TEFCA Bringing Big Changes to Healthcare and Health Data Interoperability

TEFCA Bringing Big Changes to Healthcare and Health Data Interoperability

EDITOR’S NOTE: In an earlier version of this article, which has since been corrected, two inaccuracies were noted. TEFCA was introduced by the U.S. Department of Health and Human Services Office of the National Coordinator for Health IT (ONC) not the Centers for Medicare & Medicaid Services, and TEFCA does not certify QHINs, but rather conducts evaluations. RACmonitor apologizes for the errors.

I recently saw a notable update on the Trusted Exchange Framework and Common Agreement or TEFCA, a federal program intended to improve health data interoperability across the healthcare industry.  

It made me think about how quickly healthcare interoperability is advancing.

Interoperability touches nearly all stakeholders in the industry, most especially providers, and TEFCA’s nearly weekly developments are rapidly shaping the future of healthcare.

So, here’s a quick refresher on TEFCA, its status, and why it’s worth keeping an eye on.

The exchange of health information is crucial for delivering efficient and effective patient care. However, as you may know, interoperability challenges have hindered smooth data exchange among healthcare providers, which causes fragmented care and compromised patient outcomes.

To address these issues, TEFCA was introduced by the U.S. Department of Health and Human Services (HHS) Office of the National Coordinator for Health IT, or the ONC.

At its core, TEFCA is a set of principles and requirements for secure information-sharing among health information networks across the U.S., and it serves as an outline for establishing a common set of principles, terms, and conditions for the trusted exchange of electronic health information.

TEFCA’s outline of fundamental principles for achieving interoperability includes those for data standardization and privacy protections. TEFCA’s contracted Recognized Coordinating Entity (RCE) also evaluates health information networks for potential designation as TEFCA QHINs, or Qualified Health Information Networks, across the country, responsible for facilitating health information exchange among healthcare organizations.

Several key phases have shaped TEFCA’s trajectory, including pilot testing of the program’s concepts and functionalities, engaging stakeholders to ensure alignment with diverse needs and perspectives, and, since TEFCA intersects with existing regulations such as the 21st Century Cures Act and the Healthcare Insurance Portability and Accountability Act (HIPAA), it compels the streamlining of regulatory requirements and integration into the broader healthcare landscape.

Most recently, the ONC announced updates to TEFCA’s Common Agreement, which establishes the technical infrastructure and governing approach for QHINs and their users to securely share clinical information with each other.

The updates allow QHINS to begin the process of employing FHIR standards to meet data exchange requirements, serving as yet another example of the federal governments’ intent to move toward FHIR standards on many fronts in healthcare.

You may recall that CMS recently gave a nod to FHIR standards for use in generating the Advance Explanation of Benefits (AEOBs) and Good Faith Estimates (GFEs) that stem from the No Surprises Act. Further, health plans serving the Medicare, Medicaid, and Patient Protection and Affordable Care Act (PPACA) marketplace populations are already required to use FHIR standards for certain data exchange functions.

Not only does TEFCA represent a revolutionary initiative to promote nationwide interoperability and enhance health information exchange, but it also stands to be a key driver of impending interoperability efforts between payors and providers.

What’s more, it holds immense potential to revolutionize healthcare delivery, improve patient outcomes, and steer innovation across the healthcare ecosystem by enabling patient information to move quickly and seamlessly across the country, facilitated by local QHINs, moving patient data to the appropriate providers for continuous patient care and, most importantly, getting that same patient data in the hands of patients themselves.

Something with such sweeping implications for healthcare professionals, like many of you, is sure to make big waves. Arm yourself with awareness now.

TEFCA is paving the way for a more connected and patient-centric healthcare system. I suggest taking a look at the ONC’s website for more on TEFCA and its latest progress.

Print Friendly, PDF & Email
Facebook
Twitter
LinkedIn

Adam Brenman

Adam Brenman is a Federal Legislative Analyst at Zelis Healthcare. He previously served as Manager of Public Policy at WellCare Health Plans, where he led an analyst team in review, analysis, and development of advocacy materials related to state and federal legislation/regulatory guidance. He holds a master’s degree in Public Policy & Administration from Northwestern University and has also worked as a government affairs rep/lobbyist for a national healthcare provider association.

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

Pediatric SDoH: An Essential Guide to Accurate Coding and Reporting

Pediatric SDoH: An Essential Guide to Accurate Coding and Reporting

This webcast, presented by Tiffany Ferguson, LMSW, CMAC, ACM, addresses the critical gap in Social Determinants of Health (SDoH) reporting for pediatric populations. While SDoH efforts often focus on adults, this session emphasizes the unique needs of children. Attendees will gain insights into the current state of SDoH, new pediatric Z-codes, and the importance of interdisciplinary collaboration. By understanding and applying pediatric-specific SDoH factors, healthcare professionals can improve data capture, compliance, and care outcomes. This webcast is essential for those looking to enhance their approach to pediatric SDoH reporting and coding.

August 8, 2024
Oncology and E/M Services: Compliance, Medical Necessity, and Reimbursement

Oncology and E/M Services: Compliance, Medical Necessity, and Reimbursement

Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, VP of CDM, for a webcast addressing oncology service coding challenges. Learn to navigate coding for infusions and injections alongside Evaluation and Management (E/M) services, ensuring compliance and accurate reimbursement. Gain insights into documenting E/M services for oncology patients and determining medical necessity. This webcast is essential to optimize coding practices, maintain compliance, and maximize revenue in oncology care.

July 30, 2024
The Inpatient Admission Order: Master the Who, When, and How

The Inpatient Admission Order: Master the Who, When, and How

During this webcast Dr. Ronald Hirsch delves into the inpatient admission order process including when to get it, when it becomes effective, its impact on billing and payment, who can write it, how to cancel it, the effects on the beneficiary, and more. You’ll leave with a clear understanding of inpatient orders and guidelines for handling improper orders that you can implement immediately.

June 20, 2024
Navigating AI in Healthcare Revenue Cycle: Maximizing Efficiency, Minimizing Risks

Navigating AI in Healthcare Revenue Cycle: Maximizing Efficiency, Minimizing Risks

Michelle Wieczorek explores challenges, strategies, and best practices to AI implementation and ongoing monitoring in the middle revenue cycle through real-world use cases. She addresses critical issues such as the validation of AI algorithms, the importance of human validation in machine learning, and the delineation of responsibilities between buyers and vendors.

May 21, 2024
Comprehensive Inpatient Clinical Documentation Integrity: From Foundations to Advanced Strategies

Comprehensive Inpatient Clinical Documentation Integrity: From Foundations to Advanced Strategies

Optimize your inpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. Participants will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.

June 26, 2024
Advanced Inpatient Clinical Documentation Integrity: Harnessing Technology, Analytics, and Compliance

Advanced Inpatient Clinical Documentation Integrity: Harnessing Technology, Analytics, and Compliance

Join expert Angela Comfort, MBA, RHIA, CDIP, CCS, CCS-P., as she helps you navigate advanced inpatient CDI technologies, regulatory changes, and system interoperability. Angela will provide actionable strategies for integrating AI and predictive analytics into CDI practices, ensuring seamless system interoperability, and maintaining compliance with evolving regulations. Attendees will learn to select and implement advanced EHR systems and CDI software, leverage data analytics to enhance documentation accuracy, and stay audit-ready with the latest compliance updates. Real-world case studies and practical tools will empower you to drive continuous improvement in CDI, improve patient outcomes, and enhance organizational efficiency. Don’t miss this opportunity to advance your CDI practices and stay ahead in this dynamic field.

July 11, 2024
Foundations of Inpatient Clinical Documentation Integrity: Enhancing Accuracy and Compliance

Foundations of Inpatient Clinical Documentation Integrity: Enhancing Accuracy and Compliance

Join expert Angela Comfort, MBA, RHIA, CDIP, CCS, CCS-P, for an insightful webcast on improving inpatient clinical documentation integrity (CDI). Inaccurate documentation can lead to misdiagnosis, improper treatment, and compromised patient safety. High workloads, lack of standardized practices, and outdated EHR systems contribute to these issues, affecting care quality and financial outcomes. Angela will offer practical strategies and tools to enhance accuracy, consistency, and timeliness in documentation. Attendees will learn to use standardized templates, checklists, and advanced EHR systems, while staying compliant with regulations. Improve patient care, ensure accurate billing, and reduce audit risks with actionable insights from this essential webcast.

June 26, 2024
Mastering E/M Coding: Navigating the Evolving Landscape

Mastering E/M Coding: Navigating the Evolving Landscape

Join industry expert, Kathy Pride, RHIT, CPC, CPMA, CCS-P, for an in-depth exploration of Evaluation and Management (E/M) coding, tailored for healthcare professionals navigating recent guideline changes. Dive into advanced topics beyond mere code selection, including shared visits, criteria for selecting E/M levels, and documentation best practices. Gain clarity on complex guideline terminology and ensure compliance with regulatory standards. This comprehensive session is essential for coders, auditors, educators, and practitioners seeking to enhance their proficiency in E/M coding and maximize revenue capture.

June 19, 2024

Trending News

Get 15% OFF on all educational webcasts at RACmonitor with code JULYFOURTH24 until July 4, 2024—start learning today!

Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →