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Benefits for Health Care Providers Across the Continuum
Together with the Office of the National Coordinator for Health Information Technology (ONC), we are developing the Trusted Exchange Framework and Common Agreement (TEFCA) as required by the 21st Century Cures Act. Once operational, the network-of-networks based on the Common Agreement will facilitate exchange of health information on a nationwide scale, simplify connectivity among networks, and create efficiency by establishing a standardized approach to exchange policies and technical frameworks. Together with ONC, we announced in July 2021 that we plan to publish the Common Agreement V1 in Q1 of 2022.
The network based on the Common Agreement will offer a nationwide approach for the exchange of health information to support a range of exchange purposes, enabling a multitude of use cases.
The Common Agreement’s single set of rules will simplify connectivity to a health information network (HIN) for the benefit of patients and health plans. Consistent policies and technical approaches will increase the overall exchange of health information.
The overall goal of TEFCA is to establish a floor of universal interoperability across the country. This will enhance provider, payer and consumer access to health information that supports better clinical decision-making, improved outcomes, and lower costs.
ONC has awarded a cooperative agreement to The Sequoia Project as the TEFCA Recognized Coordinating Entity (RCE) responsible for developing, updating, implementing, and maintaining the Common Agreement. The RCE will also play a central role in operational activities for the network based on the Common Agreement, including ensuring ongoing performance and creating a participatory and trustworthy governance process.
The Common Agreement will provide a single set of rules that address permitted data uses, privacy and security policies that must be followed, breach notification requirements, and other policies that must be in place before data can flow. It is important to note that the Common Agreement will not supersede or override state or local laws, such as those governing privacy or public health reporting. The Common Agreement policies will not be inconsistent with existing federal laws and rules, such as HIPAA, and other existing laws at the state and local levels.
The technical standards underlying this network-of-networks approach will connect Qualified Health Information Networks (QHINs) to serve as the high-capacity infrastructure to share electronic health information across the entire nation—with the needed privacy and security protections. QHINs will be the central connection points within the network based on the Common Agreement, responsible for routing queries, responses, and messages among participating entities and individuals. Members of participating HINs will be able to request and receive electronic health information from QHINs in the network based on the Common Agreement, starting with query and message delivery.
The Common Agreement will be signed by the RCE and each QHIN. Some provisions of the Common Agreement will flow down to other entities, such as QHIN Participants and providers. The QHIN Technical Framework (QTF) describes the technical and functional requirements for electronic health information exchange between QHINs and will be incorporated into the Common Agreement. The QTF requirements include, among others, privacy and security steps, approaches for identifying and authenticating exchange participants, how to conduct patient discovery and identity resolution, as well as support for required exchange protocols. The QTF will include a standards-based approach to directory services—an aspect of exchange that has been challenging to date. Exchange within a given QHIN will generally be covered by the QHIN’s participant agreements and technical requirements. Implementation timelines will take into account the need to modify existing agreements.
As providers across the continuum prepare for the future network based on the Common Agreement, they will need to take a number of factors into consideration. They will want to take stock of their current approach to information exchange and evaluate how greater access to simplified health information exchange could support care and care coordination. Similarly, they will want to review existing and planned efforts to engage in value-based care with an eye toward needed information exchange to best manage populations.
To prepare, providers are encouraged to:
As we continue to develop the Common Agreement, the RCE is committed to informing the community about key developments through informational calls and updates. Activities underway include:
The RCE is committed to taking a practical approach to implementation that will seek to minimize burden and build on what is working today. This includes establishing timelines that are sensitive to the scope of any necessary changes that QHINs and Participants need to undertake. We encourage providers across the continuum of care and other stakeholders to engage with us as the community works together to realize nationwide health information exchange.
Connect with us and learn more at: https://rce.sequoiaproject.org/participate/
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