ONC Survey: 64 Percent of Hospitals Plan to Participate in TEFCA
On July 17, the Office of the National Coordinator for Health IT (ONC) released the agency’s latest Data Brief and Quick Stat. According to ONC’s survey findings, 64 percent of U.S. hospitals plan to participate in TEFCA™, the Trusted Exchange Framework and Common Agreement. The agency notes that “This is an increase over 2022, when 51 percent of U.S. hospitals said they planned to participate.”
Other findings:
• Approximately 7 out of 10 hospitals that participated in national networks or health information exchanges (HIEs) planned to participate in TEFCA, compared to 4 out of 10 hospitals that did not participate in either type of network.
• Hospitals with more resources, such as those that are larger, non-critical access, and affiliated with health systems, indicated greater awareness and had higher levels of planned participation in TEFCA when compared to smaller, critical access, and independent hospitals with fewer resources.
• The percent of hospitals that were aware of TEFCA but did not know if they would participate decreased from 23% to 9% from 2022 to 2023.
The Data Brief began thus: “A critical provision of the 21st Century Cures Act, the Trusted Exchange Framework and Common AgreementTM (TEFCATM) was published in 2022. The purpose is to facilitate nationwide connectivity by enabling the exchange of electronic health information across networks.1 The three goals of TEFCA are to (1) to establish a universal governance, policy, and technical floor for nationwide interoperability; (2) to simplify connectivity for organizations to securely exchange information to improve patient care, enhance the welfare of populations, and generate health care value; and (3) to enable individuals to gather their health care information.2 The first set of Qualified Health Information NetworksTM (QHINsTM) were approved to implement TEFCA and began exchanging data in late 2023. Participation in TEFCA is not mandated by law, so it is important to assess the extent to which health care providers, as critical TEFCA participants, are aware of and plan to participate in TEFCA. This data brief uses nationally representative survey data from the 2022 and 2023 American Hospital Association (AHA) Information Technology (IT) supplement to explore non-federal acute care hospitals’ awareness and plans to participate in TEFCA.”
Further, the Data Brief noted, “Between 2022 and 2023, hospitals with greater resources reported greater increase in their awareness and plans to participate in TEFCA compared to their less well-resourced counterparts.
Among the key findings of the survey:
★ Among hospitals that were aware of TEFCA, there were increases in plans to participate in TEFCA across all types of hospitals.
★ Hospitals with greater resources (e.g., multi-hospital system member, medium to large) increased their awareness and plans to participate in TEFCA at higher rates compared to their less well-resourced counterparts.
★ Although critical access hospitals and rural hospitals’ plans to participate in TEFCA increased between 2022 and 2023, their levels of awareness and plans to participate were still lower when compared to their suburban, urban, and non-critical access counterparts.
The Data Brief went on to note that “TEFCA aims to enhance the nationwide exchange of health information by enabling the exchange of electronic health information across networks. Broad participation by health care organizations will be essential to achieve widespread exchange. In 2023, more than 60 percent of hospitals planned to participate in TEFCA, an increase from 51 percent in 2022. Planned participation also increased, with only 9 percent of hospitals aware of TEFCA indicating that they did not have plans to participate, down from 23 percent in 2022. The growth in planned TEFCA participation between 2022 and 2023 among non-federal acute care hospitals aligns with the start of exchange activities and the designation of the first Qualified Health Information Networks (QHINs), suggesting a growing recognition among hospitals of the potential benefits that TEFCA offers.”
That said, the Data Brief went on to state that, “However, while most hospitals that were aware of TEFCA planned to participate in it, one quarter of hospitals reported that they were not aware of TEFCA, unchanged from 2022. This highlights the essential need for further education and outreach about TEFCA to ensure that hospitals and smaller health care organizations are knowledgeable about its benefits and costs and how they might participate in it, even within networks in which they are already participants.”
In addition, the Data Brief noted that “Correlations between hospital characteristics and their knowledge of and plans to participate in TEFCA highlight a division between organizations planning to participate and those unaware of TEFCA. Among hospitals aware of TEFCA, hospitals’ plans to participate in TEFCA increased across all hospital types; however, the level of growth varied by hospital characteristics. Hospitals with more resources, such as those affiliated with health systems and with larger bed sizes, indicated greater awareness and had higher planned participation levels in TEFCA when compared to smaller, critical access, and independent hospitals with fewer resources.”
And, it noted, “Hospitals participating in national or regional networks were much more likely to report planning to participate in TEFCA compared to the 14% of hospitals not involved in any network type. By participating in TEFCA, hospitals can join a QHIN or become subparticipants under a participant, both of which include existing national networks and some regional HIEs. Our findings underscore the importance of prior network involvement in shaping hospitals’ participation in TEFCA, possibly due to existing technical capabilities, the need for data exchange, and familiarity with electronic health information exchange.”
Further, “While the gap in plans to participate between hospitals already in networks and those not in any network remained large in 2023, we did observe a substantial increase in the proportion of hospitals without prior network involvement planning to participate in TEFCA. In 2022, only 10 percent of these hospitals planned to participate in TEFCA, which increased by 29 percentage points to 39 percent in 2023. This trend is important because it indicates net-new participation in network-based exchange through participation in TEFCA. It will be important to monitor this trend over time. It will be particularly critical to evaluate trends in participation because the statistic for non-network participants is an outlier.”
