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Tripathi: Cures Act Provisions to Transform Interoperability in 2022

The Trusted Exchange Framework and Common Agreement (TEFCA) is one of several Cures Act provisions set to drive interoperability in 2022.

Key provisions of the 21st Century Cures Act will help transform healthcare interoperability in 2022, according to Micky Tripathi, national coordinator for health IT.

In a HealthAffairs article, Tripathi noted that more than 90 percent of hospitals and physician practices now use EHR systems. However, he emphasized that widespread EHR adoption was just the first step in delivering on the promise of a modern, digital healthcare system.

“Process change often lags behind technological change, and the healthcare industry and intertwined regulations remain deeply imbued with workflows and mindsets born of a paper-based world,” Tripathi wrote in the article.

“Health system reform should be reconceived on the premise of electronic data that can securely, appropriately, and easily flow wherever and whenever needed to improve healthcare quality, safety, efficiency, affordability, and equity,” he continued.

Tripathi pointed to three key 21st Century Cures Act provisions that will help drive nationwide interoperability in 2022.

Enforcement of Information Blocking Regulations

ONC will continue to implement and enforce information blocking regulations to promote electronic health information (EHI) exchange across the care continuum, Tripathi said.

Through October 5, 2022, the definition of EHI is limited to the data elements represented in United States Core Data for Interoperability V1 (USCDI V1). However, starting on October 6, 2022, stakeholders will be expected to share all EHI.

“Expanding the aperture of interoperability to include as much electronic information as possible will provide richer information to inform patient care and reduce the burden on patients of having to manually gather and lug reams of paper records from provider to provider,” Tripathi wrote. “It will also open new horizons for modernization across the entire healthcare continuum.”

FHIR API Certification

In addition to providing a regulatory framework for EHI exchange, the Cures Act Final Rule takes significant steps to make it easier for developers of certified health IT to exchange information.

On April 1, 2022, health IT developers certified to any of the application programming interface (API) certification criteria will be required to attest to compliance with certain pricing and contracting practices that enhance competition, Tripathi noted.

“In short, the Cures Act Final Rule helps to ensure that certain business terms of certified technology developers are not barriers that prevent providers from using certified APIs however they want and with whomever they want,” Tripathi said.

He explained that establishing such requirements will set the stage for the rollout of HL7 Fast Healthcare Interoperability Resources (FHIR) APIs across the industry later in the year.

Health IT developers seeking certification to API criteria are now required to provide a standard FHIR API to all organizations that deploy the developer’s certified API technology by December 31, 2022.

“This will create a climate of innovation by allowing technology developers to build to a common, industrywide specification,” Tripathi said.

The Trusted Exchange Framework and Common Agreement (TEFCA)

Lastly, Tripathi noted that TEFCA will create a nationwide policy and infrastructure backbone to ease data exchange across networks of EHRs and other health IT systems.

Partnering with The Sequoia Project, ONC launched TEFCA on January 18, 2022, establishing a common legal agreement and technical standards for networks to more easily connect with each other.

In a recent press briefing, Tripathi projected that ONC will begin accepting applications for participation in TEFCA in Q2.

Taken together, these three Cures Act policies are set to improve innovation in healthcare delivery, public health, and clinical research, Tripathi wrote.

“Rather than trying to determine or predict where the industry is headed, ONC’s goal is to establish and sustain basic principles and building blocks for an open health IT ecosystem that continues to expand the boundaries of what’s possible for the improvement of health care,” he said.

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