It's not just Epic: Mount Sinai deputy CIO clears up TEFCA misconceptions

While the understood goal of the Trusted Exchange Framework and Common Agreement is to establish a nationwide EHR exchange, there have been misconceptions about how this will be executed.

TEFCA is a health information exchange framework that is part of the 21st Century Cures Act, in which participating hospitals and health systems have pledged to share health information with organizations across the country.

Bruce Darrow, MD, PhD, senior vice president of information technology, deputy chief information officer, and chief medical information officer for the Mount Sinai Health System, spoke with Becker's about TEFCA's potential for creating enhanced interoperability.

"Over the past 10 years we've seen the clinical benefits of information exchange — I am already able to speak with my patients about the medication they were prescribed at an urgent care facility or what their doctor at another hospital across town recommended," Dr. Darrow said. "TEFCA codifies national standards that will allow EHR vendors to structure information with sharing in mind."

However, Dr. Darrow called attention to an existing misconception that all hospitals and health systems participating in TEFCA have pledged to use Epic's software in this framework. He specified that there are various Qualified Health Information Networks approved under TEFCA that organizations can select aside from Epic.

Dr. Darrow used an analogy of cell phone carriers to illustrate this clarification: TEFCA is the framework that says "all cell phone carriers must meet these standards so that the call that's placed over here makes it over there, and it doesn't drop when you go between places," he told Becker's. "TEFCA specifies that you have to create QHINs, and they are the equivalent to your service carriers. They are the group that each hospital and health system would work with that would allow them to get their information into the exchange environment.

"Under a QHIN, the way that it would work is each EHR would conform to standards, the QHIN would have the ability to ingest the information, and would be able to dish it up to the organization with which you wanted to share it, regardless of whether it's Epic, Meditech, Cerner or any of the other ones," Dr. Darrow told Becker's

Epic's "Care Everywhere" model allows the exchanging of health information between hospitals and health organizations that use Epic, which is made possible by their ability to control and consent processes at both the sharing and receiving end. Dr. Darrow explained how TEFCA aims to operate in a similar way by standardizing the information shared and managing the processes for sharing and accepting the data. However, TEFCA enables health systems to choose among a range of approved EHR platforms.

"Epic has been a leader in information sharing, and Mount Sinai clinicians already use Epic to share information with many of our peer organizations," Dr. Darrow said. "I'm sure Epic will come up with a very good and functional QHIN as an option for us, and it may be the one we go with. We just haven't made a decision."

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