Industry Associations Line Up to Offer Comments on ONC’s TEFCA | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

Industry Associations Line Up to Offer Comments on ONC’s TEFCA

February 21, 2018
by Rajiv Leventhal and David Raths
| Reprints
Healthcare groups seem concerned about the TEFCA’s timeline, details, and how it will be aligned with other 21st Century Cures Act provisions

An array of healthcare IT trade groups have sent in comments offering insight and recommendations on ONC’s draft Trusted Exchange Framework and Common Agreement (TEFCA).

For background, last month the Department of Health and Human Services (HHS) released its draft Trusted Exchange Framework, as required by the 21st Century Cures Act of 2016. Specifically, Congress directed ONC (the Office of the National Coordinator for Health IT) in the legislation to “develop or support a trusted exchange framework, including a common agreement among health information networks nationally.”

The draft Trusted Exchange Framework, released on Jan. 5, 2018, outlines a common set of principles for trusted exchange and minimum terms and conditions for trusted exchange. This is designed to bridge the gap between providers’ and patients’ information systems and enable interoperability across disparate health information networks (HINs) by providing a “single on-ramp” to patient information, according to ONC officials. What’s more, the TEFCA will be facilitated through ONC in collaboration with a single recognized coordinating entity (RCE).

The 45-day public comment period on TEFCA has just ended, and leading associations have made their suggestions public. Following stakeholder input, and refinements to the draft document, a final draft of the combined Trusted Exchange Framework and Common Agreement will be released. Right now, although many of the organizations are broadly showing support for the effort, they all see issues that will need to be worked out.

Leaders from the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME), for one, believe that the TEFCA draft timeline “is aggressive and sharply limits thoughtful input by stakeholders.” CHIME noted, “The TEFCA draft, however, creates an expansive, complex, and rather prescriptive structure that is not amenable to cursory reading or rapid consideration.”


Advancements in Healthcare: Interoperability, Data Exchange, and More

Micky Tripathi, President and Chief Executive Officer of the Massachusetts eHealth Collaborative, is one of the most well-informed and well-respected healthcare IT leaders in the U.S. Tripathi has...

As such, CHIME proposes that ONC opens up an additional comment period this year for the public prior to finalizing the TEFCA. However, as reported by Healthcare Informatics Senior Editor, David Raths, at the Feb. 21 meeting of the Health Information Technology Advisory Committee (HITAC), in response to a question during the meeting, ONC officials said there would not be a second round of comments on the draft TEFCA, but there will be more comment period on the common agreement later in the year.

What’s more, CHIME said that it is also worried about the timing of the forthcoming certification/ information blocking rule expected from ONC in April. “We have found it hard to offer meaningful comments without a complete picture of the policy landscape. We have heard several concerns from members and other stakeholders that while use of the Framework is voluntary pursuant to the 21st Century Cures Act, that they worry HHS could deem providers data blockers if they are not using TEFCA,” CHIME wrote in its comments.

Regarding the RCE, which ONC has said will be tasked with operationalizing the Trusted Exchange Framework, and which will have responsibilities such as overseeing security in the network, CHIME said it should be a “broad-based, neutral entity that is a not for profit with multi-stakeholder representation—to include the provider community—on its board.” And rather than naming the RCE this spring, as intended, given its central role in the process, CHIME urges that the selection process not be hurried.

Expressing similar concerns to CHIME, the Charlotte, N.C.-based Premier said that the final TEFCA “must explain when and how other 21st Century Cures provisions (i.e., application programming interfaces (APIs), information blocking and registries) will be implemented and harmonized with the TEFCA since they are interrelated and interdependent.”

Regarding the RCE, Premier said “ONC must ensure that the RCE governance and operational processes are transparent and include multi-stakeholder oversight,” and that “the final TEFCA must include an RCE evaluation strategy, approach and process.” Premier further said that “ONC needs to better articulate specific roles and responsibilities of different types of QHINs [qualified health information networks], their participants and end users.”

Additionally, the Bethesda, Md.-based American Medical Informatics Association (AMIA), urged federal officials to develop a comprehensive timeline, which includes establishment of pilots for specific aspects of the TEFCA, and they challenged ONC to establish a “share first, structure later” data policy, so that important data elements are not trapped behind siloed systems.

AMIA recommended that ONC develop a roadmap that details an implementation plan at least three years into the future and ONC should establish specific pilot tests to inform this implementation plan. AMIA also urged ONC to seek feedback from the wider stakeholder community as the roadmap is implemented, and they requested that the lead coordinating body, the RCE, be required to hold open comment periods, listening sessions, and other accountability mechanisms.

The Pew Charitable Trusts, meanwhile, focused on patient matching in its comments. It said that “The draft TEFCA recognizes accurate patient matching as essential for electronic health information exchange: QHIN participants need to ensure some patient demographic data is used.” To this end, Pew noted that two provisions in the draft TEFCA could also help improve patient matching through the consistent use of demographic data and identity proofing.

In the meantime, while the TEFCA comments poured in, at today’s HITAC meeting, two new task forces outlined their charges and time frames, as reported by Raths. The Trusted Exchange Framework Task Force will make recommendations on the language of the TEFCA surrounding the RCE and the requirements for QHINs. It will provide feedback on the six permitted purposed for disclosure and three use cases identified, as well as standards and technical requirements that ONC should specify for identity proofing and authentication, particularly of individuals. With a fast-paced timeline for its work, the Task Force plans to present its recommendations to the full HITAC on March 21.

What’s more, the U.S. Core Data for Interoperability Task Force will provide recommendations on mechanisms/approaches to receive stakeholder feedback regarding which data classes to prioritize in the future. Version 1.0 included the common clinical data set plus provider notes and provenance. The task force plans to make final recommendations on April 18.


The Health IT Summits gather 250+ healthcare leaders in cities across the U.S. to present important new insights, collaborate on ideas, and to have a little fun - Find a Summit Near You!


CommonWell Officials: Carequality Connection Now “Generally Available” for Members

November 16, 2018
by Rajiv Leventhal, Managing Editor
| Reprints
CommonWell’s executive director said this latest step “breaks down another interoperability barrier”

Connection capabilities to the Carequality framework, by members of the CommonWell Health Alliance, are now “generally available,” according to officials who made an announcement today.

CommonWell, a trade association providing a vendor-neutral platform and interoperability services for its members, announced in August that it had started a limited roll-out of live bidirectional data sharing with an initial set of CommonWell members and providers and other Carequality Interoperability Framework adopters. This marked a key step in a collaborative effort to increase health IT connectivity across the country by enabling CommonWell subscribers to engage in health data exchange through directed queries with Carequality-enabled providers, and vice versa.

In just the first two weeks of a few CommonWell-enabled providers being connected, Jitin Asnaani, CommonWell Health Alliance executive director, said there were more than 4,000 documents bilaterally exchanged with Carequality-enabled providers.

Since then, by leveraging the technological infrastructure built by CommonWell service provider Change Healthcare, members Cerner and Greenway Health successfully completed a focused rollout of the connection with a handful of their provider clients, who have been exchanging data daily with Carequality-enabled providers, officials stated today.

Now, since the connection went live in July, officials noted  that CommonWell-enabled providers have bilaterally exchanged more than 200,000 documents with Carequality-enabled providers locally and nationwide.


Advancements in Healthcare: Interoperability, Data Exchange, and More

Micky Tripathi, President and Chief Executive Officer of the Massachusetts eHealth Collaborative, is one of the most well-informed and well-respected healthcare IT leaders in the U.S. Tripathi has...

“We are proud to break down yet another barrier to interoperability by making this much-anticipated connection available to our members and their clients,” Asnaani said in a statement today. “This increased connectivity will serve to empower providers with access to patient health data critical to their healthcare decision-making.”

In December 2016, CommonWell and Carequality, an initiative of The Sequoia Project, announced connectivity and collaboration efforts with the aim of providing additional health data sharing options for stakeholders. Officials said that the immediate focus of the work between Carequality and CommonWell would be on extending providers’ ability to request and retrieve medical records electronically from other providers. In the past two years, teams at both organizations have been working to establish that connectivity.

Together, CommonWell members and Carequality participants represent more than 90 percent of the acute EHR market and nearly 60 percent of the ambulatory EHR market. More than 15,000 hospitals, clinics, and other healthcare organizations have been actively deployed under the Carequality framework or CommonWell network.

Carequality is a national-level, consensus-built, common interoperability framework to enable exchange between and among health data sharing networks. It brings together electronic health record (EHR) vendors, record locator service (RLS) providers and other types of existing networks from the private sector and government, to determine technical and policy agreements to enable data to flow between and among networks and platforms.

CommonWell Health Alliance operates a health data sharing network that enables interoperability using a suite of services aiming to simplify cross-vendor nationwide data exchange. Services include patient ID management, advanced record location, and query/retrieve broker services, allowing a single query to retrieve multiple records for a patient from member systems.

Following the August announcement of the limited bi-directional data sharing capabilities, Micky Tripathi, Ph.D., president and CEO of the Massachusetts eHealth Collaborative said, “This is the ‘golden spike’ moment, connecting the two big railroads, like when AT&T and Verizon finally got connected. This is building that bridge.” Tripathi, who also directly observes and participates in conversations with Carequality and CommonWell, added, “It will take a while for all of the production sites and different vendors to get up and running. That will probably take a couple of years. But you have to have the bridge to connect them to begin.”

One key element in this progression is that currently, EHR giant Epic is not a member of CommonWell, despite other major EHR vendors pushing Epic in that direction. “Because sharing among Epic customers is already universal, when CommonWell connects to Carequality, the entire Epic base will become available, creating instant value for most areas of the country,” a recent KLAS report on interoperability stated.

Interestingly, Tripathi noted in August that once there is “general availability” of the data sharing services for all Carequality and CommonWell members, the competition factor will become less important. “It makes both networks more valuable,” Tripathi said at the time.

It appears as if that “general availability” time has now come. “Thanks to the CommonWell-Carequality connection, our patients can have access to their medical records regardless of the EHR a health care facility uses,” said David Callecod, president and CEO of Lafayette General Health, a Cerner client located in Lafayette, La. “When data is made readily available, providers can make diagnostic and treatment decisions more quickly, and patients can recover sooner. Better data means better communication with our patients and providers, better care and better outcomes. This is a very powerful tool!”

Officials also noted that with the connection officially in production, additional CommonWell members, including Brightree, Evident and MEDITECH, are in the process of subscribing to the connection and taking it live with their provider clients.

More From Healthcare Informatics


Advancements in Healthcare: Interoperability, Data Exchange, and More

Tuesday, December 4, 2018 | 3:00 p.m. ET, 2:00 p.m. CT

Micky Tripathi, President and Chief Executive Officer of the Massachusetts eHealth Collaborative, is one of the most well-informed and well-respected healthcare IT leaders in the U.S. Tripathi has an inside look at the most significant interoperability trends that are happening nationwide and will discuss varying interoperability and data exchange efforts fit together in the bigger picture of U.S. healthcare.

Tripathi will also discuss the future of data exchange, advancements of standards such as FHIR, the reality of information blocking challenges, and more in this latest Healthcare Informatics webinar, which gives a high-level view on the many market forces that impacting nationwide interoperability.

Related Insights For: Interoperability


Epic Lowers App Orchard Program Fees, Introduces New Low-Cost Tier

November 1, 2018
by Heather Landi, Associate Editor
| Reprints

Verona, Wis.-based Epic plans to lower program fees for health IT developers participating in its App Orchard program, and will launch a new entry-level program tier, called Nursery.

Epic announced the App Orchard updates at its App Orchard conference last week at its Verona headquarters, according to reporting from Politico published Oct. 26.

In an email statement, Brett Gann, App Orchard director, confirmed the company is reducing and simplifying the costs associated with participating in the app developer program. The three tiers of the program will see program fee reductions ranging from 33 to 80 percent as part of the update, Gann said.

Epic launched its App Orchard in 2017 as an online marketplace for third-party developers with 13 applications.

To date, more than 350 companies in the healthcare industry participate in Epic’s app developer program, where they have access to hundreds of application programming interfaces (APIs), documentation, testing tools, individual technical support, training, conferences, and integration with the Epic community, Gann said,

Gann also said the program updates announced last week at the annual App Orchard Conference in Verona will “engage a broader community of developers and increase access to APIs through simplified and reduced costs.”

The updates will help drive healthcare innovation as interested developers have the opportunity to build on top of Epic’s health record platform, using emerging industry standards such as FHIR (Fast Healthcare Interoperability Resources), Gann said.

Epic also announced a new program tier, Nursery, that will enable early-stage startups to enroll in the app developer program to access Epic’s public API documentation, tutorials, and sandboxes. Early-stage startups also will have access to FHIR, SMART on FHIR, and CDS Hooks, Gann said.

Enrolling in the Nursery program tier will cost participants $100 per year, Gann said, and when a company is prepared to go to market with its product, it may graduate to one of the other three tiers.

Nursery members will have access to Epic’s FHIR sandboxes, classroom and online learning opportunities, and the ability to engage with the online community of Epic, health system, and vendor developers and experts.

In addition to the program fee reductions, as part of the update, Epic will offer new program benefits to participants in the other three tiers, such as additional training opportunities, developer events, support services, sandboxes, and program accounts.

Gann also said Epic has simplified the pricing model for API-based integrations, eliminating the minimum fees, and reducing the cap. “It’s our expectation these updates will be a price reduction for nearly all program members,” he said.

Some developers, particularly smaller developers, have complained in the past that the fees to participate in the vendor app store are too steep.

Earlier this year, Politico reported the experiences of Rick Freeman, CEO of Interopion. Freeman told Politico that a family planning questionnaire app he developed for HHS’s Office of Population Health could have cost him up to $750,000 to run on Epic or Cerner for a year.

As reported by Politico in its October 26 report, in response to the program updates, Freeman said he is “very happy with the changes.”

See more on Interoperability

betebettipobetngsbahis bahis siteleringsbahis