On January 5, 2018, the Office of the National Coordinator (ONC) released the draft Trusted Exchange Framework. The draft was released for public comment as a step toward fulfilling the requirements dictated in the 21st Century Cures Act (Cures Act), which was signed into law in December 2016. In response, the overview of the draft Trusted Exchange Framework states three main focuses that the Cures Act set out to address and advance an interoperable health system that achieves the following:

  • Empowers individuals to use their Electronic Health Information to the fullest extent;
  • Enables providers and communities to deliver smarter, safer, and more efficient care; and
  • Promotes innovation at all levels.

The overview continues to state that the “vision [they] seek to achieve is a system where individuals are at the center of their care and where providers have the ability to securely access and use health information from different sources.” This is an aim that thrusts interoperability between many Health Information Networks (HINs), to exchange health informationacross many networks locally, regionally, and nationally without losing sight of patient care as a primary focus.

Up until the initiation of the Cures Act, entities didn’t share or exchange information due to guidelines  outlined by participation agreements or other conflicts, thus limiting the flow of health information between entities, regardless of the circumstances or needs of individuals, providers, and other members of the health systems. The Cures Act outlines a need to build trust amongst those that participate in HINs as a fundamental factor of future improvement in patient care and outcomes.

The proposed Trusted Exchange Framework was intended to address the aforementioned goals and provide important groundwork to enable interoperability, as identified by Congress in the Cures Act, as a step toward improved patient care. It contains two parts: Part A, which outlines a set of principles for all HINs and any data sharing arrangements for exchange to follow; and Part B, which uses the principles from part A to layout terms and conditions that allow the exchange of Electronic Health Information between networks.

Additionally, the overview explains how this relates to those entities that require HIPAA compliance stating, “[w]e have worked with the HHS Office of Civil Rights (OCR) to ensure that the proposed Trusted Exchange Framework aligns with HIPAA and does not contradict HIPAA requirements.” For those that must follow HIPAA requirements and may feel concerned by furthering connectivity between HINs, the draft Trusted Exchange Framework is meant to both expand the reach and communication between entities to provide better patient care, as well as remain in strict alignment with HIPAA regulations. Thus stating that when finalized, “the final TEFCA must be broad enough to enable them to appropriately and securely access health information…while the proposed Trusted Exchange Framework aligns with HIPAA requirement, it also specifies terms and conditions to enable broader exchange of health information.”

Genevieve Morris from, a Principal Deputy National Coordinator for Health Information Technology offers this explanation regarding the implementation of the new agreement in her article about the Exchange Framework:

Because ONC cannot do this alone, operationalizing the Trusted Exchange Framework will include the open and competitive selection of a single Recognized Coordinating Entity (RCE) from the industry and supported by ONC. Working collaboratively with ONC through a Cooperative Agreement, the RCE will use the Trusted Exchange Framework policies, procedures, technical standards, principles, and goals to develop a single Common Agreement that Qualified Health Information Networks (Qualified HINs) and their participants can voluntarily adopt. Once this has been accomplished, the Trusted Exchange Framework and Common Agreement (TEFCA) will be published in the Federal Register.

Her article goes on to encourage public commentators to submit their remarks regarding the draft Trusted Exchange Framework by February 20, 2018, the deadline for open comments.