Last week, the Trusted Exchange Framework and Common Agreement (TEFCA) finally went live.
The Office of the National Coordinator for Health Information Technology (ONC) has been working to launch TEFCA for the better half of a decade, heralding the project as something that will boost interoperability and increase patients’ access to their healthcare data. However, a former ONC chief thinks TEFCA is ill-suited to advance either of those goals — and that the data exchange network might even set interoperability back.
Don Rucker currently serves as chief strategy officer for health data platform 1upHealth and was head of the ONC from 2017 to 2021. He believes that TEFCA is built on an archaic data exchange protocol that will prevent the initiative from being useful.
TEFCA was originally outlined in the 21st Century Cures Act, which was passed in 2016. The initiative seeks to establish a nationwide health information exchange network that shares a common set of principles, terms and conditions to facilitate the secure and seamless exchange of data across disparate health information systems.
When the ONC announced TEFCA’s launch last week, it designated five organizations as qualified health information networks: eHealth Exchange, Epic Nexus, Health Gorilla, Konza and MedAllies. The ONC said that these QHINs will establish direct connections with each other, promoting interoperability among the networks they encompass.
The purported goal of the TEFCA network is to make it easy for providers and patients to quickly access health data whenever they need it, regardless of EHR vendor. But the protocol on which TEFCA is built is too dated for the initiative to deliver on those promises, Rucker argued.
TEFCA uses a “90s-era” IHE document exchange-only interchange protocol, he pointed out. This data exchange architecture was not built for the computable data formats and programming languages of today’s Internet, Rucker explained.
“[The IHE protocol] doesn’t allow you to compute for health or fitness or wellness or things like if the meds you’re on make sense for you,” he declared. “There’s absolutely no way to do that with TEFCA, so it’s a very ancient and frankly quite insecure approach to networks.”
Health data access won’t improve because no one wants to try and load a mass of difficult-to-parse-through data on an arcane API, Rucker pointed out.
In order for TEFCA to truly support better data access for providers and patients, it would have to be modernized to handle computable data, i.e. FHIR data, he argued. However, TEFCA actually allows its participants to block access to computable data fields, as well as prevent the modern APIs that power nearly every other aspect of our web usage, Rucker noted.
“For anyone using TEFCA even once, the EHR vendors could refuse to give them the data in a modern, computable way and insist they get the data in a slow, flaky, brokered, incomputable way. That was put in as an exception to the information blocking prohibitions, which is a double negative. For example, Epic, who lobbied for this, can refuse to give any digital app selected by a patient the data in a form that can be computed,” he explained.
The ONC has said that TEFCA will move to support modern APIs, such as FHIR and HL7, in 2024. Rucker isn’t very assured by that promise, noting he is eager to see the technical plans and is confused why the project wouldn’t start with modern protocols in the first place.
Photo: GarryKillian, Getty Images
