On Monday, Kno2 submitted our comment letter to the Office of the National Coordinator for Health IT (ONC) in response to Draft 2 of the Trusted Exchange Framework and Common Agreement (TEFCA).

In general, we applaud the current focus of ONC to push interoperability forward, building upon innovation from current industry interoperability frameworks and networks, along with interoperability focus from CMS in its recent proposed rule, and the requirements from Congress in the 21st Century Cures Act. Yet we are concerned that the specifics of ONC’s proposals within TEFCA draft 2 may hinder progress that is already being made in the industry and disrupt exchange that is currently happening.

In the 21st Century Cures Act (Sections 4003(b)(9)(A) & 4003(b)(9)(B)(i)), ONC is given the task to “develop or support a trusted exchange framework” (emphasis added). Section 4003(b)(9)(F)(iii) goes on to specifically state that “the trusted exchange framework and common agreement…shall take into account existing trusted exchange frameworks and agreements used by health information networks to avoid the disruption of existing exchanges between participants of health information networks.”

Organizations like Carequality and the CommonWell Health Alliance already have wide adoption and are realizing nationwide interoperability for query-based document exchange. Carequality currently reports more than 19 Million patient records exchanged on a monthly basis. Push-based messaging, which was previously ignored in TEFCA draft 1 but has been added to draft 2, is largely facilitated today by DirectTrust™, which currently reports more than 1.9 Million DirectTrust trusted addresses nationwide with more than 164 Million Direct secure message transactions sent/received in Q1 2019. These organizations have largely focused on provider-to-provider exchange to date, but work is already occurring to expand to payors, patients and others throughout the care continuum.

We urge ONC to reconsider its direction in complying with the congressional mandate to “develop or support a trusted exchange framework” by looking to the work already taking place in the industry today, and supporting, rather than starting over and developing, a trusted exchange framework, in order to continue pushing forward nationwide interoperability while still following the additional congressional mandate to “avoid the disruption of existing exchanges between participants of health information networks.”

Kno2 commented on single on-ramps, exchange modalities, population-level data exchange, exchange purposes, EHI used or disclosed outside the U.S., Health Information Network (HIN), adherence to application standards, the role of the RCE, SAML Tokens in the QUIN technical framework, exchange content/structure, patient identity resolution, meaningful choice, as well as  QUIN fees.

To read all comments, you can access Kno2’s full comment letter here.

For any questions regarding the proposed rulings or Kno2’s response, please contact us.