What to expect from the QHIN application process

The Sequoia Project began accepting applications on Oct. 3 for potential qualified health information networks (QHINs), the entities tasked with sharing data under the Trusted Exchange Framework and Common Agreement (TEFCA) established by the 21st Century Cures Act.

A QHIN will serve as a network of healthcare organizations that directly connect with each other to share information. These could connect payers, clinical applications, government agencies, health information exchanges (HIEs) and health systems. Micky Tripathi, the national coordinator for health IT, has described the opening of the application process as a “major milestone for TEFCA” and the goal of “universal network interoperability across the country.”

The Sequoia Project was previously named the coordinating entity for TEFCA implementation and QHIN selection. Under version 1.0 of the technical framework the organization released in January, entities applying to become QHINs should “leverage existing, deployed technical infrastructure” to exchange information. These could include Representational State Transfer (REST) application program interfaces (APIs) or the Health Level Seven (HL7) Fast Healthcare Interoperability Resources (FHIR) standard.

No single exchange method was specified in the inaugural technical framework in part because “there is still work to be done in operationalizing these approaches at the scale,” The Sequoia Project said. It’s expected that future versions of the technical framework will specify the use of FHIR for QHIN exchange.

In addition, the technical framework outlines several general requirements to support information exchange.

• Each QHIN must connect with each of its participating members and with every other QHIN.
• QHINs must obtain certification for authentication, encryption and signing. (The Sequoia Project selected HITRUST for security certification.)
• All requests to send and receive information should fall within a set of six purposes: Treatment, payment, healthcare operations, public health, individual patient access services, and coverage determinations.
• QHINs must be able to resolve patient identity using an enterprise master patient index, a record locator service or “other innovative methods.”
• QHINs must maintain a local copy of The Sequoia Project’s provider director service and ensure that changes are merged at least once a day.
• The Sequoia Project will collect performance metrics such as downtime, average response times, and errors for each QHIN once a month.

In the leadup to Oct. 3, numerous entities announced their intentions to apply to be a QHIN. The list includes software vendors such as Epic, Health Gorilla, Kno2, NextGen, and NetSmart, along with HIE entities such as the CommonWell Alliance, eHealth Exchange, and the United States QHIN, a spinoff of the Michigan Health Information Network.

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It’s worth noting that many electronic health record (EHR) vendors are already CommonWell members, including athenahealth, Greenway, MEDITECH and Oracle Cerner. These vendors have expressed support for CommonWell’s potential status as a QHIN and haven’t themselves applied to be a QHIN.

According to The Sequoia Project, the first set of QHINs will be announced together, on a date to be determined, with additional QHINs named on a rolling basis.

Brian Eastwood is a Boston-based writer with more than 10 years of experience covering healthcare IT and healthcare delivery. He also writes about enterprise IT, consumer technology, and corporate leadership.