TEFCA Goes Live

Will Brandt, Class of 2022, Belmont Law

After five years of work, the Office of the National Coordinator of Health (ONC) has released the Trusted Exchange Framework and Common Agreement (TEFCA). TEFCA is essentially a plan for an interoperability framework between healthcare information networks that was mandated by the Twenty First Century Cures Act of 2016. The purpose of this mandate was to create a network where patients have better access to their electronic healthcare information (EHI).

The problem that inspired TEFCA was that many hospital systems and medical providers use multiple different healthcare information networks (HINs) to store EHI. What this means for patients seeking access to their EHI unnecessary delays and expense when attempting to access their data. The promise of TEFCA was a network where HINs could become qualified HINs and the data that one HIN stores will be interoperable with other HINs. However, as Rebecca Pfifer points out in her article, The future of ONC’s interoperability framework hinges on adoption. But the agency — and industry — is optimistic, there is generally a lack of incentive for most HINs to participate in the ONC’s plane for healthcare information interoperability.

The primary issue is the business model that currently exists for HINs. HINs make money by storing EHI and providing access to that EHI to patients through medical providers. By winning the business of more healthcare providers and hospital systems, HINs gain more business and can make more money. By participating in TEFCA, an HIN, that becomes a qualified HIN, merely becomes qualified to share their business (stored EHI) with other businesses. Although the many revisions of TEFCA seem to provide a robust method of interoperability, the plan lacks any fundamental business incentive for HINs to participate. However, the industry is optimistic that adoption will come to fruition.

So, what is the value proposition of HINs to participate? Lee Barrett, CEO of EHR standards development organization EHNAC, supports the ONCs position that not participating will be a competitive disadvantage. He says, “The hope is that the more networks use it, the more its value proposition will be proved. Patients will inquire why their provider doesn’t have their data from other facilities, and the provider will then wonder why the exchanges it’s a participant in aren’t qualified to work with other networks.” Essentially, the argument supporting the notion that HINs will choose to participate is that patients seeking their EHI at an HIN who are not yet participating, will not only be aware of the option for HINs to participate, but will make the inquiry to their provider about why they don’t have access their healthcare date from another provider. Moreover, the argument is that these inquiries will put enough pressure on providers to switch to a qualified HIN, that providers will bear the cost and time that it takes to switch from a HIN to a qualified HIN. Will this bottom-up pressure be enough?

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