As part of its mandate for more widespread interoperability, The 21st Century Cures Act called on the Office of the National Coordinator for Health IT to create a Trusted Exchange Framework, and Common Agreement, outlining an inclusive vision for how healthcare data can and should be exchanged among stakeholders and care settings.

ONC's draft of TEFCA  – which lays out a common set of principles and basic table stakes for trusted exchange and data flow among disparate networks – was published on January 5, 2018. Following months of public comment, final rule is expected by the end of this year.

"The Trusted Exchange Framework and Common Agreement is the concept that the various networks talk together: regional health information exchanges, Carequality, CommonWell, some other ones, getting those to talk and leverage the work they've already done," Dr. Don Rucker, national coordinator for health IT, explained earlier this year at HIMSS18.

Another goal is "getting them to expand their use cases, which today are almost always narrowly defined as provider to provider," Rucker added. "We should leverage them – direct to patient, to payers who buy all of our healthcare, so we can actually see what we're getting in this country when we purchase healthcare.

At HIMSS19, ONC Executive Director Steven Posnack and Dr. Terrence O'Malley, a geriatrician at Partners HealthCare who sits on ONC's Health Information Technology Advisory Committee, will offer policy and practice perspectives of how 21st Century Cures and TEFCA will help catalyze a more efficient and effective health data ecosystem.

They'll show how ONC's rulemakings, along with public-private initiatives such as the Argonaut Project, SMART on FHIR and others, are enabling easier and more user-friendly access to information for providers and patients alike.

The big picture, said O'Malley, is that these policies, spurred by the shift to value-based payment are changing the way clinicians practices and "driving up the value of interoperability."

There are six barriers to the adoption of interoperability, he explained:

• Finding a compelling business case
• Managing the complexity of multi-party information exchange
• Managing the complexity of consent and authorization of using information from that exchange
• Meeting the cost of technology acquisition and management
• Overcoming "technical difficulties" such as uneven adoption of semantic or transport standards
• Managing the impact on workforce, workflow and ongoing training

"New payment models create a compelling business case for entities that now hold financial risk for the total cost of care," said O'Malley. "These models are profoundly different from fee-for-service."

These new policy imperatives are changing the game – and speeding the evolution and expansion of the interoperability that's been sought by so many for so long.

"Someone said that the adoption of interoperability is slow because healthcare is like a giant ocean liner, it takes a long time to change course," he said.

But an ocean liner "has one captain and a clearly charted course; healthcare is more like a swarm of independent boats each with its own captain; and each sailing in the direction that maximizes FFS revenues. Some are steering towards the rocks and some towards interoperability."

Moreover, they're all moving in those directions at different speeds based on the incentives and disincentives that are felt differently across healthcare, he added. "Large healthcare systems and hospitals are different from physician practices, home health agencies, skilled nursing facilities and home and community based service providers."

By creating a guide to connect such disparate stakeholders, rules such as TEFCA are helping to reshape the playing field and shift those data exchange incentives. But it's the simple must-do of getting paid that will have the biggest impact, said O'Malley.

"Although technology and the infrastructure to support interoperability have expanded significantly in the last five years, the biggest driver that is increasing the likelihood that interoperability will be adopted as a tool by any health care provider is not the newly available technology," he said.

"Rather, it is the rollout of new payment models that impact financial survival of each of these players. The work of ONC and new technologies lower the barriers to adopt interoperability but it is the payment models that force the decision to adopt."

Now, the incentives are finally in place to share data much more freely. The goal is maintain a healthy bottom line, of course, but a welcome side effect is healthier patients, said O'Malley.

"As a clinician taking care of patients with a complex mix of chronic medical issues, depression or cognitive decline, functional impairment and adverse social determinants of health, under fee for service, the time required by me to communicate with a large care teams to manage patients such as these was not reimbursed. As a result, these patients were treated by a federation of service providers each doing their best to meet the needs of the individual but also meet their financial goals."

Among those different stakeholders, many with competing priorities, "there was no compelling business case to communicate using standard vocabulary or exchange standards," he said. "Indeed, time spent communicating was time not spent on producing a reimbursable service."

But now, with a clear shift toward a value-based approach of "outcomes rather than units of service," the need to exchange information becomes much more apparent, if not imperative, and "interoperability begins to gain value," said O'Malley.

O'Malley and Posnack will speak at the session, "Breaking Down the Silos: Connecting the Public Policy Dots," which is scheduled for Monday, February 11, from 8:45-9:45 a.m. in room W230A.

Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com

Healthcare IT News is a publication of HIMSS Media.