Enhancing Interoperability with TEFCA V2: What You Need to Know

?HHS announced?that Version 2 of the TEFCA Common Agreement is live!

Assistant Secretary for Technology Policy and The Sequoia Project have introduced Common Agreement Version 2.0 (CA v2.0) as part of the Trusted Exchange Framework and Common Agreement (TEFCA). This update includes stronger technical standards, particularly supporting Fast Healthcare Interoperability Resources? (FHIR?) APIs. These enhancements aim to make it easier for Qualified Health Information Networks (QHINs) and their partners to share clinical data efficiently. It also enables individuals to securely access their health information through their chosen applications.

?Notables:

• Individual Access Service: If you are interested in how TEFCA is working to address concerns related to Patient Health Apps and privacy concerns, it’s worth reading the updated SOP for Individual Access Service (IAS).?
• TEFCA is attempting to provide more clarity around the Treatment Exchange Purpose. There is going to be a lot of discussion around this one, as reading the SOP probably won’t answer all your questions. However, at a high level there are now two different Treatment Exchange Purposes:“TEFCA Required Treatment - Level 2”’, has a unique XP code (T-TRTMNT) and has a very specific definition in the SOP.?“Treatment - Level 1” code (T-TREAT) does not fall under reciprocity requirements. That means, under TEFCA, certain HIPAA treatment queries may not fall under the “must respond '' category, at least not initially. The idea is to allow additional time for stakeholders to review “gray area” use cases and determine if they can be well-defined and qualify to be moved to the Level 2 XP code.
• To better understand the changes related to the Treatment Exchange Purpose, we recommend you read both of these SOPs:SOP - Exchange Purpose (XP) Implementation: TreatmentSOP - Exchange Purposes (XPs).? Tables on page 4 and 5 are very helpful!

Learn more about the Version 2 TEFCA Common Agreement: https://rce.sequoiaproject.org/wp-content/uploads/2024/07/SOP-Treatment-XP-Implementation_508.pdf?

Do you know all the TEFCA Acronyms? Here are some key ones to be familiar with:

1. TEFCA - Trusted Exchange Framework and Common Agreement
2. QHIN - Qualified Health Information Network - the designated networks that will act as the primary hubs for TEFCA based exchange. They have gone through a rigorous onboarding process.??
3. SOP - Standard Operating Procedures.? Other networks often refer to these as Implementation Guides or “IGs". These documents provide the underlying definitions, specifications, and terms and conditions for various aspects of QHIN based exchange. This is the “how” it is all going to work.
4. XP - Exchange Purpose. The list of major use cases for healthcare data exchange. The current TEFCA list includes: Treatment, TEFCA Required Treatment, Payment, Healthcare Operations, Public Health, Electronic Case Reporting, Electronic Lab Reporting, Individual Access Services, and Government Benefits Determination.
5. XP code - Exchange Purpose Code that is in the message itself
6. IAS - Individual Access Services. This is how patients can access their data via a TEFCA participating Patient Health App or Portal.

Let’s do something different! Here are some common questions I get regarding TEFCA based exchange:

Will Zen become a QHIN???

No - but Zen’s Stargate solution enables access to the QHINs. In other words, we want to be “QHIN agnostic”.? We think our clients should be able to participate with whatever QHIN best meets your needs.?

Has Zen been involved with any QHIN exchange???

Yes! We recently powered the successful launch of Public Health queries with our client CRISP Shared Services who is a QHIN participant on the eHealth Exchange network!

Will TEFCA kill the other networks?

Given the extremely high message volumes across Carequality , eHealth Exchange and CommonWell Health Alliance , we are not expecting a major impact on network participation in the near future. In fact, we are actually seeing more healthcare organizations joining the established networks to “prepare” for TEFCA when that network starts to add value. Stargate supports all the networks, which allows our clients to be nimble when deciding what network, now and in the future, best meets their needs.?

Will Patient Access ever take off??

With the new version of the Common Agreement, and enhanced privacy language covering Patient Health Apps, we hope that, at least under TEFCA, Individual Access Services (Patient Access) will finally become a reality.? Perhaps then the other networks will move to make it mandatory on their networks also. Nothing like a little competition!

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Marilee Benson

President

Zen Healthcare IT?

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P.S. - We appreciate our clients' confidence in us as their primary interoperability partner. Working with you on a daily basis is truly a privilege. For those who have not yet worked with Zen, we would be delighted to serve as your trusted advisor as you map your path to a more interoperable healthcare ecosystem. Zen's Gemini Integration Platform and optional modules such as Stargate are HITRUST CSF r2 Certified.

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