HHS Names First Six QHINs to Participate in TEFCA

On Feb. 13, 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 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.”

What are those gaps? Tripathi said first, there's a digital divide. For example, perhaps 30 percent of hospitals in the country aren't connected to a nationwide network, due to lack of financial resources, technical capacity, and market confusion — not knowing where they should connect. Many of those are in rural settings.

A second gap, Tripathi said, is that public health agencies don't participate in nationwide interoperability today, even in the throes of a devastating pandemic. “Very few public health agencies were able to access health and health exchange networks to get reliable, accurate, real-time information from providers, let alone being able to share information with each other or with the CDC,” he said.

On the provider side of the equation, he added, the administrative burden of having separate unique data feeds and data use agreements for each public health program and each jurisdiction across the country poses a huge barrier to high-quality actionable public health data.

A third gap in network interoperability is information sharing between payers and providers to streamline medical documentation requirements, healthcare operations and care management, Tripathi said. “These types of payer/provider exchanges have been effectively shut out of existing networks because of competitive issues between payers and providers. It's an extraordinary hidden tax on our system because it means that neither payers nor providers have access to the data they need to be able to improve the quality and efficiency of healthcare.”

He said it also has led to a bewildering jumble of custom, costly and often manual arrangements between each payer and provider that adds layers of cost and headache to providers, payers, and patients. “TEFCA sets up a mechanism for payers to more easily get clinical data that they need, to streamline approvals and payment and for providers to get claims data they need to better manage care and reduce redundant care as called for in CMS’ most recent draft interoperability rule.”

Finally, another gap that industry hasn't been able to fill is to make it easier for patients to access their own information without special effort as the 21st Century Cures Act calls for, Tripathi said. TEFCA provides pathways for patients to access their information through a single application of their choice, regardless of where that information is. “Of course, privacy and security are major areas of concern in all aspects, but certainly with patients directly accessing their information, so we've also added provisions in TEFCA that require that vendors who provide such services — who are most often not covered by HIPAA or regulated by HIPAA — those vendors are required to meet the requirements of the HIPAA Privacy and Security rules, and in some cases go beyond those rules to give patients more control and visibility into what's happening with their data once it leaves the protection of HIPAA-regulated entities.”

Tripathi admitted that none of these gaps are easy to address and TEFCA won't solve them overnight. “However, we've grown to accept these and many other gaps and operational friction in interoperability, because so many of them can't be resolved without really meaningful public/private partnership. But we shouldn't do that anymore. Our vision is that TEFCA can get us out of this collective learned helplessness that we're in with some of these things and address head on these and many other issues that prevent forward progress that are important to all of us.”

Representatives from the six initial QHINs spoke about why they thought it was important for their organizations to participate in this process. Like Tripathi, Matt Doyle, an interoperability software development lead at Epic, touted many of the successes in interoperability. “Our community exchanges 11 million patient charts every single day. Half of that is with other vendor platforms and with our federal partners like DOD and VA. That's possible in large part not just because of what vendors have done, but also because of what Carequality has done. Carequality is one of the great success stories of healthcare interoperability so far,” he said. “Today, 70 percent of hospitals are live, exchanging health information in real time in support of treatment.” But there's still a gap, Doyle stressed. “There's still a large number of hospitals that are on the sidelines. TEFCA gives us a big opportunity to encourage those folks to come off the interoperability sidelines, to join in building on the success that we've seen before. TEFCA can help to set that expectation nationwide.”

Dave Cassel, senior vice president of customer success and operations at Health Gorilla, said that the ability to partner with the federal government is huge. “It opens up so many additional opportunities for us to see value that the private sector alone hasn't been able to achieve. I think there's also an opportunity for federal incentives to play a huge role in tapping into that additional 30 percent as well as helping enable some other use cases,” he said. “But in order to enable that type of collaboration, we also had to raise the bar a little bit and all of us have gone through a rigorous process already.”

“We want our participants to have a broader community with whom to exchange. We want our federal agencies the FDA, Indian Health Service, VA, and DOD to be able to exchange broadly with more healthcare organizations across the U.S. and the same goes for the state and regional HIEs,” said Jay Nakashima, CEO of the eHealth Exchange. “Public health is the area that we are most excited about really making that data flow to where it needs to be so that the public health authorities can make the decisions they need to make based on data.”