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The Trusted Exchange Framework and Common Agreement (TECFA) has a newly published draft iteration. This revision to the working set of principles is intended to enable widespread data exchange between health industry participants.

The Office of the National Coordinator (ONC) for Health IT is now seeking comments on the draft.

“The seamless, interoperable exchange of health information is a key piece of building a health system that empowers patients and providers and delivers better care at a lower cost. The 21st Century Cures Act took an important step toward this goal by promoting a national framework and common agreement for the trusted exchange of health information. We appreciate the comments and input from stakeholders so far, and we look forward to continued engagement.”


– HHS Secretary Alex Azar.

The 21st Century Cures Act passed by Congress, intends to empower a single trusted way to exchange healthcare information.  Currently, many providers, insurers, vendors, public health departments and individuals lack a core exchange mechanism. Federal, state, tribal and local governments have the same issue.

“The updated Trusted Exchange Framework and Common Agreement … considered the more than 200 comments we received on our previous draft and reflects extensive work with our federal partners. The future Common Agreement … will provide the governance necessary to meet the interoperability demands of diverse stakeholders, including patients, healthcare providers and health plans.”


– Don Rucker, MD, national coordinator for HIT

Friday’s release responded to stakeholder comments by making key changes to the draft requirements. Health Information Networks  (HINs) are entities that administer policies and agreements defining business, operational, technical or other requirements for enabling access, exchange or use of electronic health information between unaffiliated individuals or entities; controls for technology or services enabling exchange; or controls to support access, exchange or use of electronic health information among unaffiliated individuals or entities. HINs that choose to participate, would be expected to follow the set of requirements. Changes included updating the purposes for which information can be exchanged, adding a ‘push’ method of data exchange, added a technical framework for quality health information networks, and extended timelines for participating entities to implement changes that will be required by the Common Agreement.

Trusted exchange, must be simplified to scale. Today, industry stakeholders must use multiple exchange methods to communicate. Few hospitals use a single interoperability method, while the majority require three or four methods, and about 30% use five or more methods. It is an expensive approach because the organizations are building many point-to-point interfaces between each other.

“The Trusted Exchange Framework will significantly reduce the need for individual interfaces, which are costly, complex to create and maintain, and an inefficient use of provider and health IT developer resources.”


– HHS.

A HHS survey of about 70 hospitals found interoperability is minimal, with 63 percent of surveyed hospitals saying they had no or little interoperability, 17 percent reporting some interoperability and only 19 percent largely or fully interoperable.

HHS has developed five clear goals to achieve trusted exchange:

  • Build on and extend existing work done by the industry.
  • Provide a single “on-ramp” to interoperability for all.
  • Scale the approach to support the entire nation.
  • Build a competitive market to enable all entities to compete on data services.
  • Achieve long-term sustainability.

Technical controls for a HIN include being able to locate and transmit electronic protected health information between multiple persons and entities. Additional controls include the need to support audits, adoption of a connectivity broker service, be a neutral participant, as well as having participants actively exchanging data in a live clinical setting.

For qualified HINs, HHS expects the Trusted Exchange Framework will give them and their provider participants’ access to more data on patients they serve, enhancing care coordination and care delivery use cases. The framework ensures there is no limitation to the aggregation of data exchanged among participants, although appropriate Business Associate Agreements (BAAs) must be in place.

The framework also offers benefits to patients and their caregivers, enabling them to find all of their health information from across the care continuum, even if they don’t remember the name of the provider they saw. This further enables patients and caregivers to participate in their care and be able to manage their health information.

A final set of key provisions covered under the Trusted Exchange Framework include breach notifications and controlled unclassified information.

This year continues to disrupt the status-quo of health data exchange