Friday, October 7, 2022
HomeHealth LawONC Releases a Framework for Nationwide Well being Info Alternate

ONC Releases a Framework for Nationwide Well being Info Alternate

On January 18, 2022, the U.S. Division of Well being and Human Providers (HHS) Workplace of the Nationwide Coordinator for Well being Info Expertise (ONC) and the entity chosen as a contracting associate, The Sequoia Mission, Inc., revealed the long-awaited Trusted Alternate Framework and Frequent Settlement (TEFCA) for well being data trade. In easy phrases, TEFCA is a framework that well being data networks (HINs) might enter into to share well being information with different HINs, people, and entities. The acknowledged objective of TEFCA is to develop uniform insurance policies and technical necessities to scale well being data trade nationwide and be certain that HINs, well being care suppliers, well being plans, people, and different stakeholders can entry real-time, interoperable well being data.

The event of TEFCA was mandated by the 21st Century Cures Act (Cures Act). Within the broader context, ONC has been engaged on governance for a nationwide well being data trade for over a decade. A proposed framework was revealed by ONC in 2018 and was subsequently modified after receipt of public suggestions. Though funded by the federal government, there was little or no transparency on the method for drafting the framework or on the method for consideration of these feedback. Participation in TEFCA is voluntary, and the framework is kind of advanced; as mentioned under, it stays to be seen whether or not, and to what extent, HINs will select to take part.

Listed below are a number of the fundamentals:

What’s TEFCA?

TEFCA refers back to the Trusted Alternate Framework and the Frequent Settlement.

Trusted Alternate Framework – The Trusted Alternate Framework (TEF) describes high-level, non-binding ideas for belief insurance policies and practices that may assist facilitate trade amongst HINs. The TEF is constructed on coverage ideas which have underpinned ONC’s actions and federal well being IT insurance policies for over a decade.

Frequent Settlement – The Frequent Settlement (CA) is a authorized settlement between the Acknowledged Coordinating Entity (RCE), which is presently the Sequoia Mission, Inc., and Certified HINs (QHINs) that advances the TEF ideas and insurance policies for network-to-network information sharing. QHINs are required to movement down sure provisions to entities which have entered into Participant-QHIN agreements (Members), whereby the QHIN agrees to transmit and obtain data by way of QHIN-to-QHIN trade on behalf of the Participant. Equally, sure provisions should movement down in downstream contracts to, entities which have entered into both a Participant-Subparticipant settlement or a Downstream Subparticipant settlement (Subparticipants) to allow the Subparticipant to make use of the companies of the opposite contracting occasion to ship and/or obtain data for a number of Alternate Functions. The CA contains 6 Alternate Functions, that are causes for which data might be requested or shared by QHIN-to-QHIN trade:

  1. Therapy
  2. Fee
  3. Well being Care Operations
  4. Public Well being
  5. Authorities Advantages Dedication
  6. Particular person Entry Service

The QHIN Technical Framework (QTF) and Normal Working Procedures (SOPs) are separate paperwork however are included by reference into the CA and are, thus, a part of the contract.

QHIN Technical Framework – The QHIN Technical Framework, developed by the RCE, describes the purposeful and technical necessities {that a} HIN should fulfill to function a QHIN below the CA to assist question and message supply. The QTF contains requirements for QHIN-to-QHIN trade of well being data.

Normal Working Procedures – The SOPs, additionally developed by the RCE, are written procedures that present detailed data or necessities associated to the trade actions below the CA. SOPs for varied matters, together with Dispute Decision and QHIN Cybersecurity Protection, are posted below “Frequent Settlement Assets” on the RCE’s web site.

TEFCA Steering – As well as, ONC and the RCE revealed TEFCA steering paperwork:

Key Highlights


The CA creates a Governance Council made up of QHINs, Members, and Subparticipants. This will probably be run by the RCE. Advisory teams could also be created from time-to-time, however in any other case entities that aren’t concerned straight in governance, akin to those that have some issues about provisions within the CA or sufferers themselves, might not have a proper mechanism for offering enter to TEFCA actions.

Circulate-Down Clauses

The CA contains various clauses that should be included in downstream Participant and Subparticipant contracts, together with:

  • Cooperation and Nondiscrimination
  • Confidentiality and Accountability
  • Utilization of the RCE Listing Service
  • Makes use of, Disclosures, and Responses
  • Particular Authorized Necessities
  • Particular person Entry Providers
  • Privateness
  • Safety

Usually, HINs that want to be QHINs must modify their participation agreements, as the necessities could also be inconsistent with the insurance policies, operation, or trade functions.


There are a few fascinating notes on the QTF requirements. First, the QTF specifies that QHIN message supply should use Cross-Neighborhood Doc Dependable Interchange (XCDR) reasonably than Direct Safe Messaging, which is included in ONC’s certification program rules and is part of the workflow of each licensed EHR system. Second, the preliminary variations of the CA and the QTF don’t explicitly incorporate FHIR-based trade. Whereas there was a push towards the usage of FHIR, ONC acknowledged that “community enablement of FHIR remains to be maturing in key areas.”

What Got here Earlier than?

It has taken a while for ONC to publish TEFCA, however it is very important be aware that ONC has checked out governance for well being data trade for a few years. Listed below are some key actions:

Given these prior makes an attempt at standardizing the framework for nationwide well being data trade, it stays to be seen whether or not TEFCA will show to be successful.

What’s Subsequent?

At present, no QHINs have been permitted and established. HINs might apply with the RCE to develop into a QHIN. Throughout the software course of, the potential QHIN should display to the RCE that it meets the eligibility necessities and might adjust to the necessities included on this CA, the QTF, and the SOPs.

Since participation in TEFCA is voluntary, it’s unsure what number of entities will apply for QHIN designation. The largest query is whether or not HINs will view participation in TEFCA to be favorable sufficient to vary their current insurance policies and participation agreements to satisfy the CA necessities. There’s additionally hypothesis as as to whether HHS will tie participation to different regulatory necessities or incentives. Relying on the long run degree of participation in TEFCA, contractual phrases and technical requirements might develop into “business commonplace” or function a benchmark for contract negotiations involving HINs.

The RCE has scheduled informational webinars within the coming weeks and the RCE and ONC have requested for suggestions on its method.



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