Can TEFCA Get Us to True Interoperability?

Can TEFCA Get Us to True Interoperability?

By Connie Renda, MA, RHIA, CHDA
Vice President of Industry Advocacy and Business Development

Verisma

April 18, 2024

By January 2026, all certified electronic health record (EHR) users must comply and exchange information per the Trusted Exchange Framework Common Agreement (TEFCA). My colleague, Roberta Baranda, past president of the California Health Information Association (CHIA) and health information management (HIM) director at Valley Children’s Hospital spoke about TEFCA several years ago. I looked it up and thought, another government regulation to enforce what we’ve all been needing, wanting and working towards for many years, interoperability. If all of us are on the same page about interoperability, why is it so difficult to achieve?

An unprecedented amount of data is being collected across a diversity of sectors, which, if harnessed, could transform public health decision-making. Yet significant challenges stand in the way of such a vision, including the need to establish standards of data sharing and interoperability, the need for innovation in both methodological approaches and workforce models, and the need for data stewardship and governance models to ensure the protection and integrity of the public health data system. (Martin, et. al., 2022)

Why’s the Government Weighing in on Interoperability? Better Patient Outcomes

All healthcare professionals agree there’s a need for a viable, reliable method, and framework for health information to be exchanged. Most everything we do in health information ultimately results in trusted info being exchanged. When we analyze charts, the purpose is to ensure completeness of the record so the recipient will have the patient’s full story. When we code a record, the data are captured for research recipients and the payers to receive information pertaining to cost of care. Document imaging specialists ensure paper records are incorporated into the electronic version of the chart to provide continuity of care. Of course, clinicians feverishly document care of the patient knowing information will result in better outcomes or prevention of further illness.

Federal efforts may address some impediments to electronic health information exchange. Specifically, the Trusted Exchange Framework and Common Agreement being implemented by the Office of the National Coordinator for Health Information Technology (ONC)—which aims to describe a common set of nonbinding principles to help facilitate exchange among health information networks—may mitigate costs providers face by providing a simpler approach to connecting with other providers. However, stakeholders noted that participation in this effort is voluntary and does not address issues like information technology staffing shortages and gaps in broadband access that pose particular challenges to electronic exchange for small and rural providers. (Gordon, 2023)

Health Information Access Challenges

The government mandate speaks to the importance of access to health information. The vision of our national organization, American Health Information Management Association (AHIMA) is “A world where trusted information transforms health and healthcare by connecting people, systems, and ideas.” Can TEFCA be the conduit for us to get there? The National Institutes of Health (NIH) addresses implications and solutions for interoperability challenges, including a copious amount of health data with outdated workforce models, and numerous resource constraints.

Data science and technology companies continue to be on the cutting edge of information exchange. As such, the data science and technology sector has the expertise to help mitigate and solve challenges within legacy data systems… departments working within a resource-constrained environment and a workforce whose expertise is focused on health, rather than technology. In addition, to increase accuracy and efficiency, there is a need to develop processes for timely data sharing that require minimal human effort. (Martin et. al, 2022)

TEFCA Guidance Resources: ONC and AHIMA

During the February Verisma Academy webinar, Elisabeth Myers, Deputy Director, Office of Policy, ONC, presented an on-demand course with solid, actionable information that’s really worth checking out: Exploring HTI-1, TEFCA and AI in Healthcare – Where Are We in 2024?

Separately, AHIMA provided a two-page guideline on what TEFCA means for provider organizations, underlining the idea that when orgs exchange information through Qualified Health Information Networks (QHINs), “there’s increased focus on how to expand use cases and make a broader impact.” In terms of adaptability, “TEFCA will be able to grow and adapt as needed to ensure it serves user needs,” including “a three-year roadmap for the TEFCA to begin utilizing the Fast Healthcare Interoperability Resource (FHIR).”

Will TEFCA Help Solve Interoperability Challenges?

At the very least, TEFCA has us discussing this important topic and moving in a unified direction as an industry. Providers who struggle with resources to stay on top of what these regulations mean, or how to operationalize them, can lean on external partners who’ve expertise in this space – ultimately benefiting everyone.

I’m proud to work for a company fostering interoperability with technology-rich tools mitigating human error. We help provider partners manage the deluge of incoming records, care coordination processes, and sharing information — with privacy and security at the forefront. We’re also passionate about becoming your trusted partner.

References:

www.ahima.org; What Does the TEFCA Mean for Your Organization?
https://ahima.org/media/zw3hx0c3/tefca_summary_fin.pdf

Martin LT, Nelson C, Yeung D, Acosta JD, Qureshi N, Blagg T, Chandra A (2022) The issues of interoperability and data connectedness for public health. Big Data 10:S1, 19–24, DOI: 10.1089/big.2022.0207.

Gordon, L. (2023) Electronic Health Information Exchange: Use Has Increased, but Is Lower for Small and Rural Providers. GAO-23-105540; Published: Apr 21, 2023.
https://www.gao.gov/products/gao-23-105540.

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ONC Update on AI in Healthcare

ONC Update on AI in Healthcare

By Barbara Carr, RHIA
Strategic Advisor
Verisma

March 21, 2024

In recent years, artificial intelligence’s (AI) use in healthcare has grown into a realm of profound innovation, promising to revolutionize the very landscape of medical practice and patient care. From performing labor intensive repetitive tasks, enhancing diagnostic accuracy, treatment efficacy, and operational efficiency, AI stands as a beacon of hope to address some of the most pressing challenges facing the healthcare industry.

ONC

The Office of the National Coordinator for Health Information Technology (ONC) actively promotes the adoption and responsible use of AI in healthcare. During the February Verisma Academy webinar, Elisabeth Myers, Deputy Director, Office of Policy, ONC, presented their current guidance regarding the use of AI in clinical decision support.

Challenges

Myers also outlined numerous challenges surrounding the use of AI in healthcare such as perpetuating information asymmetries that may lead to healthcare inequalities. AI can also magnify ethical, legal and social concerns during data collection and use, leading to ineffective or even unsafe recommendations.

Guidelines and Initiatives

Given this, the ONC developed guidelines to facilitate the responsible and ethical use of AI in healthcare, including considerations for data privacy, security, and equity. A few of their key initiatives are:

  • Interoperability Standards facilitating the seamless exchange of healthcare data, crucial for AI applications to access and analyze data from various sources
  • Ethical Guidelines ensuring AI is used responsibly — protecting patient privacy and promoting equitable healthcare delivery
  • Data Governance Frameworks addressing data quality, security, and privacy issues

Impact

As a result, the ONC issued a final rule regarding Decision Support Intervention (DSI) which revises existing Clinical Decision Support (CDS) criterion, streamlining and simplifying requirements for all Health IT Modules. In addition, it establishes new maintenance of certification requirements to continuously review and update DSI-related information. Myers describes the policy impact of DSI Certification Criterion as follows:

  • Improving transparency
  • Enhancing trustworthiness
  • Fostering an information ecosystem
  • Advancing health equity by design

The final rule preamble describes each characteristic and associated approaches that can be taken to assess and mitigate risks. Myers provided participants with a link to ONC’s website for more information on their AI initiatives and fact sheets regarding DSI’s final rule.

Education and Training

The ONC also has initiatives to educate and train providers and organizations about the potential benefits and challenges of AI in healthcare. In addition, ONC works closely with other federal agencies, such as the Food and Drug Administration, to develop regulatory frameworks for AI-based medical devices and software applications.

AI is growing rapidly and the ONC is staying on top of it by developing standards and rules for the safe and effective use of AI in healthcare. Interested in learning more? Access Verisma Academy’s on-demand course: Exploring HTI-1, TEFCA and AI in Healthcare – Where are we in 2024?

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