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EHR Vendor Epic Systems: Applying as TEFCA QHIN a ‘Logical Next Step’

Epic is the first EHR vendor to announce its intention to participate in the Trusted Exchange Framework and Common Agreement (TEFCA) as a QHIN.

With over a decade of interoperability initiatives under its belt, EHR vendor Epic Systems is well-situated to fulfill the role of a qualified health information network (QHIN) in the Trusted Exchange Framework and Common Agreement (TEFCA), according to Matt Doyle, Epic Systems R&D team lead.

Epic announced its plan to apply as a QHIN in June, a move that would let Epic connect to other QHINs to support health information exchange nationwide.

“TEFCA is the next logical step in Epic's long history of supporting interoperability," Doyle, who also serves as software development team leader for interoperability at Epic, told EHRIntelligence in an interview.

“We're excited to be partners on this project,” he continued. “TEFCA is going to benefit all of us. Providers will have easier access to clinical information that they need, and patients will benefit from more complete care.”

Epic said its interoperability work began about 15 years ago with the launch of Care Everywhere, a platform for standards-based exchange of health information. Currently, all of Epic’s US customers participate in the data sharing platform. 

“Collectively, our customers exchange 10 million patient charts every single day, half of which are with other vendors,” Doyle noted. “That includes EHRs, state health information exchanges (HIEs), and critically, federal partners, like the Department of Defense, the VA, and the SSA.”

The next stage of electronic health data sharing began in 2016 with the Carequality interoperability framework, Doyle said. Carequality spans multiple networks and HIEs to pull together data independent of what health IT platform it comes from. Currently, 70 percent of hospitals across the country can exchange health data directly at the point of care through Carequality.

Doyle said that TEFCA is the next logical stage of interoperability, as it presents an opportunity to get hospitals that have yet to exchange health information connected to a nationwide network.

“This is the opportunity to reach out to that remaining 30 percent and help them get connected, help them achieve success exchanging health records at scale,” Doyle said.

Epic is the first EHR vendor to announce its intention to participate in TEFCA as a QHIN.

“TEFCA is about inviting and including a diverse set of participants,” Doyle emphasized. “That would include providers, hospitals, EHR vendors, and public health authorities. My hope is that Epic's announcement will inspire others to want to participate as well.”

Doyle said that Epic has been involved in TEFCA since ONC published the first draft in 2018.

“They've had several drafts and iterations over the last several years, and every time, we've always been there ready to give feedback,” Doyle said.

“In addition to those formal processes, we've also had a number of meetings with both the ONC and Sequoia to share our feedback and expertise,” he added. “Epic has a lot of experience with interoperability. We want to give that feedback to really help them understand what works and what ideas should be repeated.”

Doyle said that ONC and The Sequoia Project, TEFCA’s recognized coordinating entity (RCE), have been very open to feedback from Epic and other members of the private sector.

For instance, the concept of a “network of networks” has worked well in the past, as seen in the success of Carequality, Doyle said.

“They're taking those ideas that have worked in the past and rolling them into TEFCA to make sure that we learn from our past activities,” he continued.

ONC and The Sequoia Project announced the publication of TEFCA in January 2022. While ONC has not announced a specific date yet, Micky Tripathi, national coordinator for health IT, has mentioned the end of 2022 as a goal for opening QHIN applications.

“They want to get folks onboarding as quickly as possible,” Doyle said. “Epic's goal is to be ready to do the onboarding testing as soon as Sequoia and ONC are ready for QHINs to participate.”

In preparation for the application and the potential onboarding process, Epic has been working on the development needed to deploy QHIN services across its community of providers. Additionally, the vendor has been conducting outreach with customers to encourage TEFCA participation, Doyle said.  

“TEFCA's best opportunity for success and positive impact is if we have a broad set of participants, so we're hopeful that we can bring a lot of the Epic community into this,” Doyle noted. “We are taking all the expertise, and bringing that expertise into the preparation, both on development and operationally, to get our customers ready.”

Doyle noted that while Epic’s planned role in TEFCA is as a QHIN, it’s important for stakeholders to think about the right position for them to play in the interoperability framework.

“Being a QHIN requires a lot of scalable infrastructure, experience, and the technical know-how to operationalize all of that,” he said. “Some folks will want to be a QHIN, but there are spots for others to play as well. Some groups may choose that they want to be participants in TEFCA or sub-participants.”

TEFCA participants will input and exchange data with QHINs and sub-participants may include persons or entities that use the services of a participant to send and receive health data, according to The Sequoia Project.

“I see TEFCA as the opportunity for all of us to grow and improve together,” Doyle said. “I hope that EHR vendors, HIEs, public health authorities, provider organizations, and hospitals, are looking at the details to think through what the right role that they can play to make this successful to help providers and patients.”

“If they don't know what role that is, then they should reach out to the Sequoia Project to get some guidance about how they can participate,” he concluded.

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