Tech & Innovation in Healthcare

TEFCA allows for secure information sharing between health information networks.

A reliable, secure way to share health information on a nationwide scale is no longer a lofty vision for the future. The Trusted Exchange Framework and Common Agreement (TEFCA) is making nationwide interoperability possible, and if your health system is not already part of the exchange, you should start planning on how to participate.

Read on to learn about the agreement.

Understand the TEFCA Key Pieces

The two main components of the TEFCA are:

• Trusted Exchange Framework: Common set of principles that any Qualified Health Information Network (QHIN) must adhere to as a TEFCA participant.
• Common Agreement: When signed by a QHIN, the agreement provides the infrastructure necessary to securely share health information between different QHINs.

The extent of information sharing made possible by TEFCA is unlike previous attempts to facilitate information exchanges between QHINs. The TEFCA is the only interoperability effort to date that is poised to streamline accessing health information at the national level and has the potential to expand and adapt as more QHINs join.

Why Join the TEFCA?

Inconsistent data sharing between QHINs creates several inefficiencies that can be detrimental to patient outcomes and drive up costs. All QHINs who sign the Common Agreement use the same privacy and security requirements and have access to the same core set of data; this eliminates redundant legal and IT procedures, saving time and costs.

The data QHINs can access by joining the TEFCA can be used for the following purposes:

• Treatment
• Individual access
• Government benefits determination
• Utilization review
• Quality assessment and improvement
• Business planning and development
• Public health initiatives
• State/local emergency preparedness and response

What Principles Are Included in the Trusted Exchange Framework?

The foundation of the Common Agreement is the Trusted Exchange Framework. In it, you’ll find seven principles listed:

• Standardization
• Openness and Transparency
• Cooperation and Non-Discrimination
• Privacy, Security, and Safety
• Access
• Equity
• Public Health

These principles are in place to ensure QHINs who sign the Common Agreement, and thereby join the TEFCA, are transparently and safely sharing information, even with stakeholders who may be competitors, according to federally recognized best practices.

The access principle pertains to ease of individual information access for patients and caregivers, and stipulates that QHINs must ensure that individual stakeholders understand how health information can be used or disclosed under the TEFCA.

The equity principle calls for QHINs to use an “equity by design” approach, which means that the QHIN should consider health inequities and disparities before establishing any new policies or process updates. With the TEFCA specifically, the equity principle of the Trusted Exchange Framework indicates that QHINs should evaluate whether their participation in health information sharing is achieving health equity and make changes if it is not.

The TEFCA enables information sharing that can be used by public health agencies for population health initiatives. By supporting public health officials, QHINs participating in the TEFCA build a learning health system that strategically combines internal data with external information to improve public health.

How Does a Health Information Network Join the TEFCA?

To be considered a QHIN and become eligible to join the TEFCA, a United States-based health information network must complete an application and the onboarding process. If the Recognized Coordinating Entity (RCE) accepts the application, the health information network can sign the Common Agreement, which is countersigned by the RCE.

As of Aug. 29, 2024, any QHIN that signs the Common Agreement is abiding by the rules of Common Agreement Version 2.0, which was published in April 2024. The RCE is responsible for updating and maintaining the contents of the Common Agreement.

The key differences between version 2.0 and previous iterations of the Common Agreement involve updates to the Fast Healthcare Interoperability Resources (FHIR) application programming interface (API). These enhancements to the FHIR’s API will make it easier for TEFCA participants to share information directly with each other, as well as facilitate individual access to patient information.

In addition to version 2.0 of the Common Agreement, Office of the National Coordinator for Health Information Technology (ONC), part of the U.S. Department of Health and Human Services (HHS) published the Participant and Subparticipant Terms of Participation for the TEFCA in April 2024. The ONC is hopeful that the document will reduce the administrative burden for health information networks that are considering participating in the TEFCA, since the document can be integrated into existing data use agreements.

During the process of joining the TEFCA, it is important to consider the existing protocols your health network has in place for communicating with patients about how their electronic health data is stored and used. It may be necessary to update these communications after joining the TEFCA.

How Does the TEFCA Benefit Patients?

The TEFCA’s capacity to improve efficiency and reduce costs will have benefits that are passed on to patients. Secure nationwide data sharing facilitates better care coordination. For example, patients will no longer have to take redundant tests if their provider is able to easily access prior imaging and laboratory results from another QHIN.

The individual access component of the TEFCA is also an advancement for patients. Knowing that their electronic health information is stored securely, but is also accessible whenever and whenever it is necessary, provides peace of mind.

Michelle Falci, BA, M Falci Communications LLC