of TEFCA and believe our advanced technology satisfies the ONC's goal to establish a nationwide floor of universal interoperability. Our library of APIs and software products power fundamental healthcare workflows and data exchange scenarios and enable an easy on-ramp to the national exchange of data.

As we pursue our QHIN designation, we will continue to offer our well-known interoperability solutions and expand our services as we begin facilitating data exchanges for new purposes. This will allow us to provide our services to a larger pool of the healthcare community and increase how current and future clients can leverage our solutions.

We are one of the only known commercial entities applying for the QHIN designation and plan to act as a liaison between the healthcare market and TEFCA governing bodies. We believe that pairing our close relationship to the market with services that achieve the national interoperability and exchange goals of the 21st Century Cures Act will allow us to develop more efficient data flows, expand our services, and create more innovative lines of business, all while reducing the intricacies of exchange.

Ready to Expand Your Access to Clinical Data?

If you are part of a healthcare organization and interested in expanding the data available to your physicians or patients, the Health Gorilla team is here to help. We offer a comprehensive implementation plan which includes a dedicated implementation specialist and solutions architect who will work with you to configure the connection between our suite of APIs and your application. We tailor our implementation to your organization's unique clinical data workflows and provide access to the Health Gorilla development sandbox. Our team of experts is available to answer any questions through the testing and validation period. If you have any additional questions or are interested in exploring a partnership with Health Gorilla, please contact us.