The Sequoia Challenge, appearing because the Known Coordinating Entity for the TEFCA interoperability framework, has launched a remodeled FHIR Roadmap for TEFCA Alternate that has a four-stage timeline for the sluggish adoption of the FHIR (Speedy Healthcare Interoperability Sources) usual for knowledge alternate. 

Model 2 of the Roadmap envisions FHIR Alternate between Certified Well being Knowledge Networks (QHINs), which is Level 3 within the plan, to be piloted in 2025, with implementation specs advanced quickly after the pilots are finished. This may increasingly allow QHINs to leverage FHIR for alternate between QHINs whilst proceeding to strengthen non-FHIR approaches inside the QHINs’ inside networks.

The Place of work of the Nationwide Coordinator for Well being Knowledge Generation (ONC) has led a multi-year procedure along the RCE to enforce TEFCA, which was once envisioned by way of the twenty first Century Treatments Act. The speculation is to create a “community of networks” for sharing well being knowledge around the nation. The objective is that like wi-fi networks, electrical energy grids and ATMs, the person enjoy will grow to be as though it is a unmarried community.

In offering some background, the RCE famous that the preliminary paintings on TEFCA began with extra established requirements, akin to IHE-based alternate of C-CDA content material. However the speedy include of FHIR by way of the business makes it crucial that TEFCA come with a planned technique so as to add FHIR-based alternate. 

“Maximum FHIR implementation job out there has curious about point-to-point alternate of FHIR sources by means of FHIR APIs with out community intermediaries. On the other hand, some networks have leveraged their infrastructure to strengthen FHIR in more than a few techniques,” the Roadmap report states. “As an example, a couple of national and state/regional networks use current IHE-based brokering infrastructure to switch FHIR payloads. As well as, early pilot paintings has begun to make use of community infrastructure to strengthen FHIR API Alternate between endpoints and a few networks are making plans to provide brokered FHIR API alternate.”

The Roadmap envisions 4 levels of construction to supply continuity for the FHIR actions out there and make allowance TEFCA coverage and technical infrastructure to boost up FHIR adoption. “It additionally bridges network-based alternate communities and the customers of FHIR APIs by means of ONC-certified EHRs and CMS required APIs, that have been running in parallel up till now. We consider that each patterns of alternate will likely be vital at some point and that use of FHIR APIs in TEFCA can assist in making those patterns complementary and in the end ship at the promise of a contemporary, virtual healthcare machine.”

The Roadmap presentations 4 levels of FHIR alternate in TEFCA, with necessities for every level constructed at the earlier level:

• Level 1: FHIR Content material Toughen
− Integrated as a part of the preliminary release of TEFCA.
− QHIN-brokered IHE alternate of FHIR payloads between QHINs to be had.
• Level 2: QHIN-Facilitated FHIR Alternate
− QHIN strengthen for facilitated FHIR API alternate required.
− Player and Subparticipant alternate by means of FHIR APIs to be had.
• Level 3: QHIN-to-QHIN FHIR Alternate
− Toughen for alternate between QHINs by means of FHIR APIs required.
• Level 4: Finish-to-Finish FHIR Alternate
− Toughen for QHIN-brokered FHIR Alternate between Contributors and
Subparticipants.

Every level will likely be supported by way of a brand new model of the QHIN Technical Framework and controlled by means of the alternate control procedure within the Not unusual Settlement.

A timeline presentations Levels 1 and a couple of taking place in 2024, with Level 3 in 2026, and Level 4 in an unspecified long run time period.

The RCE notes that Level 4’s Finish-to-Finish FHIR Alternate would allow a Player/Subparticipant to seamlessly alternate FHIR knowledge between themselves and different community participants in the course of the QHINs and more than one different intermediaries each inside a QHINs’ community and in the course of the TEFCA-governed community. This calls for additional analysis into optimum strategies for safe alternate in the course of the community by means of the QHINs. When that analysis is whole, ONC will release a pilot with TEFCA customers to resolve how and when that analysis will also be rolled right into a manufacturing setting.

The Not unusual Settlement, launched in September 2021, comprises six alternate functions that organizations will have to strengthen to be designated as a QHIN. The alternate functions come with Remedy, Cost, Well being Care Operations, Public Well being, Advantages Choice, and Person Get entry to Products and services.

The next organizations had been formally designated because the preliminary QHINS after effectively finishing the TEFCA onboarding procedure.
• eHealth Alternate
• Epic Nexus
• Well being Gorilla
• KONZA
• MedAllies


There are roughly 20 organizations officially looking for QHIN standing.