The road to healthcare interoperability has been a long, tough slog, but a new regulation holds promise in closing some of the gaps. However, it’s unclear whether the rule, known as TEFCA, represents the impetus to push interoperability further toward the finish line.
The healthcare interoperability movement has made real progress over the last twenty years, but significant work remains. In 2021, for example, 62% of hospitals engaged in key aspects of electronically sharing health information (send, receive, query) and integrating of summary of care records into electronic health records, up from 51% 2017, according to a report from The Office of the National Coordinator for Health Information Technology (ONC). Despite the marked improvement, nearly 40% of hospitals did not achieve satisfactory interoperability during the report’s timeframe. The report also found that just 48% of rural hospitals and 52% of small hospitals (those with fewer than 100 beds) engaged in electronically sending, receiving, and integrating summary of care records and searching any health information.
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TEFCA: The short explanation
The Trusted Exchange Framework and Common Agreement (TEFCA) is likely to drive the percentage of connected hospitals higher – though how much higher remains to be seen. The same can be said for the rest of the healthcare stakeholders. 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 each other. 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 that could connect providers, payers, public health, federal agencies, and consumers. TEFCA’s rules and non-binding principles bring the potential to expand beyond the traditional treatment use case to many others, including giving consumers better access to their records and more control of their healthcare.
A key provision of TEFCA is the creation of Qualified Health Information Networks (QHINs), which are networks of organizations working together to share data. QHINs will connect directly to each other to ensure interoperability between the networks they represent.
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A framework for understanding interoperability
Several years ago, healthcare research firm KLAS developed a helpful framework for understanding interoperability and the industry’s progress towards achieving this elusive goal. The framework consists of five pillars:
- Breadth of adoption: The first pillar seeks to measure the breadth of healthcare organizations that have adopted and leveraged the connections and functionality needed to drive interoperability.
- Overall interoperability satisfaction: This pillar measures not only the overall satisfaction of interoperability users but also the clinician satisfaction and the success of specific use cases.
- Interoperability outcomes: The most important consideration of interoperability is whether the increased technical capabilities do anything to drive improvements in patient outcomes. As KLAS phrases it: “Ultimately, the work of improving interoperability carries no importance unless it drives significant advancements in patient care.”
- Connectivity for health information sharing: The fourth pillar seeks to quantify how well an organization is sending and receiving data, such as whether its systems use the Fast Healthcare Interoperability Resources (FHIR) data standard to communicate with other healthcare entities.
- Utility for healthcare stakeholders: KLAS’ final pillar measures the usability of incoming data and how seamlessly it fits into the clinician’s workflow, such as data clarity, accuracy, and usability.
How TEFCA will (and won’t) help
The extent to which TEFCA will help the industry achieve the milestones described in KLAS’ pillars of interoperability remains an open question, but the regulation should deliver some improvements. The industry has already made solid progress on connectivity and adoption: according to ONC Director Micky Tripathi, about 70% of hospitals and over two-thirds of ambulatory providers are connected to a national network. As QHINs decrease interoperability frictions by reducing the confusion around multiple networks, decreasing legal burdens, and streamlining technical integration, the remaining unconnected hospitals and other unconnected stakeholders should decrease.
Data quality and usability is already a focus emerging as connectivity is increasing. An example is the Data Usability: Taking Roots under The Sequoia Project.
One area where TEFCA is unlikely to drive much change is in clinician workflow, such as referral management. Workflow is dependent on the software of the connected systems and is highly variable. Furthermore, interoperability assumes the different systems on each end are working in concert. That challenge remains with or without TEFCA.
In the end, healthcare information technology and the regulations that govern it – as well as everything we do in healthcare – exists to create conditions that generate better health for each individual and the country at large. Continued improvements in interoperability as discussed above are a key part of the equation and TEFCA’s QHINs have the potential to play a big part.
Photo: JamesBrey, Getty Images
A. John Blair, III, MD, F.A.C.S., III, MD, F.A.C.S. is the CEO of MedAllies, a national healthcare connectivity services provider. He is a health care and technology executive with broad experience across the health care industry including clinical practice, hospital planning and governance, revenue cycle management, managed care, public health and health care informatics. Prior to establishing MedAllies in 2001, Dr. Blair worked as a general surgeon for twenty years before becoming the President of the Taconic Independent Practice Association (TIPA), a network of over 5,000 physician members
