There are fascinating things happening across the health information exchange (HIE) landscape these days, perhaps none more pressing than how TEFCA (the Trusted Exchange Framework and Common Agreement) by the Office of the National Coordinator for Health IT (ONC)—a mechanism to promote data exchange and interoperability in healthcare—will impact the operations of existing health information networks.
The comment period closed in June on the second draft of TEFCA, and stakeholders will now wait to see how ONC responds to their comments on the framework. For some HIEs and other information sharing organizations, TEFCA in its current draft form presents more questions than answers. And to that end, industry associations such as the Strategic Health Information Exchange Collaborative (SHIEC), a national trade association representing HIEs, are coming to the forefront to help their members navigate these muddy waters.
SHIEC, which is holding its annual conference later this month in Maryland, represents more than 70 HIEs, and these exchanges collectively cover more than 200 million people across the U.S., according to the organization’s officials. SHIEC’s CEO, Kelly Hoover Thompson, an attorney by background, recently spoke with Healthcare Innovation about the upcoming conference, what’s most pressing for HIE leaders today, TEFCA considerations, and more. Below are excerpts of that discussion.
As you prepare for SHIEC’s annual conference, what would you say HIE leaders are thinking about most these days?
First, regarding the conference, the fact that Seema Verma [CMS Administrator] has agreed to be the opening keynote sends a tremendous message to the rest of the community—that CMS values and recognizes the role that HIEs play. As a community, we have talked a great deal about being good partners for our federal colleagues. CMS is a very big player in our space, of course.
Also, in the plenary sessions that we have pulled together, you will see important conversations [taking place] with other key federal agencies like the CDC and the VA. And then of course, there will be [discussion] around what’s happening with interoperability and the policy issues, such as TEFCA and information blocking. Even though we will likely still be in an open-rule process, these are things that people will be talking about.
The other one that I think will be on people’s minds very much so is consumer-directed exchange, and we will hear from the CARIN Alliance on that. There will also be a larger conversation with some of these national networks, and that may come up in TEFCA discussions. We are looking for opportunities for HIEs to play a larger role in the bigger healthcare ecosystem.
The ONC and CMS proposed rules that dropped at HIMSS19 had so many elements related to health data exchange and possible requirements around that. How did all this land for you?
For CMS, it’s different when things are tied to payments and mandates, versus being voluntary. Because HIEs’ primary participants are providers, anything CMS does that impacts providers ultimately impacts us. These rules absolutely have direct impact our community. Interoperability is at the core of and is the keystone of what HIEs do and stand for. Looking at what will ultimately come out of these rules, I think you will see the decision makers who are trying to implement these new policies recognize the value of HIE and the role that we play in the larger healthcare ecosystem.
So, something like information blocking will be direct impactful for us. We work every day to liberate the data so that people can access the information, regardless of what EHR [electronic health record] or platform they are on. It is vendor-agnostic in these communities, and that is a unique role that HIEs play that you just don’t see in other places.
Also, because we are community-based and trusted organizations, working on [elements] like social determinants of health with our community partners has become more important. HIEs are uniquely positioned to address issues such as food insecurity, housing insecurity and transportation, as they have a good handle on the community already and can help the social determinants side partner with the healthcare side.
What parts of TEFCA would you like to see improved from what has been outlined so far? Does TEFCA infringe on the progress that some HIEs have already made?
One of the things we were clear about in our comment letter, and in our discussions with ONC and CMS, is that there have been a lot of federal investments—whether it’s financial investments, human resources, or energies—that have been put into creating these existing networks that have been [up-and-running] for a number of years. Those existing networks and frameworks that are already out there cannot be overlooked, and we have had that very conversation with ONC, CMS and our [member] HIE executives.
To think that you will come out and get providers to sign all new participation agreements, or flip a switch and gain that trust overnight, is short sighted. It’s just not the way things work. No information flows until you have that [data sharing and governance] agreement in place, and getting people to agree to what level they are comfortable with sharing information has already been determined within the existing networks out there.
At the same time, there is room for improvement, expansion, or to create more robust networks. There absolutely is. But to completely start over and disregard the existing networks is not something we are looking for, and I don’t think CMS and ONC are looking to wipe out what’s already existing either. They recognize the value and they keep investing in it. Grant dollars are still flowing to states to support that work.
When comparing the successful HIEs with the less accomplished ones, what are the key differentiators that you would point to?
It has to be more than just exchanging basic data. It’s not enough to just share ADT [admission/discharge/transfer] notifications and push that information out. Providers want easy, one-click, and less burdensome solutions to support them delivering precision medicine to their patients. So if an HIE is out there and is not looking at population health, public health, partnerships with federal and state agencies, talking to their payers, looking at the quality of their data, and things like NCQA [National Committee for Quality Assurance] certifications, then there will be challenges. The HIEs looking at these pieces are the [industry] leaders and the ones that will be successful.
