{"id":14041,"date":"2019-04-19T08:45:02","date_gmt":"2019-04-19T12:45:02","guid":{"rendered":"https:\/\/healthit-gov.go-vip.net\/buzz-blog\/?p=14041"},"modified":"2025-07-11T18:59:30","modified_gmt":"2025-07-11T18:59:30","slug":"moving-beyond-closed-networks-an-update-on-trusted-exchange-of-health-information","status":"publish","type":"post","link":"https:\/\/healthit.gov\/blog\/interoperability\/moving-beyond-closed-networks-an-update-on-trusted-exchange-of-health-information\/","title":{"rendered":"Moving Beyond Closed Networks \u2013 An Update on Trusted Exchange of Health Information"},"content":{"rendered":"\n<p>In the 1990s, many Americans interacted with the Internet through <em>America Onlin<\/em>e. While this platform was revolutionary, providing users with e-mail services and access to content, it was also a closed network. Their users were restricted from accessing applications, content, and services available outside of AOL\u2019s approved content providers. In the healthcare landscape, we still have a similar dynamic today. Both national networks and local or regional health information exchanges provide valuable services to their users; however, these networks are often not connected and offer varied services and use cases. To address this issue, Congress included a provision within the 21<sup>st<\/sup> Century Cures Act to advance a Trusted Exchange Framework and Common Agreement<sup>SM<\/sup> (TEFCA<sup>SM<\/sup> ) to improve data sharing between health information networks.<br><\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-trusted-exchange-framework-and-common-agreement-update\"><strong>Trusted Exchange Framework and Common Agreement Update<\/strong><\/h2>\n\n\n\n<p>Today the Department of Health and Human Services took another step towards advancing the access, exchange, and use of health information by issuing <a href=\"https:\/\/healthit.gov\/interoperability\/trusted-exchange-framework-and-common-agreement-tefca\/\">three documents<\/a> for public comment that would support network-to-network exchange of health information nationally. Collectively, these documents seek to provide a single \u201con-ramp\u201d to nationwide connectivity, while advancing a landscape where electronic health information securely follows the patient and can be queried, retrieved, and delivered when and where it is needed. These documents include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Second drafts of the (1) Trusted Exchange Framework (TEF) and the (2) Minimum Required Terms and Conditions (MRTCs), which were previously in one document; and<\/li>\n\n\n\n<li>A first draft of the Qualified Health Information Network<sup>TM<\/sup> (QHIN<sup>TM<\/sup>) Technical Framework, which describes technical and functional requirements to implement the Common Agreement and enable health information networks to connect to each other.<\/li>\n<\/ul>\n\n\n\n<blockquote class=\"wp-block-quote icon yellow tweet is-layout-flow wp-block-quote-is-layout-flow\">\n<p>The challenge before us \u2013 for ONC and the broader community \u2013 is to work as efficiently as we can to advance towards nationwide interoperability, which will inject competition and transparency into healthcare to empower patients and drive down costs.<\/p>\n<\/blockquote>\n\n\n\n<p>Collectively, these documents will form the basis of a single Common Agreement that will create baseline technical and legal requirements for sharing electronic health information on a nationwide scale. Through the Common Agreement, electronic health information sharing can occur across disparate health information networks to the benefit of improved care for the patient.<\/p>\n\n\n\n<p>I am also pleased to announce that we are issuing a <a href=\"https:\/\/healthit.gov\/funding-announcements\/\/trusted-exchange-framework-and-common-agreement-recognized\">Notice of Funding Opportunity<\/a> for a Recognized Coordinating Entity<sup>\u00ae<\/sup> (RCE<sup>TM<\/sup>) to develop, update, implement, and maintain the Common Agreement and the QHIN Technical Framework.<\/p>\n\n\n\n<p>We are incredibly grateful for the public\u2019s interest and feedback on Draft 1 of TEF. We received more than 200 comments on the first draft, the majority of which were supportive of its goals and direction. Our team carefully reviewed all of the comments to ensure we understood stakeholder concerns and suggestions. Additionally, the Health Information Technology Advisory Committee provided a set of 26 recommendations. Nationwide interoperability is not a simple undertaking, and something as expansive as a final TEFCA requires thoughtful consideration of the issues and challenges. For example, a successful \u201cnetwork of networks\u201d requires that each network that facilitates connectivity agrees to the same mix of technical standards, policies, and legal conditions. By releasing today\u2019s draft for a second round of public comment, we are working to get it right.<\/p>\n\n\n\n<p>The following are some common themes we heard from the first round of public comment along with key updates.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-wide-support-for-a-recognized-coordinating-entity-rce\"><strong>Wide support for a Recognized Coordinating Entity (RCE)<\/strong><\/h2>\n\n\n\n<p>In the first draft of the TEF, we indicated our intention to use a funding announcement to work with an outside organization to operationalize a final Common Agreement. ONC will work with the selected RCE to incorporate the TEF into a single Common Agreement to which QHINs voluntarily agree to adhere. While there were questions and varying opinions regarding the distribution of work and authority between the ONC and an RCE, the majority of stakeholders supported our plan to select an RCE. The Cooperative Agreement for the RCE will be a four-year award and will include requirements for the RCE to demonstrate a commitment to transparent, fair, and nondiscriminatory data exchange through organizational policies and governing structures.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-specification-of-standards\"><strong>Specification of Standards<\/strong><\/h2>\n\n\n\n<p>We included a number of privacy, security, and technical standards in the first draft of the TEF. Many commenters indicated that the Common Agreement would not be the best place to specify all of the standards, which may need to be updated more frequently than a legal agreement. Commenters suggested specifying standards through implementation guides, rather than in the Common Agreement itself. Thus in the second draft, we included most standards requirements in the draft QHIN Technical Framework, which will be incorporated into the Common Agreement by reference, and with appropriate notice and compliance provisions for implementation of any updated technical requirements.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-qualified-health-information-networks-definition-broadened\"><strong>Qualified Health Information Networks Definition Broadened<\/strong><\/h2>\n\n\n\n<p>In the first draft of the TEF, we defined a new type of organization \u2013 the QHIN. Our goals are to help advance a fair and equitable market and support successful QHINs that can support scalable interoperability. In response to comments that the definition of QHIN was too restrictive, we expanded the definition to allow for more types of stakeholders to apply. We also updated the application process to allow for a provisional period where QHINs will onboard to the Common Agreement and undergo testing and surveillance to ensure they are in compliance <em>before<\/em> actively exchanging data on the network.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-inclusion-of-push-transactions\"><strong>Inclusion of Push Transactions<\/strong><\/h2>\n\n\n\n<p>We received a number of requests from commenters asking that we include a push-based exchange modality in the Common Agreement. Commenters noted that push transactions play a vital role in supporting transitions of care and public health use cases and would be necessary to fully support required public health reporting. Therefore, ONC has included QHIN Message Delivery, which supports instances in which a QHIN sends electronic health information to one or more QHINs for delivery. We believe the value of push transactions is significant to deliver critical information about patient care.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-next-steps-in-implementing-tefca\"><strong>Next Steps in Implementing TEFCA<\/strong><\/h2>\n\n\n\n<p>We sincerely appreciate the thoughtful feedback we received during the first round of public comment. The challenge before us \u2013 for ONC and the broader community \u2013 is to work as efficiently as we can to advance towards nationwide interoperability, which will inject competition and transparency into healthcare to empower patients and drive down costs. We are committed to advancing a TEFCA that helps achieve these goals. Please review the new documents and <a href=\"https:\/\/healthit.gov\/interoperability\/trusted-exchange-framework-and-common-agreement-tefca\/\">provide your comments<\/a> by June 17, 2019.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>In the 1990s, many Americans interacted with the Internet through America Online. While this platform [&hellip;]<\/p>\n","protected":false},"author":619,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_selected_menu":"","_show_breadcrumbs":"true","_blog_show_featured_image":false,"footnotes":""},"categories":[37,56],"archived-category":[],"featured":[],"topics":[425,418,426,419],"class_list":["post-14041","post","type-post","status-publish","format-standard","hentry","category-interoperability","category-tefca","topics-hit-policy","topics-interoperability","topics-hit-legislation","topics-tefca"],"acf":{"blog_authors":[{"blog_author_profiles":"198669"}],"hp_news_hide":false},"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v24.3 (Yoast SEO v24.8.1) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Moving Beyond Closed Networks \u2013 An Update on Trusted Exchange of Health Information - ONC Blog<\/title>\n<meta name=\"description\" content=\"Explore the TEFCA update\u2014a crucial step towards nationwide health data interoperability. Discover draft documents and share your feedback to shape future healthcare.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/healthit.gov\/blog\/interoperability\/moving-beyond-closed-networks-an-update-on-trusted-exchange-of-health-information\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Moving Beyond Closed Networks \u2013 An Update on Trusted Exchange of Health Information\" \/>\n<meta property=\"og:description\" content=\"Explore the TEFCA update\u2014a crucial step towards nationwide health data interoperability. Discover draft documents and share your feedback to shape future healthcare.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/healthit.gov\/blog\/interoperability\/moving-beyond-closed-networks-an-update-on-trusted-exchange-of-health-information\/\" \/>\n<meta property=\"og:site_name\" content=\"ONC Blog\" \/>\n<meta property=\"article:published_time\" content=\"2019-04-19T12:45:02+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2025-07-11T18:59:30+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/healthit.gov\/blog\/wp-content\/uploads\/sites\/4\/2025\/08\/ONC.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"628\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"sleigh\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"sleigh\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\/\/healthit.gov\/blog\/interoperability\/moving-beyond-closed-networks-an-update-on-trusted-exchange-of-health-information\/#article\",\"isPartOf\":{\"@id\":\"https:\/\/healthit.gov\/blog\/interoperability\/moving-beyond-closed-networks-an-update-on-trusted-exchange-of-health-information\/\"},\"author\":{\"name\":\"sleigh\",\"@id\":\"https:\/\/healthit.gov\/blog\/#\/schema\/person\/0719592fcc77f0e269f191216da0aae7\"},\"headline\":\"Moving Beyond Closed Networks \u2013 An Update on Trusted Exchange of Health Information\",\"datePublished\":\"2019-04-19T12:45:02+00:00\",\"dateModified\":\"2025-07-11T18:59:30+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\/\/healthit.gov\/blog\/interoperability\/moving-beyond-closed-networks-an-update-on-trusted-exchange-of-health-information\/\"},\"wordCount\":1062,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\/\/healthit.gov\/blog\/#organization\"},\"articleSection\":[\"Interoperability\",\"TEFCA\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\/\/healthit.gov\/blog\/interoperability\/moving-beyond-closed-networks-an-update-on-trusted-exchange-of-health-information\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/healthit.gov\/blog\/interoperability\/moving-beyond-closed-networks-an-update-on-trusted-exchange-of-health-information\/\",\"url\":\"https:\/\/healthit.gov\/blog\/interoperability\/moving-beyond-closed-networks-an-update-on-trusted-exchange-of-health-information\/\",\"name\":\"Moving Beyond Closed Networks \u2013 An Update on Trusted Exchange of Health Information - ONC Blog\",\"isPartOf\":{\"@id\":\"https:\/\/healthit.gov\/blog\/#website\"},\"datePublished\":\"2019-04-19T12:45:02+00:00\",\"dateModified\":\"2025-07-11T18:59:30+00:00\",\"description\":\"Explore the TEFCA update\u2014a crucial step towards nationwide health data interoperability. 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