By Josh Mast (Oracle Health), Chair, EHR Association Public Policy Leadership Workgroup

As the 21^st Century Cures Act transitions from policy to practice, numerous states are looking at their interoperability and privacy regulations with an eye toward enacting laws governing healthcare and health IT utilization. This includes establishing state health data utilities (HDUs), health information exchanges (HIEs), and data sharing agreements.

The EHR Association supports states’ ability to gather information for public health, population health, and other purposes. However, a patchwork regulatory approach could create unintended roadblocks to the secure national exchange of and access to critical health information.

A better approach – one that can reduce cost and burden – is to ensure state HIEs and HDUs connect into TEFCA, which would enable a single connection to access/exchange information across the country and create efficient information sharing for all participants.

A Sampling of State Activities

Three states that exemplify the challenges confronting health IT developers and providers within this new and evolving regulatory environment are California, Iowa, and Florida.

California has established a single Data Sharing Agreement and a common set of policies and procedures governing the exchange of health information between the state’s healthcare entities and government agencies. It also mandates adherence to a state Data Exchange Framework by any businesses that store or maintain medical information on behalf of providers. This includes EHR and other health IT developers.

With federal activities already underway that accomplish these same goals, California’s legislation may create additional costs and compliance burdens. For example, the state’s Information Blocking Prohibition policy provides additional restrictions for how participants that are already subject to federal information blocking regulations can utilize the licensing and manner exceptions in California’s data exchange framework. 

Iowa, on the other hand, is considering legislation that would create and require all the state’s providers and payers to participate in a state-designated HDU. In a recent letter to the Iowa Health and Human Services Committee, we raised concerns about compelling healthcare providers to submit data to an HDU that has not yet demonstrated its value. Doing so creates additional connections, costs, and compliance monitoring when the same health information can be easily provided and exchanged through TEFCA participation.

Leveraging TEFCA

Our stance is that states should leverage the hard work and financial investment already completed by the federal government by promoting participation in TEFCA. Doing so would save the time, resources, and costs necessary to establish a state-specific HDU or HIE model.

Substantial federal resources have been invested into establishing TEFCA as a single on-ramp to data exchange in healthcare. Participants can connect to TEFCA once, and instantly request records from any other connected entity for the network’s supported use cases (treatment, payment, operations, public health, government benefits determination, and individual access services). Because connections to TEFCA can be achieved in a variety of ways, participants can choose the manner that best suits them..

Our stance is that states should leverage the hard work and financial investment already completed by the federal government by promoting participation in TEFCA. Doing so would save the time, resources, and costs necessary to establish a state-specific HDU or HIE model.

Most provider organizations already engage in the secure exchange of hundreds of millions of records monthly through direct connections facilitated by nationwide frameworks like Carequality, the CommonWell Health Alliance, the eHealth Exchange, and TEFCA. This connectivity leads to improved patient care and streamlined administrative processes.

Conversely, state HIE and HDU models that force all participants to submit patient records to a centralized repository have historically struggled with financial sustainability. It is challenging to simultaneously meet all exchange use cases as the specific types of information necessary to do so can vary greatly, leading to incompatibilities. As a result, stakeholders tend to bypass HDUs or HIEs, preferring to request data directly from the provider organization or health plan rather than relying on secondhand information from a generic repository. 

Direct connections also allow stakeholders to adopt specialized tools that meet their specific data processing needs and retrieve the up-to-date information that is most pertinent to their needs.

Economies of Scale

The more states that point to nationwide exchanges or require their state HIEs to participate in TEFCA or a nationwide exchange, the fewer connections everyone needs to exchange information. This ultimately leads to reduced cost and burden. 

Further, universal participation in TEFCA allows physicians, health plans, public health agencies, and others to directly request and receive the data they need without maintaining a costly and low-value data repository.

Ultimately, leveraging TEFCA and promoting its widespread adoption offers states a cost-effective, efficient, and scalable solution for health information exchange – one that aligns with national standards and decreases the necessity for state-specific infrastructure that could lead to higher costs and more complex maintenance requirements.