Experts weigh in on federal efforts to standardize interoperability for Texas health information networks


Boram Kim


A panel of local health information exchange (HIE) experts led a discussion on the challenges and policies impacting the state’s health information network (HIN) at the 2023 Texas State of Reform Health Policy Conference in Austin last week.


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As part of its requirements under the 21st Century Cures Act, the Office of the National Coordinator for Health Information Technology (ONC) published its Trusted Exchange Framework and Common Agreement (TEFCA) last year. 

TEFCA aims to establish the infrastructure model and governing approach for users in different networks to securely share basic clinical information with each other under commonly agreed-to expectations and rules. 

Last month, the US Department of Health and Human Services announced the first six organizations it plans to onboard and “designate” as qualified health information networks (QHINs): CommonWell Health Alliance, eHealth Exchange, Epic TEFCA Interoperability Services, Health Gorilla, Kno2, and KONZA.

TEFCA sees this as the first step toward its goal of establishing national standards of interoperability. Interoperability has proven challenging over the years because of the complicated way in which electronic health records (EHR) and the systems housing them were formatted, according to Geroge Gooch, CEO of Texas Health Services Authority. 

“Originally, the plan for stage two [of] Meaningful Use was a pretty hard requirement that you had to connect to a health information exchange organization,” Gooch said. “When we finally got around to rolling out stage two [of] Meaningful Use, that hard requirement became more of a guideline or a good idea—that you didn’t have to do it.

And that’s one of the big things that got operability because everyone was solving interoperability, but they all went their separate ways to do it. We didn’t have this one unified approach anymore, but we had EHR vendors that created networks and frameworks, [such as] CommonWell-Carequality.”

Gooch said the efforts around standardization is to create a national framework that allows local and state systems to connect and share information much like how the interstate highway system enables us to move from one point to another. 

Under CMS’s new policies around interoperability and patient access to health data, the panel pointed out that hospitals are required to share administrative discharge and transfer data with primary care physicians. 

“It’s a requirement for the hospitals to send out these notifications,” said C3HIE CEO Phil Beckett. “And because the health information exchange—they’re already sending us that data, we’re doing that for them—they didn’t have to do anything. So it’s a reduction of their burden of work. We do this for them, so they love it. It’s great.

The other end of the equation is the physician’s office, who don’t really want these [records] or it’s not necessarily in their workflow. Where do they go? It’s very optional on the physician side, so they can say, ‘I don’t want these [systems].’ So [we’re] trying to work through that. How do we make it … a practical, functional model that really makes sense in the hospital? And then those involved in the patient’s care?”

C3HIE, a local HIN with more than 1,100 providers and health connections across Texas, offers HIE services that consist of real-time data feeds between participating hospitals, primary care physicians, and other healthcare organizations. Beckett said the challenge of sharing health records is not necessarily technical but is layered with political, financial, and workflow complexities. 

The panel identified data security, specifically around HIPAA compliance, as another challenge. Gooch said HIPAA privacy and security breach rules are guidelines for safeguarding and sharing patient information. 

Under the Cures Act, the Information Blocking final rule, designed to give patients greater control over their personal health data and make it easier to share patient records, eliminates intentional barriers to electronic health information exchange. 

“There are 10 requirements, but I’d say if you’re looking for the shortcut of what you need to do in real-time, just assume that if you have a routine request for health information, you should be sharing it,” Gooch said. “If you’re not sharing it, step one is you might be in violation of the information blocking rule unless you meet one of eight exceptions …

So we really take in HIPAA, and we have flipped it on its head. Instead of ‘you may share this information but don’t necessarily have to unless it’s required,’ you have to share this information unless you can cross your t’s and dot your i’s and show us why you cannot share it. So it is really a paradigm shift.”