Year in Review: Health Data Interoperability

Dec. 18, 2021
Progress on the Trusted Exchange Framework and Common Agreement (TEFCA) and the United States Core for Data Interoperability were highlights in 2021

The year 2021 was an eventful one on the health data interoperability front, including the pandemic continuing to raise awareness about the challenges that still exist in exchanging data with public health entities. With regulations in place from the 21st Century Cures Act and the Interoperability and Patient Access final rule, stakeholders began the work of standardizing application programming interfaces (APIs) to allow patients to access their records more easily. What follows is a brief roundup of some highlights from Healthcare Innovation’s reporting this year.

Anticipating TEFCA roll-out. Progress on the Trusted Exchange Framework and Common Agreement (TEFCA) was an interoperability highlight in 2021, with the Office of the National Coordinator for Health IT (ONC) announcing a timeline with the goal of having the new network open for participation in the first quarter of 2022.

In August 2019, ONC awarded a cooperative agreement to The Sequoia Project to serve as the Recognized Coordinating Entity (RCE) to administer a new nationwide network based on the Common Agreement. Since then, ONC and the RCE have worked together to gather stakeholder input to draft and refine the approach to enabling nationwide exchange across different health information networks.

This collaborative process will culminate with publication of the Common Agreement V1 Final and Qualified Health Information Network Technical Framework V1 Final in the first quarter of calendar year 2022, at which point health information networks will be able to apply to become QHINs and, after approval, begin on-boarding on a rolling basis.

USCDI. In July 2021, the ONC released version 2 of the United States Core for Data Interoperability, a standardized set of health data classes and constituent data elements. Version 2 added significant updates such as social determinants of health, sexual orientation and gender identity data elements.

In addition, ONC launched an initiative it called USCDI+ to support the identification and establishment of domain- or program-specific datasets that will operate as extensions to the existing USCDI.

ONC executives described USCDI+ as a service that ONC will provide to federal partners who have a need to establish, harmonize, and advance the use of interoperable datasets that extend beyond the core data in the USCDI in order to meet agency-specific programmatic requirements. This approach, they said, would assure that extensions build from the same USCDI foundation and create the opportunity for aligning similar data needs across agency programs.

State-level HIE. There was a lot of talk in 2021 about the need to create state-level HIE utilities. The California Health and Human Services (CHHS) agency created an advisory group in 2021 that will partner with CHHS and the state’s new Center for Data Insights and Innovation to develop the state’s first-ever healthcare data exchange framework. The data-sharing agreement and common set of policies and procedures will govern the exchange of health information among healthcare entities and government agencies beginning in June 2024.

This new initiative was set in motion with Gov. Gavin Newsom’s signature on AB 133, legislation that provides CHHS with the authority to establish a Data Exchange Framework that will improve how health information is shared across the health and social services systems. Among the goals are protecting public health, improving care delivery, and guiding policies aimed at caring for the whole person, while maintaining patient privacy, data security, and promoting equity.

Single common data model. In March 2021, HL7 and the Observational Health Data Sciences and Informatics (OHDSI) have announced plans to create a single common data model. The organizations will integrate HL7’s Fast Healthcare Interoperability Resources (FHIR) and OHDSI’s Observational Medical Outcomes Partnership (OMOP) common data model to achieve this goal.

OHDSI’s common data model specifies how to encode and store clinical data at a fine-grained level, ensuring that the same query can be applied consistently to databases around the world. OHDSI (pronounced Odyssey) has chosen data integration standards that dovetail with those of the U.S. government and the international community, and it also supplies tools and mapping tables for converting data from other standards. In one example of its use, the National COVID Cohort Collaborative (N3C) accepts data via multiple data models and transforms them into a common OMOP analytic model during data harmonization.

Ann Arbor, Mich.-based HL7 and OHDSI will align their standards to capture data in a clearly defined way into a single common data model. They said this would allow clinicians and researchers to pull data from multiple sources and compile it in the same structure without degradation of the information. This allows the clinical community to define the elements they need, then package and share them in a consistent single structure.

Other HL7 developments. In December, HL7 announced it would be restructuring into two divisions: standards development and standards implementation. The HL7 standards development division will focus on the development and maintenance of HL7 specifications while the standards implementation division will concentrate on helping communities discover, access and understand the specifications as well as test their implementations.

Helios FHIR accelerator. As mentioned above, the pandemic highlighted how siloed public health data systems remain. To help address the situation, in 2021 HL7 expanded its roster of FHIR accelerators with one focused on public health data. The effort, called Helios, after the ancient Greek god of the sun, intends to strengthen the capacity and streamline data sharing across all levels of public health using the FHIR standard.

The FHIR accelerator program seeks to speed the development and availability of FHIR to deliver better data that leads to better health outcomes. Other accelerators include the Argonaut Project, Carin Alliance, Codex, Da Vinci, the Gravity Project, and Vulcan.

Helios is jointly supported by the Centers for Disease Control and Prevention (CDC) and the Office of the National Coordinator for Health IT (ONC).

SHIEC merger. Kicking off its annual conference in Arizona in August 2021, the Strategic Health Information Exchange Collaborative (SHIEC) announced it would be merging with the Network for Regional Healthcare Improvement (NRHI) to form a new organization named Civitas Networks for Health.

The new organization will serve as a platform for local nonprofit health collaboratives and health information exchanges to work together on policy goals and improvement efforts. It will offer engagement opportunities and support action at the local, state, and national levels to achieve policy goals for healthcare quality, cost, and equity through data-driven, collaborative, and transformative strategies.

Portland, Me.-based NRHI represents regional health improvement collaboratives (RHICs) and state-affiliated partner organizations across the United States. SHIEC represents statewide, regional, and community health information exchanges (HIEs). Lisa Bari, M.B.A., M.P.H, serves as CEO for the new organization. 

More HIE consolidation. Another trend that continued to gain steam in 2021 was consolidation among HIE organizations. In April 2021, the boards of directors of HIEs in Colorado and Arizona approved a merger to form a regional nonprofit interoperability organization. Denver-based CORHIO and Phoenix-based Health Current decided to strategically align their organizations to better serve the healthcare data needs in Colorado and Arizona, while preparing for future consolidation in the HIE landscape and possibly for becoming a Qualified Health Information Network (QHIN) under the TEFCA framework. Together, they work with approximately 1,320 healthcare organizations across both states. By coming together, the HIEs say they have the potential to create the largest health data utility in the West. The new organization is called Contexture. Melissa Kotrys, Chief Executive Officer of Health Current, serves as the CEO of Contexture, and Morgan Honea, CEO of CORHIO, serves as Contexture’s Executive Vice President.

CMS’ focus on interoperability. In a Dec. 8 blog post on the website of the Centers for Medicare & Medicaid Services, CMS Administrator Chiquita Brooks-LaSure noted that CMS is working with ONC to explore how TEFCA could be used to support a variety of CMS use cases. CMS also is exploring the use of a standards-based APIs and the FHIR standard for its price transparency efforts, including the Advanced Explanation of Benefits.  She noted that FHIR is already being used to support electronic data exchanges among providers, payers, and patients, and may allow a consumer-friendly AEOB to be produced that could encourage important discussions between patients and their care teams regarding cost and value. She said the use of FHIR is critical to enabling payers to send data to patients and to providers for a seamless exchange.

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