By Holly Miller, MD, Chief Medical Officer, MedAllies
LinkedIn: Holly Miller, MD, MBA, FHIMSS
LinkedIn: MedAllies
The Trusted Exchange Framework and Common Agreement (TEFCA) recently became operational, offering promise in, and a national focus on, boosting nationwide interoperability.
TEFCA, which was created as part of the 2016 21st Century Cures Act, is a set of regulations designed to improve healthcare interoperability by establishing standards and infrastructure that ease data exchange among key stakeholders, including providers, payers, and information technology partners. TEFCA also supports individuals who want to retrieve their own healthcare data.
Qualified Health Information Networks (QHINs) are a centerpiece of TEFCA. QHINs are set to become the “on ramp” for all electronically accessible health information without special effort on the part of the user.
With TEFCA, all healthcare stakeholders with an appropriate purpose of use can connect to a QHIN and seamlessly share or retrieve data with healthcare constituents connected to the same or a disparate QHIN. TEFCA thus acts as the internet of healthcare data.
TEFCA is also designed to ensure that there is appropriate access to data with enhanced security and provides for the sharing of a core set of data for the purposes of treatment, individual access services, public health, and benefits determination, which is a subset of the HIPAA-defined payment services and HIPAA-defined healthcare operations.
The Numbers Behind Interoperability
A recent report from the Office of the National Coordinator for Health Information Technology (ONC) showcased the gains providers across the nation have made towards interoperability – even prior to TEFCA and QHINs being implemented. The report revealed that 70% of non-federal acute care hospitals routinely or sometimes engaged in all four domains of interoperability last year (send, receive, find, integrate), a significant increase from 46% in 2018.
Of those 70% of hospitals above, however, less than half (43%) routinely engaged in interoperable exchange in 2023, while 27% sometimes engaged in interoperable exchange. More problematic, while 71% of hospitals routinely had access to necessary clinical information available electronically from outside providers at the point of care, only 42% of clinicians often used that information, according to this ONC report.
Sequoia Data Usability Workgroup
A lack of data usability is a primary reason that clinicians aren’t using exchanged data.
To help address data usability issues, the Sequoia Project – which is the Recognized Coordinating Entity (RCE) for TEFCA – formed the Data Usability Workgroup.
The Workgroup, with broad volunteer healthcare constituent representation, was formed to create guidance for developers of health information technology (HIT) to improve data usability. Thus far the groups’ areas of focus include:
- Data Provenance and Traceability of Changes- to track who originally entered the data and who has made changes
- Effective Use of standardized Codes – versus using proprietary codes
- Reducing the Impact of Duplicates – as data comes to the receiver from multiple sources, don’t show multiple entries for the same data element
- Data Integrity, Format and Trust – ensuring that information received is for the correct patient
- Data Tagging / Searchability – for example, sorting through all of the data received from multiple sources and finding everything that refers to a particular diagnosis
- Effective Use of Narrative for Usability – maintaining narrative free text in the applicable section
EHR Optimization and Training
In addition to taking advantage of the Workgroup’s efforts, healthcare organizations can take additional steps to ensure data is usable for recipient clinicians. Organizations should collaborate with their vendors to optimally configure their systems to support the adoption and use of incoming data. For example, health systems should optimize their EHRs so that incoming lab results are filed with existing lab results so all the results can be easily trended. Similarly, diagnoses and active medications should be incorporated into the respective EHR’s problem and meds lists.
Organizations defining specific role-based workflows is vital. For example, the role that processes incoming information and makes it available to the clinician, the role that incorporates relevant data into the EHR, etc.
Users then require thorough training on the role-based workflows that have been developed. Utilization can be monitored to assess usage and adoption and the need for remedial training.
Clinicians Must Do Their Part
Another usability challenge stems from data that is deemed inadequate or untrustworthy by the receiving clinician. This might happen when the original record is poorly documented or maintained by the sending system’s clinician(s).
For example, the original clinician may inappropriately include a short-term issue like an upper respiratory infection (cold) into the problem list or fail to remove a long-resolved diagnosis from a problem list or a long-expired medication from the med list. Med lists can become further confusing or inaccurate when providers fail to document a start and stop date for certain medications, such as antibiotics.
Consumers can assist in the maintenance of their health records if they are able to provide updates to their own records. For example, a patient might add a note that they had stopped a specific drug on their medication list. To ensure record accuracy, it’s then the clinician’s responsibility to review such annotations.
Of course, clinicians don’t intentionally create inaccurate clinical records, but the reality is that many could work harder to ensure record cleanliness.
Sharing the clinical record with consumers and responding to an appropriate request for information from an authorized user is now required and clinicians must do their part to ensure better data hygiene. This means dedicating the time, energy, and resources required to keep clinical records up-to-date and accurate. Such efforts will ultimately drive efficiencies and improve patient care, as well as advance interoperability.