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

Model 2 of the Roadmap envisions FHIR Alternate 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. It will allow QHINs to leverage FHIR for change between QHINs whereas persevering with to assist 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 knowledge throughout the nation. The aim is that like wi-fi networks, electrical energy grids and ATMs, the consumer expertise will develop 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, reminiscent of IHE-based change of C-CDA content material. However the fast embrace of FHIR by the trade makes it crucial that TEFCA embrace 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 through FHIR APIs with out community intermediaries. Nonetheless, some networks have leveraged their infrastructure to assist FHIR in varied methods,” the Roadmap doc states. “For instance, a number of nationwide and state/regional networks use current IHE-based brokering infrastructure to change FHIR payloads. As well as, early pilot work has begun to make use of community infrastructure to assist FHIR API Alternate between endpoints and a few networks are planning to supply brokered FHIR API change.”

The Roadmap envisions 4 phases of improvement 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 through ONC-certified EHRs and CMS required APIs, which have been working in parallel up till now. We consider that each patterns of change shall be vital sooner or later and that use of FHIR APIs in TEFCA might 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 Assist
− Included as a part of the preliminary launch of TEFCA.
− QHIN-brokered IHE change of FHIR payloads between QHINs obtainable.
• Stage 2: QHIN-Facilitated FHIR Alternate
− QHIN assist for facilitated FHIR API change required.
− Participant and Subparticipant change through FHIR APIs obtainable.
• Stage 3: QHIN-to-QHIN FHIR Alternate
− Assist for change between QHINs through FHIR APIs required.
• Stage 4: Finish-to-Finish FHIR Alternate
− Assist for QHIN-brokered FHIR Alternate between Members and
Subparticipants.

Every stage shall be supported by a brand new model of the QHIN Technical Framework and managed through 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 time-frame.

The RCE notes that Stage 4’s Finish-to-Finish FHIR Alternate would allow a Participant/Subparticipant to seamlessly change FHIR knowledge between themselves and different community members by 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 by the community through the QHINs. When that analysis is full, ONC will launch a pilot with TEFCA customers to find out how and when that analysis will be rolled right into a manufacturing setting.

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

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


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