The following is a guest article by A. John Blair, III, MD, CEO at MedAllies
It’s been well-documented for years that the healthcare industry has an interoperability problem.
Frequently fragmented and incomplete patient records may lead to negative downstream consequences, such as delayed and inefficient care, avoidable risks to patient safety, greater administrative burden on healthcare organizations, and excessive costs.
The commercial efforts to date to push interoperability forward have made true advances. For example, 70% of hospitals and over half of ambulatory providers are connected to a national network. Additionally, the treatment use case has significantly advanced under respective push and pull models.
However, the industry has stalled on connecting many hospitals and ambulatory providers to a national network – and the challenge is greater among other types of care provider groups (post-acute care, home health, and emergency medical services, for example), other stakeholder groups (including payers and federal agencies), and consumers.
Fortunately, change is coming soon. The Trusted Exchange Framework and Common Agreement, also known as TEFCA, will soon launch, with Qualified Health Information Networks (QHINs) acting as a catalyst and change agent to re-invigorate momentum within the interoperability movement.
The ultimate vision for healthcare interoperability is for the healthcare user experience to appear as if all entities are operating within a single network, much in the same way networks work for our cell phones, electricity grids, and ATMs.
What is TEFCA?
TEFCA was created under the 21st Century Cures Act and is comprised of two parts: the Trusted Exchange Framework and the Common Agreement. The Trusted Exchange Framework describes the common principles for data sharing, while the Common Agreement is a legal agreement that defines the governing approach, expectations, and rules for the QHINs.
TEFCA’s goal is to establish a universal floor for interoperability across the country by developing the infrastructure model and governing approach for users in different networks to securely share basic clinical information with one another. Importantly, this would happen under commonly agreed-to expectations and rules – regardless of which network a healthcare organization participates in.
This new regulation has delivered a unique opportunity for the U.S. healthcare system by creating a universal floor of interoperability that connects providers, public health groups, and healthcare consumers. TEFCA’s rules and non-binding principles bring the potential to expand care coordination and interoperability while decreasing delays in patient data exchange – finally delivering on interoperability’s potential to give patients real control over their own health data.
3 Big Interoperability Challenges Remain
TEFCA will greatly advance interoperability by bringing consistency in terms of policies and technical approach and increasing the volume and utility of health information exchange, which will ultimately drive better clinical decisions, more positive patient outcomes, and lower costs.
Yet despite the promise, data exchange among providers today remains spotty at best. While many providers do share data via health information networks, the effectiveness of the data exchange is often limited due to network gaps and inefficiencies.
To put together the remaining pieces of the interoperability, stakeholders must address three big challenges:
- Connectivity: Only 70% of hospitals are currently connected to networks, with many rural hospitals and smaller physician practices lagging.
- Data usability: A tremendous amount of health data is being exchanged, but the value of that data remains limited.
- Purposes of use: To date, the treatment purpose of use has become well-established, but other purposes of use have faltered. QHIN has several new purposes of use that must be supported, such as individual access service, public health, benefits determination, and payment and operations.
How QHINs Solve These Challenges
QHINs will act as connectivity brokers to deliver broader information access. As data sharing improves, patients and providers will see numerous benefits. For example, patient care will improve as essential information follows them from provider to provider. With more accurate, complete, and up-to-date data, physicians can make better decisions to generate better health outcomes.
In addition to benefiting providers and consumers, QHINs will also deliver benefits to public health entities, federal agencies, and payers. One example is with quicker access to more complete data, public health groups can further population health initiatives and facilitate emergency preparedness and response.
Though some interoperability barriers remain, the industry is taking concrete steps to overcome the current challenges. As QHINs become operational, look for significant advancements in achieving healthcare’s interoperability goals.
