Sequoia Project tackles TEFCA under FHIR

The Sequoia Project, the recognized coordinating entity of the Trusted Exchange Framework and Common Agreement, is seeking feedback on new versions of the Common Agreement, Qualified Health Information Networks Technical Framework, Participant/Subparticipant Terms of Participation and Standard Operating Procedures.

Stakeholder responses on a cache of 15 draft documents is due by February 5.

WHY IT MATTERS
TEFCA 2.0 is intended to support Health Level Seven Fast Healthcare Interoperability Resources-based transactions and is scheduled to be adopted by the QHINs this quarter, according to the TEFCA FHIR roadmap.

In the short term, TEFCA will support “facilitated FHIR” under TEFCA 2.0, according to Chris Muir and Alan Swenson of the Office of the National Coordinator for Health Information Technology.

The QHINs “will provide the network infrastructure to support FHIR API-based exchange between TEFCA Participants and Subparticipants from different QHINs,” they said earlier this month on ONC’s Health IT Buzz blog.

“Specifically, if a TEFCA Participant or Subparticipant wants to obtain a patient’s data using FHIR, they will go to their QHINs to determine who has the patient information,” they said.

“Patient discovery will take place through the QHIN-to-QHIN interaction, including discovery of the FHIR endpoints for those that have the patient data. The initiating Participant or Subparticipant will then directly (i.e., without going through the QHIN) and securely query each of those endpoints.”

As part of the update, the Sequoia Project addresses highly anticipated procedures for electronic case reporting under TEFCA with the drafts.

It’s been required by the Centers for Medicare and Medicaid Services’ Promoting Interoperability Program for eligible hospitals and critical access hospitals, and the Merit-Based Incentive Payment System Promoting Interoperability Performance Category, for eligible clinicians since 2022, as the COVID-19 emergency showed limitations of nationwide data sharing infrastructure.

“When implemented for public health, the use of TEFCA could include electronic case reporting, immunization registry data sharing, vital records data sharing and case investigations,” the RCE explained in its Public Health Exchange Purpose: Educational Guidance Draft for Stakeholder Feedback.

“The Common Agreement authorizes six types of Exchange Purposes, of which Public Health is one. This permits entities that participate in TEFCA to appropriately share and request information to and from PHAs through a secure exchange network.”

While the guidance draft explains what it means for a public health authority to participate in TEFCA, the proposed rules for electronic case reporting are outlined in the Exchange Purpose Implementation SOP: Public Health SubXP-1.

The RCE will host a webinar series on January 23, 30 and February 2, from 12-1:30 pm ET to provide an overview of goals and key changes and drill down on the draft Common Agreement Version 2, terms of participation, revised SOPs and XP implementation rules.

THE LARGER TREND
Led by ONC, the public-private effort to achieve nationwide health data exchange governed under TEFCA began to operate in December.

While some QHINs are still in the process of onboarding, eHealth Exchange, Epic Nexus, Health Gorilla, KONZA and MedAllies have been exchanging data since last month.

The lynchpin of TEFCA is robust provider participation, something FHIR exchange could ignite, according to many experts.

“Providers across the country already recognize the untapped potential and need to join TEFCA for the benefit of patients everywhere,” Craig Richardville, chief digital and information officer for Intermountain Health, said in an Epic announcement on its TEFCA go-live.

ON THE RECORD
“When TEFCA went live in December, the [QHINs] countersigned the Common Agreement v1.1 at an event at the U.S. Department of Health and Human Services,” Mariann Yeager, CEO of the Sequoia Project and RCE lead said in Friday’s announcement.

“At that time, we were already hard at work, in collaboration with the QHINs, on Common Agreement v2 to ensure swift implementation of the FHIR Roadmap for TEFCA Exchange v2.” 

Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.