Last week marked the live debut of the Trusted Exchange Framework and Common Agreement (TEFCA), from The Office of the National Coordinator for Health Information Technology (ONC). The ONC has been developing TEFCA with the goal of enhancing interoperability and increasing patients’ access to their healthcare data. However, this initiative drew criticism from Don Rucker, a former ONC chief who is now a chief strategy officer for 1upHealth.
Rucker contends that TEFCA is founded on an obsolete data exchange protocol, thereby hindering its usefulness. TEFCA, conceived in the 21st Century Cures Act of 2016, is supposed to foster a nationwide health information exchange network that leverages shared principles, terms, and conditions to facilitate data exchanges across disparate health information systems.
Upon the launch of TEFCAs, five organizations were designated by the ONC as qualified health information networks: eHealth Exchange, Epic Nexus, Health Gorilla, Konza, and MedAllies. These Qualified Health Information Networks or QHINs, as per the ONC, will establish direct connections amongst themselves to promote interoperability within their networks.
Rucker, however, raises concerns about the age and limitations of the TEFCA protocol. TEFCA uses an antiquated ’90s-era IHE document exchange-only interchange protocol. He notes that this exchange architecture isn’t compatible with the data formats and programming languages widely used in today’s internet, suggesting that the network could prove more hindrance than help in advancing interoperability.
Furthermore, he argues that TEFCA’s ability to improve health data access is flawed. Rucker notes that relatively few would be interested in loading difficult-to-parse-through data into an old-fashioned API. For TEFCA to significantly improve data access for patients and providers, Rucker suggests that it would need to be updated to handle computable data, or FHIR data.
Rucker voices his skepticism about the ONC’s promise that TEFCA will eventually support modern APIs, specifically FHIR and HL7, in 2024. He is eager to see the technical plans and confounded as to why these modern protocols weren’t implemented from the outset.