Two days after Health Gorilla was officially approved for onboarding as a Qualified Health Information Network (QHIN), we convened an expert panel fresh from the announcement in Washington, D.C., for a webinar to talk about what it all means.  

The Wednesday session was moderated by Avery Haller, MPH, Executive Director of Strategy and Partnerships at Health Gorilla, and kicked off with a word from our CEO and Co-founder Steve Yaskin.

“I'm really excited about the path forward. I believe the establishment of QHINs really sets a new standard for what it means to participate in national health information exchange in this country,” he said. “Exchange must be rooted in trust and a commitment to protecting patient privacy.”

The history of modern interoperability

Steven Lane, MD, MPH, Health Gorilla’s Chief Medical Officer, spoke about the background of the Trusted Exchange Framework and Common Agreement (TEFCA) and how we got to this place. 

“I just couldn't be more excited to be here at this milestone in our journey,” said Dr. Lane, who is also a practicing primary care physician and a veteran in the clinical informatics space. “But of course this journey started a long time ago.”

Referencing his fellow panel members, he pointed out that they played a large part in the construction of the interoperability ecosystem. 

In 2013, CommonWell Health Alliance – one of the other organizations approved for onboarding as a QHIN – was founded by a handful of Health IT companies with Jitin Asnaani as its executive director. Asnaani now serves on the Board of Directors for Health Gorilla.

A year later, in 2014, Carequality was founded as a public-private initiative implementing a common interoperability framework with Dave Cassel serving as Executive Director. Cassel is now Health Gorilla’s Senior Vice President of Customer Success and Operations.

With the passage of the 21st Century Cures Act in 2016 came TEFCA and prohibitions against information blocking. And coincidentally, that was the same year that the first data exchange under the Carequality framework took place between Sutter Health and Athenahealth provider – and it was one of Dr. Lane’s patients. 

A rising tide lifts all boats

“Despite my best efforts, and Steven’s and Jitin’s and a whole host of others, there were just some areas that we weren't able to unlock in that organic private sector-driven exchange,” Cassel said. 

“A wave hits that tide line and it doesn't go any further. And you need to raise the level of the water before you get any further up the beach,” he added. “And that's really what we're seeing here with TEFCA.”

At the event in D.C. on February 13, Micky Tripathi, National Coordinator for Health IT, said that 30 percent of hospitals in the country aren't connected to a nationwide network. Many of those are in rural areas and are disconnected due to lack of financial resources, technical capacity, and market confusion.

“Heightened trust ultimately is the crux of it,” Cassel said. “In order to raise that water level, we also needed to raise the bar for those who are actually operationalizing connectivity.”

“But at the end of the day we do expect the QHIN ecosystem to result in broader availability of a lot of different use cases,” he added.

Next steps

Now that Health Gorilla and CommonWell have been approved for onboarding as QHINs – along with eHealth Exchange, Epic, Kno2, and KONZA Health Alliance – the next immediate step is testing and implementation. All of the players committed to getting it done by the end of 2023. 

The huge commitment displayed by various governing agencies, including the Veterans Administration (VA), the Centers for Disease Control (CDC), and the Centers for Medicare & Medicaid Services (CMS), all of whom had representatives speak at Monday’s QHIN event, is so encouraging, Asnaani said. 

“They’re incredibly motivated,” he added, citing revisions to the Inpatient Prospective Payment Systems (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Final Rule. The CMS rule will ensure that participation in TEFCA will qualify as part of the reimbursement scoring mix for hospitals and critical access hospitals in 2023, incentivizing QHIN participation.

Use cases

Six specific use cases under TEFCA have been identified. QHINs will support Individual Access Services (IAS) and Treatment on day one. Operations, Payment, Public Benefits Determination, and Public Health will be added later.

“Clinicians have enjoyed tremendous benefits of interoperability over the last 10 or 15 years, but there are clearly so many opportunities to improve the exchange of data with other caregivers with the patients themselves,” Dr. Lane said. “I think this really is going to give us the platform to move that forward.”

“We are reweaving the fabric of health data exchange, which means that all the possibilities are open,” Haller said. 

Which QHIN is right for me?

Another big question on webinar participants’ minds was: What differentiates Health Gorilla as a QHIN?

Yaskin pointed out that all QHINs would not be created equal, despite having some foundational overlaps between all the QHINs and all adhering to the same governing principles. “Health Gorilla is differentiating ourselves in our technology first and foremost,” he said. 

Yaskin cited Health Gorilla’s Master Patient Index and Record Locator Service, as well as advanced APIs that are ready for expansion into new use cases today.

Dr. Lane said that when it comes to choosing a QHIN, variety is important. Depending on the use case, a simple pass-through of data may be sufficient. Whereas for others, a longitudinal record is needed and that means aggregation and deduplication.

“So that's one way in which the QHINs will be very unequal. Some are proudly pass-through and others are firmly committed to enriching the data,” he said.

Ultimately, your use case will inform your decision about which QHIN to join, Haller said.

“We want data to follow the patient,” Haller said. “It's the value-added services on top that you would be choosing as you look towards your QHIN.”

ICYMI

To learn more about our health data security and privacy protocols, click here, or find out more about Health Gorilla’s journey on our Path to QHIN page.