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To Interoperability and Beyond- Topic Summary NURS 516

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In the Fiscal Year (FY) 2022 Inpatient Prospective Payment Systems (IPPS) for Acute Care Hospitals and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) Final Rule , CMS finalized changes to the Medicare Promoting Interoperability Program for eligible hospitals and critical access hospitals (CAHs) attesting to CMS.

For calendar year (CY) 2022, in order to be considered a meaningful user and avoid a downward payment adjustment, eligible hospitals and CAHs may use (1) existing 2015 Edition certification criteria, (2) the 2015 Edition Cures Update criteria, or (3) a combination of the two in order to meet the CEHRT definition, as finalized in the CY 2021 Physician Fee Schedule final rule (85 FR 84818 through 84828) .

Learn more about the CEHRT requirements . To learn more about the 2015 Edition Cures Update, please review ONC's 21st Century Cures Act final rule . To check whether a health IT product has been certified to the 2015 Edition Cures Update criteria, visit the Certified Health IT Product List .

Adoption of the Health Information Exchange Bi-Directional Exchange measure as an alternative to the two existing measures (worth 40 points) under the Health Information Exchange Objective;

Note: The Public Health Registry Reporting and Clinical Data Registry Reporting measures will remain optional and available for a total of 5 bonus points.

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In the Fiscal Year (FY) 2022 Inpatient Prospective Payment Systems (IPPS) for Acute Care Hospitals and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) Final Rule, CMS finalized changes to the Medicare Promoting Interoperability Program for eligible hospitals and critical access hospitals (CAHs) attesting to CMS.

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Please answer one of the two questions:

(1) In your own words, describe two of the following terms and how it relates to health information exchange.

Fast Healthcare Interoperability Resources (FHIR)

Application Programming Interface (API)

Interoperability

(2) How are the HITCH Act of 2009, HIE, and reimbursement connected?

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Doll, J., Malloy, J., & Bland, J. (August 2021). The Promise of Interoperability. American Journal of
Occupational Therapy, (75)4, 1-7. 10.5014/ajot.2021.049002

Centers for Medicare and Medicaid Services. (2022, March 4). 2022 Medicare Promoting Interoperability Program Requirements. https://www.cms.gov/regulations-guidance/promoting-interoperability/2022-medicare-promoting-interoperability-program-requirements

HIMSS. (n.d.). Interoperability in Healthcare. https://www.himss.org/resources/interoperability-healthcare

Islam, M., Rahaman, A., & Islam, R. (26 May 2020). Development of Smart Healthcare Monitoring System in IoT Environment. SN Computer Science, (1)185. https://doi.org/10.1007/s42979-020-00195-y

Joseph, R., Lee, S.,
Anderson, S., & Morrisette, M. (2020, August). Impact of Interoperability
of Smart Infusion Pumps and an Electronic Medical Record in Critical Care. American Journal of
Health-System Pharmacy, (77)15, 1231-1236. https://doi.org/10.1093/ajhp/zxaa164

Millard, M. (2022, January 19). TEFCA,
Framework for Nationwide Health Info Exchange, is Now Live From ONC.
Healthcare IT News. https://www.healthcareitnews.com/news/tefca-framework-nationwide-health-health-exchange-now-live-onc

Nahm, E., Schoenbaum, A., Behm, C., &
Rowen, L. (2020, November). Health Information Exchange: Practical Overview and
Implications for Nursing Practice. The Journal of Nursing Administration,
(50)11, 584-589. DOI: 10.1097/NNA.0000000000000941

Sayeed, R., Gottlieb, D. & Mandl, K.D. (2020,
January). SMART Markers: Collecting Patient-Generated Health Data as a Standardized
Property of Health Information Technology. NPI Digit. Med, (3)9. doi.org/10.1038/s41746-020-0218-6

Sewell, J. (2019). Informatics and nursing:
Opportunities and challenges (6th ed.). Wolters Kluwer.

Siwicki, B. (2022, January 27). Everything You Wanted to Know About TEFCA (But Were too Afraid to Ask). Healthcare IT News. https://www.healthcareitnews.com/news/everything-you-wanted-know-about-tefca-were-afraid-ask

The Office of The National Coordinator for Health Information Technology. (n.d.). What is HL7 FHIR. https://www.healthit.gov/sites/default/files/page/202104/What%20Is%20FHIR%20Fact%20Sheet.pdf

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The Office of the National Coordinator for Health Information Technology (ONC) launched the Trusted Exchange Framework and Common Agreement (TEFCA).

Establish a universal policy for interoperability, simplify connectivity for organizations, and enable patients to access their health information.

The Trusted Exchange Framework aims to establish standards for all networks involved

Common Agreement serves as a standard of governing rules for data sharing (Millard, 2022).

Creating and maintaining a portable, comprehensive health record that spans the continuum of care is the greatest promise of interoperability.

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The Office of the National Coordinator for Health Information Technology made the Trusted Exchange Framework and Common Agreement available on January 18.

While TEFCA is structured to create national connectivity of electronic health records, it can't perform unless a network of provider organizations becomes a part of the Qualified Health Information Networks, or QHINs, which facilitate data sharing. Unfortunately, many providers still aren't familiar with the new agreement, industry observers note.

Drew Ivan, chief strategy officer at healthcare interoperability vendor Lyniate, is a TEFCA expert and knows data sharing well. Healthcare IT News interviewed Drew, asking him to do a deep dive into TEFCA so readers can get a better understanding of what the agreement means and requires.
Q. On January 18, the ONC announced the publication of TEFCA. What is TEFCA, and were there any surprises in the announcement?
A. ONC called for the creation of TEFCA under the 21st Century Cures Act, which was passed in 2016, and TEFCA drafts were released in 2018 and 2019. Healthcare leaders have been anticipating this for several years.

TEFCA was developed, in part, to create a nationwide system that enables safe and easy sharing of healthcare information across care settings with a goal of increasing access to data for improved outcomes.

It is made up of two parts: the Trusted Exchange Framework details standards that networks must follow when sharing data, and the Common Agreement is a legal agreement that governs data sharing between networks.

A common use case that represents the benefit of TEFCA is associated with travel. Let's say you live in Boston and travel to Orlando for a vacation and become sick or injured. You want your medical record to be available so that the doctor taking care of you in Orlando has all the information she needs to give you the best care in the context of any other care you receive.

Another example is when patients are transported from a rural care setting for treatment a long distance away. Connecting rural and urban care settings is an expected benefit. TEFCA will enable this type of complete and accurate understanding of an individual's medical history.

While this is happening to some extent through health information exchanges at regional and state levels, the frameworks for how data is shared are inconsistent, which hinders efficiency and efficacy.

TEFCA aims to bring learned best practices to others by establishing a framework for Qualified Health Information Networks. QHINs will all share information with each other and will be organized under an umbrella organization called the Recognized Coordinating Entity (RCE). In support of this initiative, the ONC has contracted with a private organization - the Sequoia Project - to serve as the RCE.

We were pleasantly surprised to see that ONC also released the TEFCA FHIR Roadmap, which outlines how TEFCA will accelerate FHIR adoption throughout the healthcare industry.

ONC recognizes that health data exchange today relies heavily on established standards - including Integrating the Healthcare Enterprise profiles and HL7 Consolidated Clinical Document Architecture - and that FHIR is a more modern approach. The road map outlines a three-year plan to accelerate adoption through what ONC calls "achievable, incremental steps."

As healthcare organizations learn how TEFCA will affect them, they should evaluate their interoperability strategy and apply best practices. Connecting to QHINs and participating in TEFCA will require a clear understanding of their data-sharing capabilities, which might mean looking outside the organization to trusted interoperability partners for help and to ensure success.
Q. TEFCA cannot work unless a network of provider organizations become a part of the QHINs, which facilitate data sharing. Yet there is not a mandate at this time for providers to participate. How will there be a critical mass of providers to make TEFCA work?
A. Incentives tend to be better drivers than mandates. If governmental and commercial payers offer incentives for providers to participate in a QHIN, that may be more of an encouragement to providers than a mandate. Or we may see health plans deciding to contract only with providers that connect with a QHIN.

Another driver will be patients. People want to manage their own health information, a trend that has grown since COVID-19. With some patients in rural areas having to travel outside their communities for care, they need access to their full medical records. Another example is vaccination status. Many of us now access our vaccine credentials via a smartphone app.

The more empowered consumers become by stewarding their own health data, the more they will expect this type of data access as the norm. If patients learn they can start getting their health information with less effort than it takes now, they will choose providers that participate in QHINs over those that don't.
Q. Why is it important for healthcare professionals to be educated on TEFCA and raise awareness?
A. It's important for healthcare leaders to stay up to date on TEFCA developments, not only because of the drivers noted earlier, but also because they should be focusing on the long-term goals and positive outcomes of participating in TEFCA, such as eliminating gaps in care, lowering the cost of care and delivering the best care for their patients.

Larger provider organizations will have more resources to educate themselves about connecting to a QHIN. Individual physicians or smaller provider networks may have more difficulty finding the time and resources to educate themselves.

I encourage these providers to visit the ONC website, healthIT.gov, check with other key players in health information exchanges, or count on their existing health IT vendors, which are likely to have efforts underway to enable data sharing through TEFCA. The RCE also is hosting informational webinars in the coming months.

Beyond educating themselves, providers will need a plan, which starts with understanding where their data is and how it is currently shared. Next, they will need to execute their plan. Doing this when they're trying to do everything else that's required of a provider is daunting, so I encourage providers to ask their professional organizations or vendor partners for assistance.
Q. How do you think TEFCA will play out in 2022 and 2023?
A. Large health IT networks can begin the application process to become a QHIN during the second quarter of 2022, and QHIN designation will be awarded toward the end of the year.

Later in 2022, QHINs will likely begin having conversations with each other about the technical connections required to connect QHIN to QHIN. Then there will be a slow and gradual build-out of connectivity over the next 18 months.

Whether TEFCA will be fully embraced by the healthcare industry in this time frame is to be determined, as this will require education, community buy-in and careful consideration of incentives for participation.

Something could catch us off guard, of course. But it's reasonable to expect that two years from now there will be a functioning infrastructure in place to share data across the nation.
Twitter: @SiwickiHealthIT
Email the writer:bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.

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Everything you wanted to know about TEFCA (but were afraid to ask)

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The Office of the National Coordinator for Health Information Technology made the Trusted Exchange Framework and Common Agreement available on January 18. While TEFCA is structured to create national connectivity of electronic health records, it can't perform unless a network of provider organizations becomes a part of the Qualified Health Information Networks, or QHINs, which facilitate data sharing.

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Islam et al (2020) explores the use of a smart healthcare monitoring device. The device uses a sensor to remotely capture a patient’s heart rate and body temperature. In their proposed study, an Internet of Things (IoT) is used to transmit sensed information over a network to a computer for graphical plotting. The interface updates every few seconds, allowing for continuous trending of these vitals

Joseph et al (2020) investigates the use of smart infusion pump software in conjunction with the electronic medication administration record (eMAR). Infusion limits and dose alerts for two common vasopressors were programmed into the infusion pump. Dosing information, titration, start, pause, and stop times were captured in real time and transmitted to the eMAR. The results of the study demonstrate a decrease in dose-alert triggers, increase in documentation and accuracy, and an increase in charge capture (Joseph et al, 2020).

Sayeed et al (2020) seeks to integrate patient generated health data (PGHD) by incorporating SMART markers. SMART markers use request and report actions to allow clinicians the ability to request PGHD from smartphone apps during point of care. This study lays important groundwork for health entities that utilize patient portal applications on mobile devices

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The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 is an incentive to increase meaningful use of health information technology and health information exchange systems (Sewell, 2019)

Health information exchange- movement of electronic data in a way that allows secure, timely access and retrieval

Interoperability- a system’s capability to share health data and information with another system or device.

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Levels of Interoperability

Foundational interoperability- interconnectivity of applications and systems

Organizational interoperability- executive functions such as polies, legalities, and governance

Structural interoperability- synthesis, format, and organization of data

Semantics- standardized vocabulary in terms of coding and value sets (HIMSS, n.d.).

Health Level Seven (HL7)

Leading organization for standards in healthcare messaging.

Created Fast Healthcare Interoperability Resources (FHIR)

Uses an application programming interface (API) and functions of the internet to facilitate resource exchange (The Office of the National Coordinator for Health Information Technology, n.d.).

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Explore how the CDC encourages the use of health information exchange and data interoperability.

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Effective interoperability of healthcare data ensures that electronic health information is shared appropriately between healthcare and public health partners in the right format, through the right channel at the right time.

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Effective interoperability of healthcare data ensures that electronic health information is shared appropriately between healthcare and public health partners in the right format, through the right channel at the right time.