TEFCA gets green light from most hospitals

The Trusted Exchange Framework and Common Agreement (TEFCA) is designed to usher in a new era of health data interoperability, and it appears that the vast majority of hospitals are at least somewhat on board with its ambitious plans. 

In a new poll conducted by the American Hospital Association (AHA), close to three-quarters of hospital entities are aware of TEFCA and what it might mean for their organizations. Among those who know about the data sharing framework, just 1% have stated that they are actively planning not to participate – although at the time of the poll in December of 2022, 48% had not yet made a full commitment to whether they would participate. 

That may be because when the survey was conducted, ONC had yet to announce the six organizations accepted for onboarding as Qualified Health Information Networks (QHINs) under TEFCA, explained Jordan Everson and Kimberly Tavernia, public health analysts with the Office of the National Coordinator for Health IT (ONC), wrote in a HealthITBuzz blog post. 

However, even the earlier results are encouraging for interoperability enthusiasts who are pinning their hopes on TEFCA to create a viable “network of networks” for more seamless, timely data exchange. 

“We think that [the poll] reflects widespread enthusiasm for TEFCA with few concerns preventing participation among those knowledgeable enough to have developed plans,” said Everson and Tavernia. 

Despite the promising top-level data, there are disparities in the types of hospitals that are aware of TEFCA and its potential impacts and necessary investments. Smaller hospitals, including critical access hospitals (CAHs), were less likely to know about TEFCA and less likely to show their early commitment to the framework. 

For example, the survey revealed that only 29% of independent hospitals planned to participate compared to 61% of multi-hospital health systems. Just 32% of CAHs planned to participate compared to 59% of non-CAH hospitals.   

And a mere 18% of hospitals that do not currently participate in one of three national HIE networks (eHealth Exchange, CommonWell or Carequality) have signaled their commitment, while 65% of existing HIE members are ready to pledge to TEFCA as well. Non-participants in national HIE were the most likely to unequivocally reject TEFCA, with 3 percent of those organizations asserting they will not sign on to the framework. 

“Acknowledging that we are in the early stages of supporting data exchange through TEFCA, these trends, whereby low-resource hospitals are less likely to plan to join TEFCA, give us insight into opportunities for more education and engagement with these hospitals,” said Everson and Tavernia.  

“The trend we see here is not surprising but rather reflects broader trends in data ONC has recently published on hospitals, physicians, and individuals, as well as broader work on the ‘digital divide’ in the use of health IT. A key goal of TEFCA is to shrink this digital divide by shining a light on these gaps, lowering the cost and complexity of interoperability, and identifying resources to support broader access to nationwide interoperability networks.” 

ONC will continue to work with stakeholders to develop and share educational resources about TEFCA, but momentum already appears to be on its side. In late May, two dozen large health systems – all customers of Epic Systems – announced their alignment with TEFCA and its guiding principles of standardization, transparency, cooperation, privacy and security, access, equity, and public health. 

As more information about TEFCA rolls out across the industry, it is likely that awareness will continue to rise and more influential entities will signal their alignment with the potentially transformative interoperability roadmap. 

Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry.  Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.  She can be reached at jennifer@inklesscreative.com.