With EHR implementation now widespread across hospitals and physician practices across the country, healthcare providers and vendors have the digital foundation to make “real moves at an industry level” toward advancing value, says Micky Tripathi, PhD, PhD, MPP, National Coordinator for Health IT with the Office of the National Coordinator (ONC). However, in a recent podcast interview with Lumeris, Tripathi clarified that digitizing healthcare wasn’t necessarily the end-game for EHR implementation: “Interoperability isn’t the goal. The goal is value-based care enabled by interoperability.”
Now, it seems like many moving pieces are aligned to make this goal a reality. With this foundation for digital information exchange in place, supported by FHIR APIs and TEFCA (the Trusted Exchange Framework and Common Agreement), Tripathi anticipates the healthcare industry will see increased traction with value-based care initiatives.
TEFCA is a framework developed by the ONC to establish a standardized approach for health information exchange (HIE) across different networks, systems, and organizations. It is part of the 21st Century Cures Act, which seeks to improve healthcare through enhanced data sharing and patient access to health information. TEFCA aims to create a unified and secure network for health information exchange, and its implementation is expected to have several significant impacts on interoperability.
According to Tripathi, such a framework “will enable…interoperability to happen as a routine matter so that people can start to think about the higher-level objectives that they want to accomplish,” he said.
Making Interoperability as Common as Cell Phone Connectivity
During the conversation with Lumeris, Tripathi discussed the ways in which TEFCA will support both public health and population health management with the concept of value-based care.
He compared connectivity in healthcare to that of the nation’s leading cell phone networks. “Imagine a world where AT&T and Verizon, Sprint and T-Mobile were not connected with each other,” he said. “Each of them are great nationwide networks. But what if I wanted to talk to you [and] you were on Verizon, and I was on AT&T, and we couldn’t talk to each other because we were on different networks? That would be a very frustrating experience.”
Yet this is an experience healthcare consumers, providers and payers encounter every day when disparate data systems are incapable of seamless data exchange.
This was the impetus for the federal government to establish TEFCA, Tripathi said. Today, seven organizations have been designated as Qualified Health Information Networks™ (QHINs), capable of nationwide health data exchange governed by TEFCA, and two more are applying for QHIN status.
Meanwhile, FHIR-based data exchange “opens up a lot more opportunity for us to have the kind of interoperability that everyone wants—in particular, for use cases like value-based care,” Tripathi said. For one, it allows healthcare organizations to exchange only the data they want to exchange, rather than a full continuity-of-care document that presents more information than is needed, requiring clinicians to search for relevant data. For another, it opens the door for payers and providers to exchange information in ways that previously weren’t possible.
“Obviously, that now presents the opportunity for a lot of rich use cases related to value-based care in a way that really hasn’t existed before,” Tripathi said.
Achieving Next-Level Interoperability for Value
Ultimately, Tripathi believes TEFCA will position health plans and providers to roll out value-based initiatives at scale, supported by claims data and information from other key stakeholders that informs better care management.
He anticipates judicious use of regulation by the federal government could help “iron out the wrinkles” in achieving next-level interoperability that informs value-based care.
“There’s a huge opportunity here to use TEFCA for scalability to allow [health plans] to get the kind of information that [they’ve] wanted from providers, and now, there’s the opportunity for providers to be able to get their claims data on patients [regardless] of who submitted the claims [so] that they can do better care management,” Tripathi said.
To learn more about Tripathi’s take on value and where the industry is heading, listen to the podcast, “Scaling Innovation in AI, Interoperability, and Health Equity, with Micky Tripathi,” and subscribe to stay up-to-date on our conversations with leading experts about the move to value-based care.