Updated TEFCA SOPs for Health Care Operations and NCQA
September 9, 2024 · Becky Kolinski
NCQA is encouraged by the expansion of TEFCA (Trusted Exchange Framework and Common Agreement) and its potential to enhance national health outcomes through timely data exchange. The recent inclusion of HEDIS® reporting as a Level 2 exchange purpose in two standard operating procedures under TEFCA highlights the industry’s dedication to leveraging interoperable health data for digital quality measurement.
While participation in TEFCA is not a requirement for HEDIS reporting, it does create new options for organizations currently using or interested in using the TEFCA network to reduce the cost and burden associated with data collection.
HEDIS is included in the standard operating procedures: Exchange Purposes (XPs) and Exchange Purpose (XP) Implementation: Health Care Operations. Learn more about the TEFCA standard operating procedures here.
What Is TEFCA?
TEFCA establishes a universal standard for interoperability across the country, and provides individuals and health care organizations with more efficient, secure access to health information. It went live in December 2023.
TEFCA is referred to as a “network of networks” because it creates a common framework and protocol for sharing data, and expands and improves access to the health care information networks provide.
Participation in TEFCA is voluntary. The Common Agreement establishes the infrastructure model and governing approach for secure data sharing in TEFCA networks, and standard operating procedures outline implementation specifications for transmitting data.
Learn more about how TEFCA works here.
Who Participates in TEFCA?
TEFCA supports health care data exchange for a variety of individuals and organizations, including providers, health systems, payers, health information exchanges (HIE) and government agencies.
Data is exchanged through Qualified Health Information Networks (QHIN) that connect directly to each other to ensure interoperability between the networks they represent. QHINs go through a rigorous application and onboarding process to ensure they have the capabilities needed to serve in this crucial role.
Learn more about TEFCA participation here.
How Does TEFCA Relate to HEDIS?
Including data exchanges for HEDIS reporting in the TEFCA standard operating procedures creates more options for health care organizations to exchange standards-based, regulated clinical data at scale. Like any other data source used in HEDIS reporting, data exchanged through the TEFCA network must be accompanied by appropriate data quality and validation controls.
Before we can fully realize the benefits of TEFCA data exchange for HEDIS reporting, however, some issues need to be resolved. For example, we need more real-world testing to ensure that FHIR® (Fast Healthcare Interoperability Resources) data are suitable for use in quality measurement, and we need scalable processes for validating large amounts of data exchanged via networks, such as TEFCA.
What Does This Mean for NCQA?
While TEFCA helps reduce barriers to data exchange, it does not address concerns about data quality. Health care organizations need to be able to trust the data supplied through TEFCA and other networks to achieve full adoption of value-based care; ensure patients/members receive timely and appropriate care; and prevent duplicate and wasteful utilization.
NCQA is committed to ensuring the quality of data supplied for HEDIS and other downstream reporting needs. Large digital exchange networks like TEFCA create an opportunity for data quality and validation approaches that are more robust, continuous and automated, and support connectivity on a broader scale. NCQA is evolving our products and processes to achieve the full benefits of digital data validation.
NCQA is excited to support TEFCA and collaborate with ASTP/ONC, CMS and other stakeholders to ensure continued access to reliable, robust data to evaluate health care quality. We are working to develop data quality strategies that instill confidence in TEFCA data for a wider set of use cases.
What Health Care Organizations Can Do
To get started:
- Assess your TEFCA strategy, and encourage your partners, clients and vendors to consider joining TEFCA to streamline data exchange.
- Learn more about NCQA’s Data Aggregator Validation program, which evaluates management and exchange of health data for HEDIS and other quality reporting.
- Join the NCQA Bulk FHIR Quality Coalition to participate in end-to-end, real-world testing of regulated data for HEDIS quality measurement. The coalition will also evaluate data quality approaches and TEFCA’s HEDIS reporting exchange purpose.
The Bottom Line
Including HEDIS in the TEFCA standard operating procedures creates opportunities—for the digital quality transition, for NCQA and our customers—but it will take time and effort to turn the vision into reality. NCQA is working to address outstanding questions regarding HEDIS and TEFCA, and we look forward to sharing more information with you soon.
To learn more about TEFCA, listen to our podcast, the New Rules of Data Sharing, featuring NCQA’s Eric Musser, Vice President, Federal Affairs and Amol Vyas, Vice President, Interoperability.
