One of the primary goals attached to the Trusted Exchange Framework and Common Agreement (TEFCA) is to establish the first Qualified Health Information Networks (QHINs). QHINs will act as the supernodes under TEFCA's "network of networks" structure and be the designated entities responsible for facilitating the national exchange of health information.
On July 13, 2021, the Recognized Coordinating Entity (RCE) and Office of the National Coordinator for Health Information Technology (ONC) released the timeline for the operationalization of TEFCA. The timeline was followed by iterative documents defining the legal, technical, and functional requirements that Health Information Networks (HIN) must follow to be designated QHINs. Public feedback has been encouraged throughout the process.
After a detailed review of the Elements of the Common Agreement and QHIN Eligibility Criteria, released September 21, 2021, our team provided feedback focused on the benefits that commercial QHINs could bring to the TEFCA "network of networks" architecture.
Below we discuss the history and evolution of Health Information Exchange, highlight the benefits that a commercial entity would bring as a QHIN, and include examples of how Health Gorilla has impacted the healthcare ecosystem with our cutting-edge solutions and growing health information network.
According to HIMSS, Health Information Exchanges (HIEs), also commonly referred to as Health Information Networks (HINs), originated as regional health information organizations (RHIOs). They were typically non-profit organizations and connected providers that were using different EHR systems through a centralized exchange.
The HITECH Act, released in 2009, provided funding for states and their state-designated entities (SDEs) to support statewide HIE services and encourage a nationwide model of change. In 2010, ONC announced the State Health Information Exchange (State HIE) Cooperative Agreement Program awardees which provided states, eligible territories, and qualified State Designated Entities (SDEs) funding, allowing them to develop systems to exchange clinical information electronically. HIEs, and the structure they've put in place, have allowed healthcare providers to begin replacing paper documents and traditional sharing methods with electronic health records (EHR). These quickly improved the comprehensiveness of patient records and enhanced the speed, quality, and security of care.
The development of state and regional HIEs brought tremendous growth to healthcare interoperability and the exchange of eHI. In addition to facilitating the exchange of clinical information nationwide, they are now aggregating disparate EHR data, making it more reliable and actionable. They also supply provider services with advanced analytics that contribute to social determinants of health and payers' data that improve operational efficiency, care management, and risk adjustments.
The success of state and regional HIEs sparked a few key organizations, including Commonwell, Carequality, and eHealth Exchange, to explore interoperability at the national level. They each began developing frameworks to facilitate secure exchanges between networks and quickly became the three largest public HINs in the country. Today, they provide connections and/or memberships to their services to organizations that satisfy their permitted exchange purposes and facilitate data exchanges across the country.
That being said, there continues to be room for improvement in national data exchanges. Today, for digital health companies, payers, hospitals, and other healthcare providers to have complete access to the nation's clinical data, they need to build one-off connections with each public HIE above, which can be costly, time-consuming, and resource-intensive.
To reduce the burden of creating individual connections, Health Gorilla has been pioneering a National HIN under the known TEFCA guidelines. We have connections and memberships with the three organizations above and enable the entire healthcare ecosystem to seamlessly share clinical data and aggregate each patient's complete clinical history in one place.
Earlier this year, we announced our intention to become one of the first designated QHIN's under TEFCA. We believe that our robust HIN, which executes the goals of the 21st Century Cures Act and TEFCA, paired with our proven ability to bridge the gap between the commercial sector and government, and unparalleled master patient index (MPI), have us well-positioned to become one of the first organizations designated.
We look forward to the final TEFCA documentation and are excited to apply for our QHIN designation alongside other industry leaders.
The RCE describes QHINs as high-performing, highly reliable, and highly secure transactional hubs. For an HIE to transition to a QHIN under TEFCA, they will have to be certified and designated by the RCE and, by proxy, receive a government certification. Once appointed the prestigious "Q" they will be responsible for facilitating information exchanges within their own and across other networks. The QHIN Technical Framework (QTF), released July 28, 2021, addressed the standards for exchanging data across networks but did leave flexibility for QHINs. This flexibility will allow them to determine the best exchange methods so long they uphold the security, trust, and standards of TEFCA.
QHINs will also be responsible for the onboarding and management of their networks Participants and Subparticipants and will have to report transaction metrics regularly to the RCE to ensure they comply with the Common Agreement. While the volume of transactions that QHINs will facilitate is unknown, it is estimated that each will be managing tens of millions of transactions monthly. During the first year, QHINs will most likely have to report on the number of organizations that participate in their network and the transaction volume of document deliveries. The RCE continues to develop its long-term reporting metrics and has said that required reporting will likely grow over time as the ecosystem advances.
Commercial HIEs have historically played a unique and essential role in the healthcare ecosystem and will continue to do so once the TEFCA structure is in place.
According to a report released by Facts and Factors, the demand of global Digital Health Market size & share is expected to reach USD 220.94 Billion by 2026 and have a compound annual growth rate (CAGR) of 14.8% between 2020 and 2026. This level of growth magnifies the need for a QHIN model that incorporates commercial entities. They are often leading the innovation and changing the way healthcare is delivered and will be pivotal in addressing the fast-paced digital health market as new actors begin exchanging healthcare information.
Two recent examples of rapid innovation stemmed from the COVID-19 pandemic, where we saw drastic increases in the demand for telehealth visits and remote patient monitoring. While the concepts of telehealth and remote patient monitoring are not new, their rapid growth in popularity did disrupt the industry and increased the need for providers to access and exchange healthcare information quickly and easily. They needed an HIE that could help ensure that providers and care coordinators had access to the correct information at the right time and that their patients' information followed them when and where needed.
Health Gorilla's services became popular solutions for these growing sectors because of our ability to power a diverse set of use cases, including telemedicine and remote patient monitoring. Our APIs, built through the lens of TEFCA and our growing HIN, allow the entire health care ecosystem – patients, payers, providers, digital health solutions, and labs – to seamlessly share health data and aggregate each patient's full clinical history in one place.
Our team believes that pairing the TEFCA regulations with commercial QHIN's close relationship to the market will add a tremendous amount of value. By connecting with a broader scope of organizations, commercial QHINs will be able to develop more efficient data flows, expand their services, and create more innovative lines of business, all while reducing the intricacies of exchange.
While there may be fears that commercial QHINs could monopolize the clinical data market, it is important to keep in mind that they will be subject to the same rules and regulations as any other regional, state, or national HIN when exchanging clinical data. They will act as a liaison between the healthcare market and governing bodies, compliment the more traditional QHINs by allowing them to focus on their core objectives, and relay significant developments as they emerge.
One of the reasons that our team at Health Gorilla is so confident that commercial entities will be valuable additions to the QHIN community stems from the work we've accomplished in Puerto Rico.
On July 1, 2021, our team launched the Puerto Rico Health Information Exchange (PRHIE) in collaboration with the Puerto Rico Department of Health. The PRHIE, which adheres to the 21st Century Cures Act and TEFCA, has brought forward a new era of interoperability for Puerto Rico by streamlining care, reducing costs, empowering patients and providers, and giving public health officials the necessary data to act decisively.
Today, we act as the single-source provider of Health Information Exchange for the Puerto Rico Department of Health and operate as the HIN connecting payers, labs, providers, patients, and public health officials. The PRHIE now includes more than 800 care sites, 12,000 providers and connects more than 2.1 million patients, enabling patient medical record data to be shared securely and electronically. The PRHIE is an excellent example of a commercial entity and government organization coming together to create a cutting-edge solution that benefits the entire healthcare community.
Health Gorilla will be applying to become one of the first designated Qualified Health Information Networks under TEFCA once the final Trusted Exchange Framework is released.
We have been working under the known regulations set forth by TEFCA, are committed to the legal, functional, and technical requirements, and have positioned ourselves to satisfy all six exchange purposes.
Health Gorilla continues to be a market leader and is well-positioned to become a QHIN, having already worked with multiple government entities and commercial organizations to expand interoperability. We look forward to expanding our services and facilitating access to health data across the country with our flexible platform, unique national master patient index, and FHIR-based clinical data APIs.