Defining Health IT: TEFCA

Defining Health IT: TEFCA

Healthcare is complicated (stop us if you’ve heard this before). We are all familiar with the detailed organization chart developed by the Joint Economic Committee, which illustrates a bewildering array of government agencies, regulations and mandates.

From appropriate treatment plans, to documenting the details of the care experience, the highly fragmented industry is filled with complexity and has long suffered from a lack of coordination, high variability, and failure to tie costs to quality.

Further compounding the issue, healthcare is filled with its own unique jargon. ACA, VBC, PQRS, HCC, HIE, DRG, RVU – the array of acronyms is dizzying. It can be difficult to keep up with the acronyms, not to mention the buzzword bingo that seemingly changes from year to year. 

With this background, we introduce our “Defining Health IT” blog series. In order to provide additional value to our subscribers and the healthcare communities we serve, we will distill a complex acronym, topic, or concept into a clear and simple explanation, with a list of curated resources to dive deeper. 

What is TEFCA?

TEFCA, or the Trusted Exchange Framework and Common Agreement, is meant to define standards for interoperability as required by the 21st Century Cures Act (signed into law in December 2016). On January 5, 2018, Health and Human Services (HHS) released the Draft Specifications for TEFCA, which took an expansive look at interoperability and improving data exchange by health information networks (HINs).

The concept is to create a network of networks, connecting authorized participants or end users including payers, vendors, networks, government agencies, health information exchanges (HIEs) and individuals. TEFCA therefore strives to establish a single “on-ramp” for health information exchange (HIE) that enable a wide variety of healthcare stakeholders to join any HIN and automatically connect to and participate in nationwide health information exchange.

The current TEFCA legislation is a draft rule, and once published, there was a comment period open for 45 days. ONC has been reviewing comments and is expected to release a Final TEFCA in late 2018

How TEFCA may work

The draft TEFCA guidance contains policies, procedures, and technical standards that the government views as an on-ramp to interoperability. This is expected to bridge the gap between providers’ and patients’ information systems and enable interoperability across disparate HINs.

TEFCA implementation will depend on specific entities:

  • Recognized Coordinating Entity (RCE). The RCE will administer TEFCA and will act as the governing body that will operationalize the Trusted Exchange Framework. It will be selected competitively and is likely to be a private-sector entity. To establish the RCE, ONC will release an open and competitive Funding Opportunity Announcement (FOA) in spring 2018 to award a single, multi-year Cooperative Agreement to an RCE.
  • Qualified HINs (QHINs) QHINs will provide a network of HINs that can exchange information with each other and are envisioned as the vehicle for delivering a nationwide health information exchange. Qualified HINs will offer a Connectivity Broker service, providing such functions as a master patient index (federated or centralized); Record Locator Service; Broadcast and Directed Queries, and return of health data to a requesting, authorized Qualified HIN. QHINs therefore are a vehicle for enabling disparate HINs to connect to each other and share data, delivering a nationwide health information exchange.


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