ONC Releases Trusted Exchange Framework and Common Agreement Resources

ONC Releases Trusted Exchange Framework and Common Agreement Resources

On Friday, Jan. 5, 2018, the Office of the National Coordinator for Health IT (ONC) released its draft Trusted Exchange Framework and Common Agreement (TEFCA) to scale interoperability nationwide and ensure that patients, providers across the care continuum, community and social services, and many more stakeholders can effectively and efficiently participate in interoperability efforts. ONC is providing a 45-day comment period to TEFCA with comments due by February 18, 2018.

Look to HIMSS in the coming days for additional information and resources related to TEFCA.

TEFCA and ONC’s work on interoperability is implementing the 21st Century Cures Act and its focus on trusted exchange as an important step toward advancing the establishment of an interoperable health system.

In addition to the draft Trusted Exchange Framework, ONC also released several additional resources, including a User’s Guide to Understanding the Trusted Exchange Framework and the US Core Data for Interoperability (USCDI) Glide Path to identify a roadmap for broadening the data that can be exchanged via TEFCA.

ONC’s Trusted Exchange Framework includes five overarching goals:

1. Build on and extend existing work done by the industry

2. Provide a single “on-ramp” to interoperability for all

3. Be scalable to support the entire nation

4. Build a competitive market allowing all to compete on information services

5. Achieve long-term sustainability

Part A of ONC’s draft Trusted Exchange Framework includes general principles designed to provide guardrails and promote trust between Health Information Networks (HINs) based on the current state of existing trusted exchange frameworks, while Part B identifies a set of minimum terms and conditions to help ensure that common practices are in place and required of all participants and operationalizes the principles in Part A by creating a well-defined path to create the single on-ramp described in the goals.

The single on-ramp described by ONC seeks to enable existing HINs access to electronic health information regardless of what health IT developer they use, health information exchange or network they contract with, or how far across the country the patients’ records are located. Moreover, the on-ramp would provide opportunities for HINs to innovate and build out additional use cases and services that would provide value to their participants and support their long-term sustainability.

Part A of the proposed Trusted Exchange Framework also describes a set of six principles to which all stakeholders should adhere in order to facilitate interoperability and the exchange of electronic health information necessary to support the entire care continuum. The six principles are:

• Principle 1 – Standardization

Adhere to industry and federally recognized standards, policies, best practices, and procedures

• Principle 2 – Transparency

Conduct all exchange openly and transparently

• Principle 3 - Cooperation and Non-Discrimination

Collaborate with stakeholders across the continuum of care to exchange electronic health information, even when a stakeholder may be a business competitor

• Principle 4 – Privacy, Security, and Patient Safety

Exchange electronic health information securely and in a manner that promotes patient safety and ensures data integrity

• Principle 5 – Access

Ensure that individuals and their authorized caregivers have easy access to their electronic health information

• Principle 6 - Data-driven Accountability

Exchange multiple records for a cohort of patients at one time in accordance with Applicable Law to enable identification and trending of data to lower the cost of care and improve the health of the population

ONC is also creating a process to establish a single ONC-supported Recognized Coordinating Entity (RCE) to operationalize the Trusted Exchange Framework. With the competitive selection of an RCE, ONC will empower the RCE to use the Trusted Exchange Framework principles, policies, procedures, and technical standards to develop a single Common Agreement that Qualified HINs and their participants can voluntarily adopt. An open and competitive process to select a single RCE will be announced in spring 2018.

Overall, ONC’s Trusted Exchange Framework effort also supports its broader interoperability goals:

• Patients must be able to access their health information electronically without any special effort;

• Providers and payer organizations accountable for managing benefits can receive population level health information allowing them to analyze population health trends, outcomes, and costs; identify at-risk populations; and track progress on quality improvement initiatives; and

• The health IT community should have open and accessible application programming interfaces (APIs) to encourage entrepreneurial, user-focused innovation to make health information more accessible and to improve electronic health record (EHR) usability.


Look to HIMSS in the coming days for additional information and resources related to TEFCA.

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