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Health information sharing framework unveiled

Federal health IT officials under the 21st Century Cures Act have proposed regulations for health data information sharing, the Trusted Exchange Framework 'network of networks.'

If you want a say in how the government deals with health data interoperability, now's your chance.

The Office of the National Coordinator for Health IT (ONC) has released draft rules for a health information sharing plan, called the Trusted Exchange Framework, and the public has until Feb. 18 to comment.

The framework stems from the interoperability provisions of the 21st Century Cures Act of 2016, a wide-ranging law that includes many aspects of healthcare and health IT, of which the health information sharing plan is only one part.

In a conference call with reporters, ONC National Coordinator Donald Rucker, M.D., called the framework concept a "network of networks," and he noted that Congress explicitly called for a way to link disparate existing health information networks.

"How do these networks, which are typically moving very similar sets of information, how do we get them connected?" Rucker said.

Donald Rucker, M.D., ONC National CoordinatorDonald Rucker

The framework, Rucker said, is a response to what he called the "national challenge" of interoperability.

"It hasn't been easy. Folks have made some great progress, but obviously there's a lot of work to be done," he said.

Among the existing networks that ONC officials are looking to link within the health information sharing framework are the many health information exchanges that have sprung up since the HITECH Act of 2009 spurred data sharing with the meaningful use program.

Other such networks include vendor-driven interoperability environments, such as the one overseen by the CommonWell Health Alliance.

CommonWell's director, Jitin Asnaani, told Politico that he thinks the ONC model is a "path to scalable nationwide interoperability."

Mariann Yeager, CEO of another vendor network, the Sequoia Project, was quoted by Politico expressing a somewhat more neutral assessment: "Overall, the approach seems reasonable," but "we need to better understand the details."

ONC envisions the Trusted Exchange Network -- expected to be started by the end of 2018 and fully built out by 2021 -- as being used by federal agencies, individuals, healthcare providers, public and private health organizations, insurance payers and health IT developers.

[The Trusted Exchange Framework is a] network of networks. How do these networks, which are typically moving very similar sets of information, how do we get them connected?
Donald RuckerONC national coordinator

The agency conceives of the network as a technical and governance infrastructure that connects health information networks around a core of "qualified health information networks" (Qualified HIN) overseen by a single, "recognized coordinating entity" to be chosen by ONC in a competitive bid process.

According to ONC, among other things, Qualified HINs must be able to locate and transmit electronic protected health information between multiple organizations and individuals; have mechanisms to audit participants' compliance with certain core obligations; use a connectivity broker; and be neutral as to which participants are allowed to use the network.

A connectivity broker is a service provided by a Qualified HIN that provides the following:

  • A master patient index to accurately identify and match patients with their health information;
  • A health records locator service;
  • Both widely broadcast and specifically directed queries for health information; and
  • Guaranteed return of electronic health information to an authorized Qualified HIN that requests it.

Governance for the proposed framework consists of two parts. Part A is a set of "guardrails" and principles that health information networks should adopt to support interoperability; part B is a set of minimum required legal terms and conditions detailing how network participation agreements should be constructed to ensure health information networks can communicate with each other.

Genevieve Morris, ONC's principal deputy national coordinator, specifically acknowledged the efforts of private sector organizations in laying groundwork for health data interoperability and noted that another private organization will coordinate the health information sharing framework.

"We at ONC recognize that our role is to make sure there is equity, scalability, integrity and sustainability in health information sharing," Morris said.

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