Interoperability vendor NextGen Healthcare Inc. (Nasdaq: NXGN) will apply to become a Qualified Health Information Network (QHIN) under the Trusted Exchange Framework and Common Agreement (TEFCA).
Large national networks such as the CommonWell Health Alliance and eHealth Exchange have expressed their intention to apply to become QHINs, as has the EHR giant Epic Systems. Another company called Health Gorilla has said it intends to go through the formal application process.
NextGen says it supports more than 100,000 providers with its ambulatory electronic health records (EHR) and practice management (PM) solutions, as well as one-third of health information exchanges (HIEs) across the country, with interoperability tools. The company is the first ambulatory-focused solutions provider to announce its intention to become a QHIN.
If approved by the Sequoia Project, the Recognized Coordinating Entity appointed by the Office of the National Coordinator for Health Information Technology (ONC), the designation will enable NextGen Healthcare to participate in a network of organizations that work together on a national scale to share clinical data. Under the model laid out by TEFCA, QHINs will exchange information with other QHINs, facilitating a flow of information that is vital to interoperability.
The company’s NextGen Share is a cloud-based solution that provides access to several national interoperability networks, in addition to other key services. NextGen says it facilitates the exchange of tens of millions of health-related documents each month via national network exchanges. It announced earlier this year that NextGen Enterprise was the first complete ambulatory EHR to receive 2015 Edition Cures Update Health IT certification from the ONC.
In an Aug. 16 webinar, Muhammad Chebli, vice president of solutions at NextGen Healthcare, engaged in a conversation with Lisa Bari, CEO of Civitas Networks for Health, and Scott Stuewe, president and CEO of DirectTrust, about the promise of TEFCA.
Bari said the intention to set up set a floor for nationwide interoperability is an admirable one, and she thinks it is great that the recognized coordinating entity for TEFCA is the Sequoia Project, a multi-stakeholder organization that taken into account the voices and the perspectives of many across our community.
She stressed, however, that we can only get so far at the national, standardized level. “Then you get down to the place where you're looking at, how can I provide specific value that actually helps physicians, providers, practices, hospitals, systems improve health, and you're in the last-mile territory, and that's going to be really, really hard to aggregate at the national level, because needs are different, states are different regions are different, the healthcare community populations are different.”
Bari noted that the collaboration between Carequality and Commonwealth made a huge difference in the industry. “Where we are, today is a very different place than where we were when we were first thinking about these solutions at the government level and at the advocacy level,” she said. “I want us to be able to adjust and evolve with the state of exchange today, because [TEFCA] should be a helper; it should not hinder.”
"Overall, I think that it is very positive to have more focus on nationwide interoperability and query-based exchange,” Bari said. “I also actually believe in the process of commoditizing exchange. We should be driving down the cost of exchange and making it more accessible over time. That's a natural process of creation and destruction and development that has to happen for innovation. How can we drive down the cost? How can we make it more ubiquitous? How can we make it more standardized? those are really positive things that ultimately do drive better outcomes over time. However, I think workflows are really, really important. You have to completely redesign workflows to not be duplicates of paper processes. You know what's worse than paper processes? Electronic versions of paper processes, and that really gets in the way of true interoperability and getting health data where it needs to go at the right time.”
DirectTrust's Stuewe agreed that workflow is key. “We talk about the last mile. Well, we've laid all this track, and we've got the last mile actually pretty well plumbed. Our problem is actually the last inch. We have this problem of what happens when people are actually trying to use interoperable workflows, and how useful are those? It is going to take a village of folks to actually make a difference in that space. Who will educate the legion of users that need to think differently about workflows? Who does that job now? The biggest barrier we have now is that people don't know what they already have. If TEFCA helps people understand that they can actually use something other than fax to communicate healthcare information, then that will have been a good thing. But I can tell you that it won't happen without people on the ground to do the work.”