HHS has released a draft of
a guideline for implementing
nationwide interoperability

HHS releases second draft of TEFCA for nationwide interoperability

April 22, 2019
by John R. Fischer, Senior Reporter
The U.S. Department of Health and Human Services is seeking public feedback for the second draft of the Trusted Exchange Framework and Common Agreement (TEFCA), a form of guidance designed to support national, network-to-network exchange of health information.

The agreement will specify technical and legal requirements for sharing electronic health information across disparate networks, and address challenges that interrupt or prevent the flow of data. In addition, HHS has also issued a notice of funding opportunity for a nonprofit, industry-based organization that will advance nationwide interoperability.

“Currently, seamless exchange of electronic health information across health information networks is limited due to variations in the participation and data use agreements that govern data exchange,” officials from the Office of the National Coordinator for Health Information Technology (ONC), told HCB News. “Some of these variations include differences in the scope of exchange supported; privacy and security requirements governing access, exchange, and use of health information; the technical standards leveraged for data exchange; and permitted uses and disclosures. For example, some health information networks currently limit uses and disclosures to treatment purposes only, whereas others allow for treatment, payment, and healthcare operations, as defined in HIPAA.”

The documents released include a second draft of the Trusted Exchange Framework (TEF); a second draft of the Minimum Required Terms and Conditions (MRTCs) for trusted exchange; and a first draft of a Qualified Health Information Network (QHIN) Technical Framework. All three will be the basis of a single Common Agreement that can be utilized by QHINs and their participants.

Development of TEFCA is centered on providing a single "on-ramp" to nationwide connectivity, ensuring the secure transmission of electronic information when and where it is needed, and supporting countrywide scalability for network connectivity.

For the TEF portion, the ONC will define minimum required terms and conditions for resolving current differences among data sharing agreements that prevent the flow of information. A nonprofit, industry-based organization known as the Recognized Coordinating Entity will receive funding to develop, update, implement and maintain the Common Agreement, setting up additional required terms and conditions for operationalizing it, and meeting the interoperability mandates of the 21st Century Cures Act.

In addition to facilitating the transfer of information across healthcare networks throughout the country, the aim behind TEFCA is to create timely and true bi-directional information sharing to address public health threats and epidemics.

The first draft of the proposal released was based on more than 200 public comments regarding various concerns and suggestions, including those of the private sector. ONC officials stress that part of TEFCA’s success relies on collaborations between public and private sector entities.

“ONC updated the TEFCA based on those comments, including the addition of a “push-based” exchange modality, in part, because commenters noted that push transactions play a vital role in supporting public health use cases,” they said. “The two most important things that the private sector can do now are comment on the Trusted Exchange Framework, the Minimum Required Terms and Conditions, and the QHIN Technical Framework; and review and apply to the notice of funding opportunity for the TEFCA Recognized Coordinating Entity Cooperative Agreement.”

The public comment period on the TEF, MRTCs, and QHIN Technical Framework is open until June 17, as is the application period for the Notice of Funding Opportunity — Trusted Exchange Framework and Common Agreement Recognized Coordinating Entity (RCE) Cooperative Agreement.