I know the official calendar new year is months away, but for those of us with kids in school or those who take a breather in the summer, school opening may feel like a new year. With that comes time to think on what has passed, what is to come and what next.This year, the hot topic in health interoperability has been TEFCA. Even when we try to think of other things it comes back to that. Here at CommonWell we are proud of 10 years making connections and over 210M lives registered in our system for whom we have made health better through data. Without TEFCA, we are having a meaningful impact on nationwide health data exchange, but even we recognize TEFCA and striving to become a QHIN ourselves is an important next step.

Why? I’ll have the opportunity to expand more out in the wild – with this pseudo new year comes a wealth of conferences, speaking engagements and frequent flier mile accumulation. Amidst all the chaos, there are three key topics that are top of mind for me in our collective and ongoing quest for ubiquitous interoperability.

  1. New use cases. We have tried for years in CommonWell and Carequality but it isn’t going as fast as we would all like it go. With the ONC we expect this to accelerate. CommonWell itself added patient access 7 years and adoption is just now picking up and while we added Payment and Health Care Operations support a couple years ago, it has been slow going. Bring it on! There are many, many clinical and administrative workflows we can tackle and continue to improve on.
  2. Documents do and will continue to have a crucial place in interoperability. That said, many use cases will work better when we have FHIR at scale. CommonWell has had FHIR document exchange for a long time, but moving to discrete data over FHIR will move many needles. Rather than throwing or stalling out TEFCA because it didn’t have FHIR, starting with what existed at scale (document exchange), but sliding in a FHIR roadmap and herding the market in this direction is a wise move.
  3. Getting the rest of the job done. We have a lot more to connect. We have about one quarter of the ambulatory clinics in the country connected and while they are the bigger ones, we have a lot more to connect. A final rule set likely linked to federal incentives will help. The ultimate away to achieve health equity is making sure ALL health providers are armed with the right data at the right time for ALL their patients.

4 – I know I said three, but this is important… I am looking forward to a new t-shirt to take over social media within our interop circles. I love my QHINs Aren’t Real shirt but can’t wait to see what pops up when this thing IS real.

At CommonWell, we have deliberately taken a slower route than some to our launch of TEFCA capabilities. With our size and diverse membership, changing things takes time. We wanted to be intentional and evaluate everything we do vs focusing solely on TEFCA. After all, the CommonWell network has grown and provided value throughout health care long before TEFCA was even on our radar. We went through a 1-year committee process cutting across all of CommonWell and its dozens of Members to debate what TEFCA means for us, how we want to attack it and what else we might want to fix while we build it. While TEFCA is a significant element of a national strategy to improve interoperability so are elements not within the scope of TEFCA—such as  event notifications (ADT exchange), bringing on alternative products such as query only products for individual and population health management. We are even integrating a large regional Health Information Exchange into CommonWell which is something TEFCA somehow does not currently work so well with given the state of the vendor networks like CommonWell and others. Add in a lot more automation and even more scalability and I promise this is going to be fun!

The truth is that the real benefits of TEFCA are likely to be different than the four things I mentioned above. Efforts like this change the way things get done often in ways the creators did not expect. A lot to come. Stay tuned for more as we keep everyone updated on our progress. Our planning phase may be over, but now we have a lot to do…