HomeHealthcareWhy a Former ONC Chief Thinks TEFCA Is Inherently Flawed

Why a Former ONC Chief Thinks TEFCA Is Inherently Flawed

Why a Former ONC Chief Thinks TEFCA Is Inherently Flawed


Final week, the Trusted Alternate Framework and Widespread Settlement (TEFCA) lastly went reside

The Workplace of the Nationwide Coordinator for Well being Info Know-how (ONC) has been working to launch TEFCA for the higher half of a decade, heralding the undertaking as one thing that can enhance interoperability and enhance sufferers’ entry to their healthcare information. Nonetheless, a former ONC chief thinks TEFCA is ill-suited to advance both of these targets — and that the information alternate community would possibly even set interoperability again.

Don Rucker at the moment serves as chief technique officer for well being information platform 1upHealth and was head of the ONC from 2017 to 2021. He believes that TEFCA is constructed on an archaic information alternate protocol that can forestall the initiative from being helpful. 

TEFCA was initially outlined within the twenty first Century Cures Act, which was handed in 2016. The initiative seeks to ascertain a nationwide well being data alternate community that shares a typical set of rules, phrases and situations to facilitate the safe and seamless alternate of information throughout disparate well being data programs.

When the ONC introduced TEFCA’s launch final week, it designated 5 organizations as certified well being data networks: eHealth Alternate, Epic Nexus, Well being Gorilla, Konza and MedAllies. The ONC stated that these QHINs will set up direct connections with one another, selling interoperability among the many networks they embody.

The purported aim of the TEFCA community is to make it straightforward for suppliers and sufferers to rapidly entry well being information each time they want it, no matter EHR vendor. However the protocol on which TEFCA is constructed is just too dated for the initiative to ship on these guarantees, Rucker argued.

TEFCA makes use of a “90s-era” IHE doc exchange-only interchange protocol, he identified. This information alternate structure was not constructed for the computable information codecs and programming languages of at this time’s Web, Rucker defined. 

“[The IHE protocol] doesn’t mean you can compute for well being or health or wellness or issues like if the meds you’re on make sense for you,” he declared. “There’s completely no means to do this with TEFCA, so it’s a really historical and admittedly fairly insecure strategy to networks.”

Well being information entry gained’t enhance as a result of nobody desires to try to load a mass of difficult-to-parse-through information on an arcane API, Rucker identified. 

To ensure that TEFCA to really help higher information entry for suppliers and sufferers, it must be modernized to deal with computable information, i.e. FHIR information, he argued. Nonetheless, TEFCA truly permits its contributors to dam entry to computable information fields, in addition to forestall the trendy APIs that energy almost each different side of our net utilization, Rucker famous.

“For anybody utilizing TEFCA even as soon as, the EHR distributors might refuse to present them the information in a contemporary, computable means and demand they get the information in a gradual, flaky, brokered, incomputable means. That was put in as an exception to the data blocking prohibitions, which is a double unfavorable. For instance, Epic, who lobbied for this, can refuse to present any digital app chosen by a affected person the information in a kind that may be computed,” he defined.

The ONC has stated that TEFCA will transfer to help fashionable APIs, akin to FHIR and HL7, in 2024. Rucker isn’t very assured by that promise, noting he’s wanting to see the technical plans and is confused why the undertaking wouldn’t begin with fashionable protocols within the first place.

Picture: GarryKillian, Getty Photographs



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