TEFCA QHIN-to-QHIN FHIR Change to be Piloted in 2025

The Sequoia Mission, appearing because the Acknowledged Coordinating Entity for the TEFCA interoperability framework, has launched a revamped FHIR Roadmap for TEFCA Change that has a four-stage timeline for the gradual adoption of the FHIR (Quick Healthcare Interoperability Sources) customary for information change. 

Model 2 of the Roadmap envisions FHIR Change between Certified Well being Data Networks (QHINs), which is Stage 3 within the plan, to be piloted in 2025, with implementation specs developed quickly after the pilots are accomplished. This can allow QHINs to leverage FHIR for change between QHINs whereas persevering with to help non-FHIR approaches inside the QHINs’ inner networks.

The Workplace of the Nationwide Coordinator for Well being Data Know-how (ONC) has led a multi-year course of alongside the RCE to implement TEFCA, which was envisioned by the twenty first Century Cures Act. The thought is to create a “community of networks” for sharing well being information throughout the nation. The purpose is that like wi-fi networks, electrical energy grids and ATMs, the consumer expertise will change into as if it is a single community.

In offering some background, the RCE famous that the preliminary work on TEFCA began with extra established requirements, akin to IHE-based change of C-CDA content material. However the fast embrace of FHIR by the business makes it crucial that TEFCA embody a deliberate technique so as to add FHIR-based change. 

“Most FHIR implementation exercise available in the market has centered on point-to-point change of FHIR assets by way of FHIR APIs with out community intermediaries. Nevertheless, some networks have leveraged their infrastructure to help FHIR in varied methods,” the Roadmap doc states. “For instance, just a few nationwide and state/regional networks use present IHE-based brokering infrastructure to change FHIR payloads. As well as, early pilot work has begun to make use of community infrastructure to help FHIR API Change between endpoints and a few networks are planning to supply brokered FHIR API change.”

The Roadmap envisions 4 phases of growth to offer continuity for the FHIR actions available in the market and permit TEFCA coverage and technical infrastructure to speed up FHIR adoption. “It additionally bridges network-based change communities and the customers of FHIR APIs by way of ONC-certified EHRs and CMS required APIs, which have been working in parallel up till now. We consider that each patterns of change will likely be necessary sooner or later and that use of FHIR APIs in TEFCA may help make these patterns complementary and eventually ship on the promise of a contemporary, digital healthcare system.”

The Roadmap reveals 4 phases of FHIR change in TEFCA, with necessities for every stage constructed on the earlier stage:

• Stage 1: FHIR Content material Help
− Included as a part of the preliminary launch of TEFCA.
− QHIN-brokered IHE change of FHIR payloads between QHINs accessible.
• Stage 2: QHIN-Facilitated FHIR Change
− QHIN help for facilitated FHIR API change required.
− Participant and Subparticipant change by way of FHIR APIs accessible.
• Stage 3: QHIN-to-QHIN FHIR Change
− Help for change between QHINs by way of FHIR APIs required.
• Stage 4: Finish-to-Finish FHIR Change
− Help for QHIN-brokered FHIR Change between Members and
Subparticipants.

Every stage will likely be supported by a brand new model of the QHIN Technical Framework and managed by way of the change administration course of within the Widespread Settlement.

A timeline reveals Levels 1 and a pair of taking place in 2024, with Stage 3 in 2026, and Stage 4 in an unspecified future timeframe.

The RCE notes that Stage 4’s Finish-to-Finish FHIR Change would allow a Participant/Subparticipant to seamlessly change FHIR information between themselves and different community members via the QHINs and a number of different intermediaries each inside a QHINs’ community and thru the TEFCA-governed community. This requires additional analysis into optimum strategies for safe change via the community by way of the QHINs. When that analysis is full, ONC will launch a pilot with TEFCA customers to find out how and when that analysis might be rolled right into a manufacturing surroundings.

The Widespread Settlement, launched in September 2021, consists of six change functions that organizations should help to be designated as a QHIN. The change functions embody Remedy, Fee, Well being Care Operations, Public Well being, Advantages Willpower, and Particular person Entry Providers.

The next organizations had been formally designated because the preliminary QHINS after efficiently finishing the TEFCA onboarding course of.
• eHealth Change
• Epic Nexus
• Well being Gorilla
• KONZA
• MedAllies


There are roughly 20 organizations formally in search of QHIN standing.