As the demand for interoperability persists, health systems nationwide are turning to the Trusted Exchange Framework and Common Agreement to set new standards for interconnectedness and quality of care.
Bruce Darrow, MD, PhD, interim chief digital and information officer and chief medical information officer at New York City-based Mount Sinai Health System connected with Becker's to discuss the evaluation process for selecting a Qualified Health Information Network through TEFCA.
Mount Sinai pledged to join TEFCA in May 2023 but is still in the process of choosing a QHIN. Dr. Darrow said the decision is more complex than data sharing within the QHIN network, as it also includes data sharing for functions such as payers and prior authorization.
"In order to commit to something, I need to understand what it is that I need to do," Dr. Darrow said. "It's a matter of making sure I understand all the ramifications, that we have the right people and competencies to be able to implement, that we've budgeted the process and included people's schedule and work around ongoing projects. It will be a 2025 priority for us."
Epic is a leading option for Mount Sinai's QHIN. Dr. Darrow said he received additional information at Epic's 2024 User Group Meeting, which will be reviewed internally in the upcoming weeks.
Beyond improving and standardizing data sharing across organizations, Dr. Darrow highlights the increased access to organizational benchmarking as a significant advantage of joining TEFCA. Benchmarking against other organizations within the network can reveal successes and areas for improvement, providing insights into quality outcomes and offering long term benefits. However, Dr. Darrow said it is not necessarily TEFCA that will provide the framework for immediate benefits upon implementation.
"When we go live with the data sharing agreement, it is likely to include QHIN participation under TEFCA as a portion of data sharing, which will include interoperability services with payers or payment prior authorization and validation of insurance participation for patients and providers," Dr. Darrow said.
These services can drive immediate impact by streamlining processes such as receiving authorization for services or ensuring a patient knows which providers are in network, Dr. Darrow said.
Despite the opportunities TEFCA holds for a seamless data exchange, healthcare leaders remain concerned about the ease of sharing patient information.
"The challenge in healthcare is to make the exchange of information seamless in service of the patient and the people who are taking care of them," Dr. Darrow said. "When the tools that make those goals achievable are the same things that make it easier for bad actors to abuse the system, it's a challenge."
Dr. Darrow said that the Change Healthcare cyberattack highlighted the problems an organization can face when there is an issue outside of their organization. While Mount Sinai was not the direct target of the cyberattack, it significantly impacted its operations. This disruption prolonged its evaluation process for partnerships to ensure a clear understanding of the vulnerabilities and risks to the organization, Dr. Darrow said.
"I think interoperability has been an elusive goal, but it has come a long way," Dr. Darrow said. "Everybody who's working in this space has really good intentions, and the execution is really challenging."