TEFCA is operational. Now what?

The moment is here: We have watched as the Office of the National Coordinator (ONC) laid the foundation for a nationwide health data exchange network, governed by the Trusted Exchange Framework and Common Agreement (TEFCA). Now the first Qualified Health Information Networks (QHINs) are exchanging data. What does this mean for the way data will be exchanged within the healthcare ecosystem moving forward?

At the most basic level, the first cohort of QHINs coming online represents progress, albeit slow progress, toward true interoperability. Remember, the 21st Century Cures Act, which called for the development of a trusted exchange framework and a common agreement, passed back in 2016. Although 2016 may seem like it happened minutes ago to many of us, it was, in fact, eight years ago. While there is certainly reason to celebrate finally reaching this milestone, there is also reason to believe the full vision of TEFCA will not be realized for quite a while longer.

The “CA” part of TEFCA, or Common Agreement, authorizes six exchange purposes. Initially, however, responses to requests are required for only two of them: 1) treatment and 2) individual access. While it is expected that standard operating procedures (SOPs) will eventually be finalized for the other exchange purposes, including payment and operations, the timeline and the scope of those SOPs is to be determined. For example, the draft payment SOP only focuses on risk adjustment, and even once finalized, responses to requests will only be required where FHIR is enabled. The FHIR roadmap will be proposed in a second version of the Common Agreement, which ONC is hoping to finalize in the first quarter of 2024. The roadmap will likely contain milestones into 2026 and beyond.

So, while TEFCA certainly represents a step in the direction of true interoperability, we expect its rollout will continue slowly. This is where Moxe comes into play. As our Chief Administrative Officer Mike Arce previously discussed, our solutions are designed to help customers today, but are also flexible enough to address requirements that may come out of TEFCA or any other regulatory framework in the future. Moxe isn’t limited by use case or by the pace of FHIR adoption.

Navigating the nuances of interoperability can be challenging. Having a partner, like Moxe, helps. Factoring internal resources, levels of sophistication, and data sources, Moxe works hand-in-hand with payers to tailor clinical data solutions that meet their needs and can scale.

Beyond data acquisition

As meaningful interoperability becomes more of a reality in the coming years, the primary question will no longer be, “How do I get the data I’m looking for?,” but rather, “How do I use the data I’ve acquired to improve patient outcomes?” After all, what is the purpose of all this interop stuff if not to improve the lives of patients?

We go beyond the acquisition of data, adding further value by activating the data to drive meaningful results. Moxe’s payer-agnostic Point of Care Insights solution presents patient-specific insights from payers within the clinical workflow, allowing providers to easily address suspected conditions, reconfirm diagnoses, and attend to gaps in care before or at the point of care. This type of bidirectional data exchange—the type that helps providers make better care decisions faster—is ultimately what is going to move the needle in a big way in how healthcare is delivered in our country.

When thinking about your clinical data strategy for 2024 and beyond, we encourage you to think about not just how you’ll keep compliant with today’s regulatory requirements, including TEFCA, but how you’ll prepare for a future where the exchange of data is increasingly required and imperative to better run the business of healthcare. We’re here to not only provide tech-first solutions, but also to be a true partner in optimizing your clinical data program.

About Greg Meltzer
As Moxe’s Director of Channel Partnerships, Greg works closely with our customers and partners. Prior to joining Moxe, Greg held roles at athenahealth, PatientPing, and Bamboo Health.

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