What are HIEs, the TEFCA, and the Future of Interoperability?

It’s important for healthcare professionals to understand healthcare information exchanges (HIE), the Trusted Exchange Framework and Common Agreement (TEFCA), Quality Health Information Networks (QHINs), and electronic health record (EHR) interoperability. In simple terms, they work together to create a better flow of electronic health data between different providers and organizations. Let’s break down what these terms mean and how they affect our modern healthcare systems.

Health Information Exchanges (HIEs)

HIEs, in general, are state, regional, or local organizations that enable the secure electronic exchange of patient health information between providers in a geographical region. Their purpose is to improve care coordination across organizations by making it easier for medical professionals to access patient records. This promotes consistency and reduces redundancy thereby promoting accurate diagnosis and treatment, improving collaboration between medical teams, reducing costly delays in care and overall healthcare costs for both providers and patient.

Trusted Exchange Framework and Common Agreement (TEFCA)

The TEFCA is an initiative from the Office of the National Coordinator for Health Information Technology (ONC). It was created to help healthcare providers securely share electronic health data through standardized processes that follow HIPAA. TEFCA sets standards for participating entities including protocols for transmitting data securely, meeting privacy standards, and establishing trust among participants.

Qualified Health Information Networks (QHINs)

The first version of the TEFCA was published in January 2022 and includes updated criteria for QHINs. The draft QHIN Onboarding and Designation SOP and draft QHIN Application provide additional details regarding the process and requirements for becoming a QHIN.

To apply for QHIN Designation, a Health Information Network (HIN) must meet certain prerequisites. These include operating a network that locates and electronically transmits EHR between multiple persons or entities within in a live clinical environment, as well as providing the Recognized Coordinating Entity (RCE) with a written plan of how it will achieve all the requirements within a specified period.

A HIN must submit a QHIN Application to the RCE that documents how it meets these prerequisites. The RCE must certify in writing that the HIN in question has satisfied these requirements. Once the RCE has approved a QHIN Application, the HIN becomes a Provisional QHIN and is assigned to a Cohort to complete the remainder of the requirements in the Common Agreement and QHIN Technical Framework (QTF).

A Provisional QHIN is only designated as a QHIN once the RCE has confirmed and documented that it has satisfied the requirements of the Common Agreement and the QTF. The RCE is also responsible for monitoring QHINs on an ongoing basis and adjudicating noncompliance with the Common Agreement up to and including removal of the QHIN from ONC’s public directory on HealthIT.gov, when necessary.

HIEs, QHINs, and Interoperability

Health Information Exchanges and Qualified Health Information Networks are two distinct entities that play a critical role in the sharing of patient health information. While HIEs and QHINs have similar objectives in improving healthcare quality through data sharing, they operate at different levels of scope and responsibility. That said, they both address similar challenges like privacy concerns and the promotion of standardization across various EHR systems.

To recap, HIEs are state, regional, or local entities that facilitate the exchange of health information among healthcare providers and organizations within a specific geographical area. They aim to improve care coordination and patient outcomes by offering clinicians a simple way to access their patients’ medical records. More than 50% of local and statewide HIEs plan to participate in the TEFCA in the near future.

By contrast, QHINs are private organizations accredited by the TEFCA and the Sequoia Project to manage the secure exchange of protected health information (PHI) among different HIEs, as well as with public health agencies, HITECH developers, payers, and other nationwide organizations. Their primary goal is to ensure interoperability between different EHR systems and protect PHI from breaches or mishandling.

This February, six organizations were recognized as the first QHIN candidates. I used to refer to CommonWell and CareQuality as “vendor-based HIEs,” as they have historically been offered by EHR developers to their clients, for free, to ease the burden of interoperability. These HIEs are now woven into EHR software, so well in some cases, that you don’t even know you’re using them. Plus, they use query-based pulls from anyone participating in the network (other EHR users) to bring all data available into a single patient record with the ability to reconcile this data in an efficient and intelligent manner.

Ask Us about the Future of Interoperability

HIEs, QHINs, and the TEFCA all aim to improve our healthcare system by allowing the secure sharing of important patient health information between providers while also following federal laws like HIPAA.

By making it easier for medical professionals to quickly access patient records via secure networks with HIPAA-compliant standardized processes, we can ensure accuracy in diagnosis and treatment as well as avoid costly delays in care delivery resulting from incompatible systems and outdated software. Ultimately this will result in vastly improved patient outcomes due to streamlined access to accurate information.

To learn more about HIEs, the TEFCA, or QHINs, we welcome you to give us a call, reach out online, or schedule a free introductory meeting. We’d be happy to walk you through the finer details of these essential healthcare systems.