A draft of the Qualified Health Information Network (QHIN) Technical Framework (QTF) for the Trusted Exchange Framework and Common Agreement (TEFCA) has been published for public comment.
The nonprofit Sequoia Project, serving as the Recognized Coordinating Entity for TEFCA, will host an interactive webinar series to provide an overview of the QTF and receive public input over the coming weeks.
The technical framework focuses primarily QHIN-to-QHIN exchange requirements. QHINs will be designated by the RCE and will act as the central connection points within the network-of-networks enabled by the TEFCA Common Agreement. They will route queries, responses and messages among entities and individuals sharing information according to the specific exchange purposes.
The QTF supports at least two forms of information exchange among authorized parties:
• QHIN Query to request standardized electronic documents from other connected participants (such as providers or health plans); and
• QHIN Message Delivery to send information to a specific recipient (such as a primary care provider or public health agency).
In addition, the RCE will maintain a directory of exchange participants connected to each QHIN so that other QHINs and participants can direct their queries or message deliveries appropriately. QHINs will be required to support QTF Directory requirements for maintaining their directory entries.
In general, the information to be exchanged within the TEFCA ecosystem builds on the HL7 Guide for CDA Release 2: Consolidated CDA Templates for Clinical Notes (US Realm) Draft Standard for Trial Use Release 2.1 (C-CDA 2.1) document format. This includes data defined as part of the United States Core Data for Interoperability Version 1 (USCDI v1) with allowance for flexibility to further expand the content of messages to support a multitude of use cases.
The QTF also specifies high-level functional requirements that QHINs will need to support within their health information networks. So long as QHINs are able to achieve the required functional outcomes within their networks and satisfy the privacy, security, and other requirements of the Common Agreement, they generally have the operational flexibility to select appropriate standards, architectures, and approaches consistent with the needs of their business environments.
Newer standards, such as HL7’s Fast Healthcare Interoperability Resources (FHIR), will be specified in future versions of the QTF. A TEFCA FHIR Roadmap will be released with the final versions of the QTF and the Common Agreement after careful deliberation and industry engagement regarding the complexities of deploying FHIR in a network environment.
“The publication of the draft QTF for feedback is an important milestone as we look to live, in production, exchange under the Common Agreement in 2022,” said Micky Tripathi, Ph.D., national coordinator for health information technology, in a statement. “The QTF will also evolve to support new standards such as FHIR in the future and we welcome industry feedback on a proposed FHIR roadmap which will be released in the near future.”
The QTF document lays out the detailed expectations and requirements for:
• QHIN Exchange Scenarios, including the Document Query and Message Delivery use cases;
• Functions and Technology to Support Exchange, including: Connectivity and Remediation, Certificate Policy, Secure Channel, Mutual Server Authentication, User Authentication, Authorization and Exchange Purpose, Patient Discovery Query, Document Query and Retrieval, Message Delivery, Patient Identity Resolution, Record Location, Directory Services, Auditing, Error Handling, Constraints for Participants and Sub-participants, Testing Procedures Supporting Requirements, and Performance Measures; and
• Onboarding and Testing, including for connectivity and authentication, RCE directory lookup and update, patient discovery, document query and retrieve, and message delivery.