ONC hears from healthcare industry on TEFCA interoperability proposals

Just weeks after receiving voluminous comments from all corners of the healthcare industry about its proposed rules for the data exchange provisions of the 21st Century Cures Act, the Office of the National Coordinator for Health IT is getting an earful about another set of interoperability regs.

Among the groups responding this week to ONC’s Trusted Exchange Framework and Common Agreement Draft 2 are HIMSS (the parent company of Healthcare IT News), the Sequoia Project, the UCSF Center for Digital Health Innovation and others.

Build on the successes of state and regional HIEs

For its part, HIMSS, along with its Personal Connected Health Alliance, encouraged ONC to make sure it’s leveraging existing interoperability efforts to the fullest extent possible as it rolls out its TEFCA roadmap.

HIMSS and PCHA said they have concerns about “the proposed structure and the impact that it could have on existing exchange processes.”

For instance, in calling on ONC to relax requirements for provisional Qualified Health Information Network status and give a “longer glidepath” for organizations to fully adhere to the drafted Common Agreement, asked the agency to “not disrupt the existing successful business models of state and regional HIEs and HINs as well as other exchange entities.”

Instead, it should “build upon their innovations, partnerships, and successes thus far,” enabling QHINs to “maintain their provisional status for a significant period of time” while eventually developing “additional, more ambitious capabilities, exchange modalities, and exchange purposes, that could be met by adapting the existing ecosystem of HIEs and HINs.”

Among HIMSS and PCHA’s other suggestions to ONC:

  • Expand exchange modalities to include push transactions
  • Streamline the exchange purposes in the initial roll-out, but ensure TEFCA is positioned to expand activities
  • Ensure a robust role for connected care use case in the future framework
  • Align privacy and security obligations across the healthcare landscape
  • Push for the creation of a patient-focused and driven QHIN
  • Clarify the role of QHINs in future uses of patient data

Don’t duplicate existing mechanisms of exchange

In its comments, interoperability collective The Sequoia Project offered a series of detailed technical suggestions for how TEFCA Draft 2 can be even further improved since the first go-round.

Among its bigger-picture suggestions, Sequoia echoed HIMSS’ sentiment that ONC to be “very mindful to “avoid disruption and duplication of existing exchanges between participants of health information networks.”

As currently drafted, said Sequoia officials TEFCA “would both disrupt and duplicate existing exchange mechanisms and would require extensive changes to existing activities and revisions to the terms of thousands of legal agreements.”

Of specific concern, the group pointed to the potential need to “revise legal agreements that have, in many cases, taken years to be developed and executed in support of large-scale information sharing.”

Sequoia also emphasized that TEFCA should ultimately “address real, material gaps in current exchange networks, frameworks and agreements,” noting that a specific area where it could to a lot of good is with the “harmonization of agreed upon purposes for exchange and use of information.”

Twitter: @MikeMiliardHITN
Email the writer: [email protected]

Healthcare IT News is a publication of HIMSS Media.

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