The Sequoia Project, acting as a Recognized Coordinating Entity for the TEFCA interoperability framework, has launched a renewed project FHIR roadmap for TEFCA exchange which has a four-stage timeline for gradual adoption of the FHIR (Fast Healthcare Interoperability Resources) standard for data sharing.
Version 2 of the roadmap envisions FHIR sharing between Qualified Health Information Networks (QHINs), which is Stage 3 of the plan, to be piloted in 2025, with implementation specifications developed shortly after the plans are completed. pilot tests. This will allow QHINs to leverage FHIR for QHIN-to-QHIN exchange while still supporting non-FHIR approaches within QHINs’ internal networks.
The Office of the National Coordinator for Health Information Technology (ONC) has led a multi-year process together with the RCE to implement TEFCA, which was envisioned by the 21st Century Cures Act. The idea is to create a “network of networks” to share health data throughout the country. The goal is that, like wireless networks, electrical networks and ATMs, the user experience is as if it were a single network.
Providing some background, ICE noted that initial work on TEFCA began with more established standards, such as the IHE-based C-CDA content exchange. But the industry’s rapid adoption of FHIR makes it imperative that TEFCA includes a deliberate strategy to add FHIR-based exchange.
“Most of the FHIR deployment activity in the market has focused on the peer-to-peer exchange of FHIR resources via FHIR APIs without network intermediaries. However, some networks have leveraged their infrastructure to support FHIR in various ways,” the Roadmap document states. “For example, some national and state/regional networks use existing IHE-based brokerage infrastructure to exchange FHIR payloads. Additionally, initial pilot work has begun using network infrastructure to support FHIR API sharing between endpoints and some networks plan to offer negotiated FHIR API sharing.”
The roadmap foresees four stages of development to provide continuity to FHIR activities in the market and enable TEFCA’s policy and technical infrastructure to accelerate the adoption of FHIR. “It also unites network-based exchange communities and users of FHIR APIs through ONC-certified EHRs and CMS-required APIs, which have been operating in parallel until now. “We believe that both patterns of sharing will be important in the future and that the use of FHIR APIs in TEFCA can help these patterns complement each other and ultimately deliver on the promise of a modern, digital healthcare system.”
The roadmap shows four stages of the FHIR exchange at TEFCA, with requirements for each stage based on the previous stage:
• Stage 1: FHIR content support
− Included as part of the initial TEFCA release.
− QHIN-managed IHE exchange of FHIR payloads between available QHINs.
• Stage 2: FHIR exchange facilitated by QHIN
− QHIN support is required to facilitate FHIR API exchange.
− Exchange of participants and subparticipants through the available FHIR APIs.
• Stage 3: Exchange QHIN to QHIN FHIR
− Support for exchange between QHINs via FHIR API is required.
• Stage 4: End-to-end FHIR exchange
− Support for QHIN-managed FHIR exchange between participants and
Subparticipants.
Each stage will be supported by a new version of the QHIN Technical Framework and managed through the change management process in the Common Agreement.
A timeline shows that stages 1 and 2 will take place in 2024, stage 3 in 2026, and stage 4 in an unspecified future time period.
The RCE notes that the end-to-end FHIR exchange of Stage 4 would allow a participant/subparticipant to seamlessly exchange FHIR data between themselves and other network members through the QHINs and many other intermediaries both within the QHIN network as through the network governed by TEFCA. . This requires further research into optimal methods for secure exchange over the network via QHINs. When that research is completed, ONC will launch a pilot with TEFCA users to determine how and when that research can be implemented in a production environment.
The Common Agreement, published in September 2021, includes six exchange purposes that organizations must support to be designated as a QHIN. The purposes of the exchange include Treatment, Payment, Health Care Operations, Public Health, Benefit Determination, and Individual Access Services.
The following organizations were officially designated as initial QHINS after successfully completing the TEFCA incorporation process.
• eHealth exchange
• Epic Nexus
• Gorilla Health
• CONZA
• Medical allies
There are approximately 20 organizations formally seeking QHIN status.
