InSync Healthcare Solutions Submits Public Comment on TEFCA Draft

Last week, InSync Healthcare Solutions submitted public comment to the Office of the National Coordinator, Department of Health and Human Services, regarding the initial draft release of the Trusted Exchange Framework and Common Agreement (TEFCA).

While InSync believes the current draft of TEFCA is a step in the right direction for interoperability, it also is concerned about potential issues that may arise with the establishment of minimum required terms for HINs.

Read the full letter below:

Dr. Rucker: 
I am writing to provide our comments on the ONC’s release of the Trusted Exchange Framework and Common Agreement (TEFCA), a provision under the 21st Century Cures Act, which is intended to improve interoperability and patient health information access. Thank you for the opportunity to do so. 
At InSync Healthcare Solutions, we have an EHR and practice management technology, that is configured to support the unique needs of physician practices — including practices that focus on primary care and behavioral health, as well as other specialties — who require the ability to view, download and transmit medical record data to coordinate care. 
We know interoperability from experience. InSync’s executive leadership team has developed and deployed a platform that enables patients and providers to connect to HIEs for the purpose of aggregating and concatenating a patient’s longitudinal medical record. We are able to overcome the technical challenges, faced today, achieving interoperability that allows patients and providers to access individual patient’s medical records regardless of the originating technology that captured the medical record at the point of care.
As healthcare becomes more integrated and value-based, we believe that sharing patient data effectively will become more essential in order to optimize patient outcomes and maximize efficiencies. This is and has been the inspiration of our collection of congruent technologies for some time.
We are continually upgrading our EHRs to work well with other healthcare technologies. This is no small feat, as regulations such as HIPAA or 42 CFR Part 2 can make it challenging to share information that is in the best interest of the patient, healthcare providers and the entire healthcare system. 
We believe the current Draft Trusted Exchange Framework released on January 5, 2018, is a step in the right direction, in terms of underscoring the importance of interoperability by calling for the establishment of national standards for trusted data exchange. The proposed Framework aims to scale interoperability nationwide by providing a single “on ramp” to allow all types of healthcare organizations to join any Health Information Network (HIN), regardless of their health IT developer affiliations, existing health information exchanges or the location of their patient records. We appreciate ONC’s efforts to ease the flow of information between all healthcare stakeholders, including patient and provider access to health data. 
However, we are concerned about major problems that may arise with the establishment of minimum required terms for HINs that will become part of a so-called “trusted” exchange: 
Minimum Data Set
We understand the importance of defining the minimum data set (MDS) so the existing Health Information Exchanges (HIEs) would adopt the MDS and standards. However, one must ask, where do you draw the line? Establishing a national MDS could potentially limit the sharing of important patient health information that exceeds the set minimum (e.g., if the MDS is 1,000 data fields but a practice uses an EHR with 1,001 fields). It’s important to remember that some of the most valuable information isn’t found in structured data, but rather the unstructured narrative of EHR practice notes.  


It goes without saying that a national HIE would need to be protected by the most robust security solution(s) possible. However, one only needs to think about the ongoing fallout from the Equifax security breach to shudder at the possibility that healthcare could suffer the same fate. While a security breach impacting a regional HIE would be devastating, a national security breach impacting hundreds of millions of patients and stakeholders would be unfathomably disastrous. By funneling protected health information into one network, you’ve just given hackers a honeypot — all they need to do is find an “edge” or vulnerability point, and many are excited by that challenge. 
Innovation and Cost
One of the best things about the U.S. EHR market is the fact that any organization, big or small, can participate so long as they follow the minimum regulatory and security requirements. The process of “on ramping” EHRs into a national HIE adds cost and complexity that is a drop in the bucket for a major health IT player like Allscripts or Cerner, but highly burdensome to small EHR providers like ourselves. Larger EHRs will have an unfair advantage in bidding to control the standards of a national HIE, and may set guidelines that make it too hard for smaller EHR providers to participate. It will stifle innovation and hinder positive patient outcomes. 
The proposal’s language is complex and difficult to translate into actionable steps for compliance. There are conflicts between multiple regulations already in existence—including Meaningful Use, HIPAA, CFR 42 Part 2, and state-by-state regulations. We fear that, as written, TEFCA will create additional conflict and only create more barriers to achieving the vision of interoperability. 
In closing we would like to reiterate our support for ONC in taking the matter of interoperability seriously, and for considering how healthcare information sharing can positively impact more patients and organizations. We do believe it is a step in the right direction for ONC to propose an MDS. That will allow companies to create patientfocused applications so they can find their data and bring it into their own PHR.
However, we don’t believe that the government should over-regulate EHRs. More often than not, when healthcare organizations have the flexibility and freedom to work together to establish their own collaborative relationships, they are successful. We believe we’re proof of that.
We hope that the ONC takes our concerns into consideration as we move forward. 
Charles Hutchinson
Chief Financial Officer InSync Healthcare Solutions