Seven Things I Learned About TEFCA at HIMSS

By Jim Tate, EMR Advocate
Twitter: @jimtate, eMail:
Host of The Tate Chronicles#TateDispatches

I attended the recent HIMSS conference in Chicago with a particular interest in finding out what is going on with the Trusted Exchange Framework and Common Agreement (TEFCA). This interoperability initiative, more than six years in the making, appears to be close to bearing fruit. My observations are based on conversations with pending Qualified Health Information Networks (QHINs), TEFCA presentations, and a little eavesdropping.

  1. There are no QHINs: A number of organizations have been approved to enter the testing phase of this initiative, but none are expected to be fully designated as QHINs until later in 2023.
  2. Every QHIN is different: While they all must meet certain minimum requirements that is where the similarity ends. Some intend to be focused on a specific type of health care organization while others may be intended for use by a specific EHR. Some QHINs intend to add value by cleaning up and massaging the data by removing duplications, etc. Others will just open the tap and let whatever comes down the pipe in a raw fashion. It will be important for EHR vendors and providers to find QHINs that meet their specific needs and goals.
  3. No pricing: We don’t know what the various QHINs will charge for TEFCA access. Possibly some EHR vendors might roll it into their base fees while others charge separately. It will be important for providers and EHR vendors to have a clear understanding of the costs associated with TEFCA access to make informed decisions.
  4. TEFCA is not a soup to nuts solution: The pipe of data flow is just being made bigger. Initially the data will be dumped at what is called the ‘edge’. It will be up to EHR vendors and providers to decide on the workflows and processes to take advantage of the data and develop and deploy best practices. The fact that TEFCA is not an end-to-end solution underscores the need for collaboration and innovation among EHR vendors and providers. While TEFCA will facilitate data exchange, it will be up to the industry to develop and implement best practices for using that data effectively.
  5. TEFCA Awareness: Even six years into the TEFCA initiative there are still those in the industry who are not aware of its existence. I spoke with the President of a US based global healthcare technology company that had never heard the word ‘TEFCA’. This highlights the need for continued education and awareness-building around the benefits and potential of TEFCA.
  6. Trusted Data: We know that medications are often prescribed for off label use with an inaccurate diagnosis to obtain insurance coverage. That can lead to all kinds of problems with Clinical Quality Measures, Clinical Decision Support, and lead to a basic mistrust of TEFCA supplied data. The issue of trust in TEFCA-supplied data is a complex one, and it will be important for the industry to develop safeguards and protocols to ensure the accuracy and reliability of that data.
  7. Digital Divide: Without widespread education and training TEFCA could increase the digital divide. The TEFCA regulations make no provision for provider education and training. Rural and small healthcare provider organizations will not have the staff or funding in comparison to large and urban organizations. It will be important to ensure that all providers, regardless of size or location, have access to the resources and support they need to effectively use TEFCA and benefit from its potential. This could include training, education, and technical assistance programs.