It was a wonderful experience to moderate a panel discussion today at the 2019 Florida HIE User Summit, sponsored by Florida HIE Services, and co-located with our Florida Health IT Summit, which begins tomorrow. I was able to facilitate an excellent discussion with a wonderful panel of industry leaders, at the Saddlebrook Resort outside Tampa.
I was honored to moderate the first panel of the afternoon, “Megatrends Disrupting Healthcare Delivery,” with discussants Nora Belcher, executive director of the Texas e-Health Alliance; Sarah Miller, vice president of state government services at Audacious Inquiry, a consulting and solutions company that works extensively with health information exchange leaders across the country; and Jay Nakashima, vice president for eHealth Exchange at the Sequoia Project, a not-for-profit created to advance the implementation of secure, interoperable nationwide health information exchange.
Nora, Sarah, and Jay and I had a very stimulating, very lively discussion about the current moment in federal policy around health information exchange. And it is a very complex, fraught one. On the one hand, some progress is being made in certain policy areas. For example, federal healthcare officials did listen to some of the comments being made around the first version of TEFCA, and have responded. On the other hand, much remains to be done to improve and optimize TEFCA.
As Healthcare Innovation Senior Editor David Raths wrote on April 19, “After receiving more than 200 comments on the first draft of its Trusted Exchange Framework and Common Agreement (TEFCA) for connecting health information networks, the U.S. Department of health and Human Services (HHS) has released the long-awaited second draft and a four-year funding announcement for a nonprofit Recognized Coordinating Entity (RCE) to manage the network of networks.” Raths quoted National Coordinator for Health IT Donald Rucker, M.D., who stated in a blog post on the website of the Office of the National Coordinator for Health IT (ONC), as stating that, “By releasing today’s draft for a second round of public comment, we are working to get it right.” Among other elements that changed between Drafts 1 and 2 of TEFCA, the definition of who can be a Qualified Health Information Network (QHIN) has been broadened from the first draft; the QHIN Technical Network (TEF), added to Draft 2, details the technical and functional components for exchange among QHINs; meanwhile, both the timeframe around the mandated updating of agreements and technical requirements, and the list of exchange modalities, were modified.
That said, the panelists today agreed that things remain cloudier rather than clearer, in terms of the direction in which TEFCA could ultimately head. They also agreed that state governments are pushing the HIE phenomenon forward, through Medicaid program-related requirements for provider data-sharing.
At the same time, the panelists also agreed that it remains undetermined what breakthrough developments might soon occur that might fundamentally alter this rather confused landscape. Might one of them be a sudden quickening in the development of technology, possibly including interoperable APIs, that might move forward the sharing of key discrete pieces of data—such as lab results, diagnostic images, and smaller pieces of information in the form of text elements? It’s impossible to say what development might be a true breakthrough. But, as the panelists agreed, it could be one of any large number of developments, including, for example, the advancing evolution of the health records section in Apple’s iPhone health app.
At this point, there are so many variables involved in the policy and industry landscape around health information exchange, that it can be difficult to parse the tableau of situations. But what is clear is that those HIE organizations that will be successful going forward, will be those that continue to find truly useful, as well operationally and financial sustainable, roles for themselves, during a time of rapid change and considerable uncertainty. Indeed, organizations like Florida HIE Services, have been doing so, successfully. And they will continue to do so, even as federal healthcare policy officials work to clarify and prioritize their federal healthcare policy goals.
And the sense of mission, high skill levels, and vitality of the nation’s successful HIEs look to continue forward, even at this somewhat cloudy, confused nexus point in the evolution of data and information in U.S. healthcare. Will everything be quickly resolved? No, not at all. But if leaders like those who spoke on my panel today continue to lead the sector forward, there’s no question whatsoever in my mind that things will ultimately be resolved to the benefit of consumers, providers, and yes, those leading the advancement of data exchange across the industry.
