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HHS Releases Final Trusted Exchange Framework and Common Agreement

The Department of Health and Human Services’ Office of the National Coordinator for Health IT has released the final version of its Trusted Exchange Framework and the Common Agreement (TEFCA) – a governance framework for nationwide health information exchange. Two previous versions of TEFCA have been released, the first in 2018 and the second in 2019, with the final version taking into consideration feedback provided by healthcare industry stakeholders. TEFCA was a requirement of the 21st Century Cures Act and has been 5 years in the making. The announcement this week sees the HHS finally move into the implementation phase of TEFCA.

The Trusted Exchange Framework is a set of non-binding foundational principles for health information exchange and outlines propositions for standardization, cooperation, privacy, security, access, equity, openness and transparency, and public health. The second component is the common agreement, which is a legal contract that a Qualified Health Information Network (QHIN) enters into with the ONC’s Recognized Coordinating Entity (RCE). The RCE, the Sequoia Project, is a body charged with developing, updating, and maintaining the Common Agreement and overseeing QHINs.

The framework promotes secure health information exchange across the United States and is intended to improve the interoperability of health information technology, including the electronic health record systems used by hospitals, health centers, and ambulatory practices, and health information exchange with federal government agencies, health information networks, public health agencies, and payers.

“The Common Agreement establishes the technical infrastructure model and governing approach for different health information networks and their users to securely share clinical information with each other – all under commonly agreed-to rules-of-the-road,” explained ONC in a press release. The Common Agreement supports multiple exchange purposes that are required to improve healthcare and should benefit a wide variety of healthcare entities. The Common Agreement operationalizes electronic health information exchange and provides easier ways for individuals and organizations to securely connect. TEFCA will also provide benefits to patients, such as allowing them to obtain access to their healthcare data through third parties that offer individual access services.

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ONC’s RCE will sign a legal contract with each QHIN and entities will be able to apply to be designated as QHINs shortly. When designated as a QHIN they will be able to connect with each other and their participants will be able to participate in health information exchange across the country. ONC has released a QHIN Technical Framework which details the functional and technical requirements that QHINs will need to bring the new connectivity online. The HHS has also announced that the TEFCA Health Level Seven (HL7) Fast Healthcare Interoperability Resource (FHIR) Roadmap (TEFCA FHIR Roadmap) is now available, which explains how TEFCA will accelerate the adoption of FHIR-based exchange across the industry.

“Operationalizing TEFCA within the Biden Administration’s first year was a top priority for ONC and is critical to realizing the 21st Century Cures Act’s goal of a secure, nationwide health information exchange infrastructure,” said Micky Tripathi, Ph.D., national coordinator for health information technology. “Simplified nationwide connectivity for providers, health plans, individuals, and public health is finally within reach. We are excited to help the industry reap the benefits of TEFCA as soon as they are able.”

ONC said its RCE will be hosting a series of public engagement webinars to provide further information on the Trusted Exchange Framework and the Common Agreement, which will explain how they work to help prospective QHINs determine whether to sign the Common Agreement

Author: Steve Alder is the editor-in-chief of HIPAA Journal. Steve is responsible for editorial policy regarding the topics covered on HIPAA Journal. He is a specialist on healthcare industry legal and regulatory affairs, and has several years of experience writing about HIPAA and other related legal topics. Steve has developed a deep understanding of regulatory issues surrounding the use of information technology in the healthcare industry and has written hundreds of articles on HIPAA-related topics.