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ONC Seeks to Build Trusted Exchange Framework to Achieve Interoperability

Laura Joszt
Draft framework from the Office of the National Coordinator on Health IT seeks to build a single on-ramp to advance interoperability in the United States through the Trusted Exchange Framework.
Despite the growth in health information technology (IT) and the ever-increasing amounts of patient data, healthcare information is still very siloed, with computer networks unable to talk to one another. 

The 21st Century Cures Act of 2016 included provisions on increasing interoperability and leveraging existing work in building electronic medical records. The Office of the National Coordinator (ONC) on Health IT released the draft of the Trusted Exchange Framework, which will take a significant step toward achieving interoperability.

The draft was created after 3 listening sessions, 1 public comment period, and hundreds of stakeholder meetings and phone calls. It is open for public comment until February 18, 2018.

“This is almost the, if you will, network of network concept,” explained Don Rucker, MD, national coordinator for health information technology, during a briefing. “How do these networks—which are often, and typically, moving similar sets of information—how can we get them connected?”

Rucker called interoperability a “national challenge.” But despite the difficulty with trying to implement interoperability, he also noted that there has been some progress, such as regional health information exchanges and other collaborative networks, which ONC is trying to build off of with the Trusted Exchange Framework.

Genevieve Morris, principal deputy national coordinator for health information technology, outlined the 2 parts of the draft:
  1. Principles for Trusted Exchange, which provides guardrails and information for what the network should do to promote interoperability
  2. Minimum Required Terms and Conditions for Trusted Exchange, which provides the legal language
As ONC looked to what people in the industry were already doing, it attempted to narrow its focus for part B on areas causing issue with exchange, such as variations in the participation agreements that cause problems when trying to connect, Morris explained.

She added that the draft ONC has released is “a floor, not a ceiling.” It outlines the minimum that people need to do to facilitate the exchange of information on qualified health information networks.

To operationalize the Trusted Exchange Framework will require a Recognized Coordinating Entity (RCE)—a third-party organization to facilitate exchange.

“We at ONC recognize that our role is to make sure there is equity, scalibility, integrity, and sustainability of health information sharing, and ensure folks are not disenfranchised at all,” Morris said. “But it’s not necessarily our role to operationalize some of these things, and the industry is really better served by doing that themselves.”

The RCE, which will be chosen at a later date, will be an industry-based organization with experience in the space of facilitating exchange of information. There will be a competitive bidding process for companies that have built cooperative agreements, been involved with stakeholder agreements, and that understand governance principles that need to be in place.

The goal of the Trusted Exchange Framework is for ONC to build a single “on ramp” to interoperability. Morris likened the exchange to cell phones: Verizon and AT&T are different providers, but those phones can still connect to one another.

“We want to build network-to-network capabilities that allow a provider to join a single network and be able to get to all the different participants that they need to regardless of where that patient data sits,” Morris said.

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