One of the biggest obstacles to using electronic health data to the fullest potential is the lack of interoperability. At every level of healthcare, the lack of interoperability causes problems: patients cannot easily access their own health data, providers have problems accessing the health information of new patients, researchers cannot access the data necessary to identify trends that would improve population health, and technology companies struggle to compete in a closed marketplace.
The 21st Century Cures Act, sometimes referred to as the Cures Act, which was passed in December 2016, identifies the need for interoperability. Interoperability would make the exchange of personal health information (PHI) possible while still maintaining security. Currently, information is siloed within EHR systems, and data integration with those EHRs is frequently cited issue for healthcare providers.
Alongside the need for various stakeholders to be able to access information, there is the requirement to follow the dictates of the Health Insurance Portability and Accountability Act (HIPAA). Information needs to be accessible, but must also remain secure. Through the Cures Act, Congress instructed the Office of the National Coordinator (ONC) to create or support the creation of a framework for health information networks (HINs) to exchange health information through a common agreement.
What is The Trusted Exchange Framework?
The draft Trusted Exchange Framework is the first step toward interoperability. The ONC has published a User’s Guide to Understanding the Draft Trusted Exchange Framework. The document was released on January 5, 2018, and consists of two parts:
Part A - Principles for Trusted Exchange Part B - Minimum Required Terms and Conditions for Trusted Exchange
Stakeholders are encouraged to submit comments through February 20, 2018. Once comments have been submitted and a final version agreed upon, the Trusted Exchange Framework and Common Agreement (TEFCA) will be published in the Federal Register. The ONC expects the final version to be published by late 2018.
The stakeholders include:
- Health information networks
- Federal agencies
- Public health organizations
- Technology developers
One of the most important goals of the Trusted Exchange Framework is to create what the ONC describes as “a single on-ramp” to interoperability. Currently, healthcare organizations use different point-to-point interfaces to exchange PHI with each other. This system requires the creation and maintenance of all those individual interfaces, which is expensive and inefficient.
Creating one framework for various stakeholders to exchange information will simplify the process, make accessing their own PHI easier for patients, and create a more competitive market for technology companies.
Two Parts of the Trusted Exchange Framework
Trusted Exchange Framework Part A
The first part of the Framework is Principles for Trusted Exchange. The ONC has defined six principles: 1. Standardization 2. Transparency 3. Cooperation and Non-Discrimination 4. Security and Patient Safety 5. Access 6. Data-Driven Accountability
These general principles are described as “guardrails,” and the goal of Part A is to build trust among the various HINs.
Trusted Exchange Framework Part B
The second part of the framework is Minimum Required Terms and Conditions for Trusted Exchange. This section creates common practices for the exchange of health information, including a common authentication process, rules for exchange, and organizational and operational practices.
Speaking to Fierce Healthcare, Genevieve Morris, the principal deputy national coordinator for health information technology at the ONC said,
This is just the floor of what those required terms and conditions are. We all just have to agree to the same terms in order for that exchange to happen.”
Building on the 3 Goals of Interoperability
The Trusted Exchange Framework builds on the work that the industry has already done to advance interoperability. A press release from the Department of Health and Human Services regarding the draft stresses that there are three important goals of interoperability:
- Patient access - patients should be able to easily access their own health information.
- Population-level data exchange - both providers and payers need access to population-level health data in order to analyze trends, outcomes, and costs.
- Open and accessible APIs - giving the health IT community access to health information will improve the entrepreneurial climate, leading to innovation and improved usability.
The ONC will outsource the actual implementation of the framework. The ONC will hold an “open and competitive selection of a single Recognized Exchange Framework Entity (RCE) from the industry,” wrote Morris in a blog post on HealthIT Buzz.
The RCE will work with the ONC to develop the final version of the TEFCA that is published in the Federal Register.