Q&A: Health Gorilla’s Steven Lane, M.D., on TEFCA, State of Interoperability

In February, the U.S. Department of Health & Human Services announced the first six organizations approved as Qualified Health Information Networks (QHINs) under the Trusted Exchange Framework and Common Agreement (TEFCA), a 21st Century Cures Act requirement to create a “network of networks” for sharing health data across the country.

The goal is that like wireless networks, electricity grids and ATMs, the user experience would become as if it's a single network.

In a significant milestone in the history of health data interoperability, representatives from the CommonWell Health Alliance, eHealth Exchange, Health Gorilla, Konza, Epic Systems, and Kno2 were on hand in Washington, D.C., to be recognized by HHS Secretary Xavier Becerra in the Great Hall at the HHS building.

The QHIN applications were approved by the nonprofit Sequoia Project, which was selected by the Office of the National Coordinator for Health IT (ONC) to serve as the Recognized Coordinating Entity (RCE) to support the implementation of TEFCA and determines the process and requirements for becoming a QHIN. Other organizations are in the process of applying to become QHINs, according to the RCE.

At the announcement event, Micky Tripathi, Ph.D., M.P.P., national coordinator for health IT, said the six QHINs have committed to begin exchanging data by the end of 2023. He also spoke about the progress made over the last decade on interoperability as well as the gaps that still exist that TEFCA might help solve.

Tripathi noted that as hospitals and physician offices adopted electronic health records and health information exchanges sprang up to connect them, the nationwide network problem shifted to aligning and connecting networks — the ‘network of networks’ problem that TEFCA seeks to solve. “The private sector made significant and very meaningful progress on interoperability,” he said, “However, there are still big gaps, and it's increasingly obvious that filling those gaps is going to require more active and coordinated public/private collaboration, because the private sector cannot tackle all these issues on its own.”

Before the announcement of the six initial QHINs, Healthcare Innovation sat down with Health Gorilla’s chief medical officer, Steven Lane, M.D., M.P.H., to talk about the potential impact of TEFCA and the role of the QHINs, as well as other interoperability issues. Health Gorilla recently announced a partnership with a company called CLEAR, a secure identity verification platform, to launch Individual Access Services, which allows consumers to access their personal health information securely. The program will begin in Puerto Rico with the Puerto Rico Health Information Exchange (PRHIE) and expand to other regions in the future.

Lane recently left his position as clinical informatics director at Sutter Health in California to become CMO at Health Gorilla. He also sits on the Office of the National Coordinator’s Health IT Advisory Committee (HITAC).

HCI: Is Health Gorilla part of a new wave of health information networks and interoperability service providers along with companies like Particle Health and Zus Health?

Lane: There are a bunch of players in this space. What's unique about Health Gorilla is the vision of our founding team. They had a very clear vision of what is possible with a private health information network platform and the intention of building out the highest-quality, most secure health data platform.

The whole promise of TEFCA is that you bring government in as more of an active participant, and then you allow a diversity of QHINs to participate with more use cases and more data types. I think there's a key role for a private network in that. I think it's great that we're going to have not-for-profits, and the QHINs really are going to be very different from each other. Some of them are just going to pass data through. The eHealth Exchange has a wonderful niche and they're going to continue to meet the needs of the federal partners and many HIEs. Epic and CommonWell have a defined group that they're going to be servicing as QHINs, but there's a whole world of patient access, public health access, payer access, community-based social services, aging services — everybody's going to want to connect to the framework over time, so I think it is important to have some QHINs that are set up to be flexible, and also to provide that platform of data that can be used for many purposes.

HCI: Does Health Gorilla have provider types it prioritizes as a QHIN?

Lane: Well, like eHealth Exchange, Epic, and CommonWell, we have a network today that's already connected to the existing Carequality framework. Our network participants would be obvious candidates to become our QHIN participants. We are, I believe, the only QHIN candidate organization at the moment that has, publicly committed themselves to individual access services, and that's huge, right? I mean, all QHINs need to respond to IAS queries, but they can choose whether they want to launch those queries. Our company wants to support individual access, and that specifically is going to be in a B-to-B-to-C [business-to-business-to consumer] model. We are not going to be selling our app on the Apple App Store to be your PHR [personal health record], but we're going to create the back-end connectivity, the APIs, the workflows, so that a thousand flowers can bloom to support individual access, and then we can facilitate that into the new framework.

Also, we already support one HIE [in Puerto Rico] and are talking to other regional HIEs around the country. Just yesterday, there was an announcement that a handful of the large HIEs are going to work with the eHealth Exchange, and that makes perfect sense, but for a number of them Health Gorilla might be a better choice. The large HIEs have already invested years and so much energy into creating their own longitudinal health records and getting data access within their community, and that's great. All they really need is a pass-through QHIN and eHealth Exchange is perfect for that. They're not going to touch the data, they're not going to really look at the data — just like the eHealth Exchange hub today. But if you're a smaller regional HIE or if you're any number of other stakeholders that can benefit from having the data collected, normalized, and de-duplicated — the same thing the big HIEs are doing successfully today, but doing that on a nationwide scale, and being able to make that available as a component of your QHIN exchange, that's going to be great for a whole lot of participants.

HCI: Health Gorilla recently released its inaugural 2023 State of Interoperability report. One of the survey findings was that only 40 percent of health system execs believe the data retrieved by an HIE is good or great quality, and that 50 percent of the CIOs plan to spend up to 20 percent more on interoperability initiatives in 2023. What is the significance of those findings?

Lane: I can tell you that as a clinician vs. a public health person vs. a health policy person, what defines good or great data is different. But let's have that conversation. Let's agree what are the relevant dimensions of quality for health data, especially as it's being shared across the ecosystem, and let's measure it and improve on it. That is definitely something that I'm hoping to help with here at Health Gorilla.

The other question is about what people intend to spend. I think all of these folks see TEFCA coming, and there's going to be a cost. People have invested in interoperability, and they will continue to invest in interoperability because the value proposition is absolutely there, whether you're talking about public health, individual care, value-based care arrangements, digital health, and payer/provider exchange. I mean, there's huge value in improving the efficiency of the system, in removing burden from the various participants, and that is going to have some cost. I think that the point is looking at the value of that.

HCI: Another finding is that digital health execs are reporting gaps in their data to deliver better care for chronic conditions. What are some types of data that are crucial for working with people with those chronic conditions?

Lane: Lab data is critical. As we mentioned in the report, labs have been very slow to come on board, even though they are an actor under the information blocking prohibitions, and it's a little crusade of mine to try to help the labs understand that they need to come on board. All the labs are federally required to share data today, without delay, without special effort in the form and format that's been requested and they're just not doing it. If I need to get all of David's labs from every lab that has seen him in the last 10 years because I want to see his longitudinal lab record, that's not possible because people are literally breaking the law.

HCI: Do we need more teeth to the regulation?

Lane: That's coming. We are waiting this year for the NPRM [Notice of Proposed Rule-making] that's going to clarify the disincentives for providers for info blocking. What I anticipate is that there will be a queue of labs that have been identified as information blockers that will be ready to be processed once we have those disincentives for providers.

HCI: Is there anything else you are excited about working on with the ONC HITAC this year?

Lane: The interoperability standards advisory now has a predictable annual cycle of updates. I've been very involved in and bullish on the advancement of USCDI since its inception and I'm excited it's going to continue to move forward. It is really going in a direction of supporting equity, supporting public health, supporting richer data sets and that's very exciting. I think equity as a separate topic is also a real focus for ONC and for HHS generally.