On Friday, April 19, 2019, the Office of the National Coordinator for Health IT (ONC) published its second draft of the Trusted Exchange Framework and Common Agreement (TEFCA) and opened it for public comment, with a deadline to respond of Monday, June 17. This second draft of TEFCA follows the initial iteration that was released in January 2018. HIMSS, along with many other stakeholder organizations, proposed significant revisions to the original TEFCA – our February 2018 public comment letter is available online.
ONC has focused its TEFCA development on three high-level goals:
- Provide a single “on-ramp” to nationwide connectivity
- Enable Electronic Health Information (EHI) to securely follow the patient when and where it is needed
- Support nationwide scalability
This new draft makes clear that the Trusted Exchange Framework (TEF) and the Common Agreement (CA) will be distinct components that together aim to create technical and legal requirements for sharing EHI at a nationwide scale across disparate health information networks (HINs).
ONC describes the TEF as a common set of principles that facilitate trust between HINs, where these principles serve as “rules of the road” for nationwide electronic health information exchange. The Common Agreement will provide the governance necessary to scale a functioning system of connected HINs that will grow over time to meet the demands of individuals, clinicians, and payers. The agency intends for the architecture to follow a “network of networks” structure, which allows for multiple points of entry and is inclusive of many different types of health care entities. Stakeholders have the option of participating at multiple levels of the TEF and Common Agreement exchange environment, as is appropriate for them.
ONC’s release today includes three separate but complementary documents: the TEF Draft 2, the Minimum Required Terms and Conditions Draft 2 (MRTCs Draft 2), and the Qualified Health Information Network (QHIN) Technical Framework Draft 1 (QTF Draft 1). The TEF sets forth the aspirational principles for trusted exchange that apply to a broad audience of HINs. The MRTCs constitute the required terms and conditions that would be binding for those who elect to sign the Common Agreement. The QTF would be incorporated by reference in the Common Agreement and details the technical components for exchange among QHINs. As they serve different purposes, ONC separated these parts into three different appendices.
The MRTCs Draft 2 requires support for a minimum set of exchange purposes for sending and receiving EHI. The proposed exchange modalities for exchanging EHI include QHIN Targeted Query, QHIN Broadcast Query, and QHIN Message Delivery, which will facilitate core use cases for interoperability, including Individuals’ electronic access to and use of their EHI.
Moreover, under the MRTCs Draft 2, the Common Agreement will require strong privacy and security protections for all entities who elect to participate, including entities not covered by the Health Insurance Portability and Accountability Act (HIPAA). Establishing baseline privacy and security requirements is important for building and maintaining confidence and trust that EHI shared under the auspices of the Common Agreement will be appropriately protected.
It is important to note that a QHIN was a new entity that was first proposed in the original TEFCA, and was intended to have the technical capabilities to connect participants on a nationwide scale. In order to apply for QHIN Designation, a HIN must also meet certain prerequisites, including already operating a network that provides the ability to locate and transmit EHI between multiple persons or entities electronically, with existing persons or entities exchanging EHI in a live clinical environment; and, providing the Recognized Coordinating Entity (RCE) with a written plan of how it will achieve all of the requirements of the Common Agreement within a specified time period.
As the TEF and the Common Agreement seek to serve many different stakeholders across the country who have unique needs and constituencies, the TEF, MRTCs, and QTF do not dictate the internal requirements or business structures of QHINs. This new draft offers QHINs flexibility to provide different services and support different stakeholders.
In addition, ONC issued a Notice of Funding Opportunity to select an RCE to develop, update, implement, and maintain the Common Agreement and the QTF. The Cooperative Agreement for the RCE will be a four-year award and will include requirements for the RCE to demonstrate a commitment to transparent, fair, and nondiscriminatory data exchange through organizational policies and governing structures.
HIMSS will be releasing more information on TEFCA Draft 2 and its core components as it becomes available.