A New Era of Clinical Information Exchange: What Practice Leaders Need to Know About TEFCA and QHINs
Download MP3Well, hi, everyone. I'm Daniel Williams, senior editor at MGMA and host of the MGMA Podcast Network. We are here today with a partnership we're real proud of at MGMA. We work very closely with SureScripts. And today we have their director of product innovation, Justin McMartin.
Daniel Williams:Justin, first of all, I just wanna welcome you to the show.
Justin McMartin:Yeah, thanks, Daniel. And yeah, we appreciate that partnership with MGMA as well. So excited to be here.
Daniel Williams:Yeah, today we're going to be looking at a new era of clinical information exchange. We're going to dig into that and look at some of the issues there related to it. So before we do that, let's just get to know you a little bit, Justin. Then we'll dig in a little bit about SureScript and then talk about that topic. So tell us a little bit about your background in healthcare.
Daniel Williams:Anything you wanna share with us.
Justin McMartin:Yeah, happy to. So I've worked in the healthcare industry now for shoot, just short of twenty years. I started working in healthcare by finding an electronic health record vendor. And in that space, I worked with provider practices across the country to be able to implement electronic health records during that meaningful time called Meaningful Use. And in doing that, I was able to really learn from providers and physicians and the folks that we worked with in that space just how useful technology could be, but also how disruptive it could be in certain cases.
Justin McMartin:And then over my time working in that electronic health record space, transitioned into a role really working in the network based industry, thinking about what SureScript operates. And at that time was really the growth of things like our clinical direct messaging solution at SureScripts. What that offered was really an opportunity to say, Hey, here's all this stuff we've been putting into records at each of these practice offices. Here's how we can ultimately start to exchange that information. And then my career path at SureScript has grown really to be, as I like to joke, the guy who doesn't do anything with prescriptions when you think about it.
Justin McMartin:And so what that really means is we're trying to find ways of exchanging information know, outside of prescriptions, in addition to the prescriptions is maybe the better way of saying it, to ensure that we're connecting healthcare from beginning to end with all the various information that needs to be exchanged. So that's what brings me to be the director of our team that's really focused in on that kind of broad interoperability landscape.
Daniel Williams:Okay. Thank you so much for filling us in on that, and thanks for the work you're doing there. Now, as far as SureScripts, I could assume that all of our listeners know who SureScripts is and how they impact and integrate with medical practices, but I'm not going to do that. I want you to just give us maybe an elevator pitch or a little bit of background on SureScripts and really through the lens of how they can benefit and work with our listeners today.
Justin McMartin:Sure. And so for those folks who didn't get my joke, SureScripts really grew up being the network for exchanging prescriptions. So enabling the physician practices and physicians, you know, across healthcare settings to be able to send an electronic prescription to their local pharmacy. We've evolved that organization or that network into doing so much more. So it includes things like eligibility for that prescription information, working with pharmacy benefit managers.
Justin McMartin:In addition, we've added in our medication history solutions and expanded how we can provide that data for med reconciliation into providers and healthcare providers throughout our healthcare system in The United States. And then in addition to that, over the course of the last really ten years, we've expanded, like I said, into these broader aspects of interoperability, launching our partnership with Direct Trust and introducing our clinical direct messaging, expanding prescription benefit information into the real time space to provide that into the physician practices. And then most recently expanding into kind of the request response data exchange world for things like our record locator and exchange solution, working within the care quality framework. And then as a final piece, I think some of the really exciting things that we're emerging into is partnering better with our providers to be able to solve things like prior authorizations in a real time manner, and really trying to take the friction out of that data exchange that doesn't occur as data exchange in today's world and is much more of a manual let's get on the phone process. So we really work across the gamut there in finding ways to exchange data in healthcare.
Daniel Williams:Okay. Now, today, we're gonna be talking a lot about TEFCA and Qualified Health Information Networks, or as you told me last week in another call, QHENs. So if any of our listeners have no idea what any of that terminology means, or even if they do and you want to shed even more light on it, let's give a little brief background on TEFCA and those QHENs as well.
Justin McMartin:Yeah. So I will try to keep my professor jacket off here and not go into too much detail. But it is important to understand where the trusted exchange framework common agreement or TEFCA comes from, which is, this goes all the way back to 2016 when there was a bipartisan bill passed through the US Congress that introduced a host of changes to our healthcare system. And one of them was this introduction of the trusted exchange framework and common agreement. And the idea, or really the drive behind it, why it got included in that bill was to say, there's a lot of emerging opportunities to exchange data.
Justin McMartin:If we don't try to consolidate or bring these things together, it's going to be very costly to adopt 50 different ways that states might want to do it, or hundreds of different ways that different companies might want to do this. So let's put this out there kind of as a gold standard to say, we want to see a single framework for The United States to make it as efficient as possible. So that's where it came from. And since then, it's really progressed through regulatory processes, and then ultimately the creation or the identification of an organization called the Recognized Coordinating Entity. And that's a group called the Sequoia Project, who we work with in a number of different settings, who are really a public interest group, being able to focus in and say, how do we exchange data better in the country?
Justin McMartin:So they were a perfect candidate to be selected in this way. And they now partner with the federal government to kind of create the rules of the road for what a qualified health information network is, or a QHIN, and who are participants who can exchange data through this framework. And maybe even more importantly, how can we continue to grow who those participants are to reach kind of all the edges of who should be able to get access to information safely, effectively, and securely in our country? So, that's the framework under which has been created and kind of a little bit of history on how we got to get here.
Daniel Williams:Yeah, thanks for sharing that. Now, when we think about QHENs, how does SureScripts then work with them? What is that relationship like? How does it come about?
Justin McMartin:So thanks for asking. I think one of the other exciting things that we've been working on here at SureScripts is actually how do we participate in that trusted exchange framework common agreement? Obviously, you know, all the things that I mentioned leading up to this, we've done a lot to become a network that's trusted and exchanges data within the healthcare setting. So it's kind of a logical next step for us to be a QHIN in some way. And so we have actually done that, through a subsidiary that we created called the SureScripts Health Information Network.
Justin McMartin:And we've been qualified as a qualified health information network or approved as a qualified health information network so that we're starting to bring customers on board into that space so that they can connect to this broad framework and exchange clinical data, you know, with all the other partners in in the that, variety of care settings that they're connected to.
Daniel Williams:Us a little bit about the data then. Y'all shared with me some information about how many clinicians are in this network and how many links. Just give us the scope of this because I think you could shed light on this that I think would be helpful to our listeners so they'd go, Okay, this is pretty broad here.
Justin McMartin:Yeah. So there's kind of two different things that get rolled into that question, Daniel. So the first one is, TEFCA is really a, I'm going to call it an upgrade on what we've been doing in this framework already. So I mentioned this briefly earlier in my introduction around working in the care quality framework. So we've been working in that space for almost ten years now.
Justin McMartin:And in that time, we've grown and helped to support that framework with other electronic health record vendors and other participants in that space to be able to exchange billions of clinical records. Actually, it's starting to be a billion or more clinical records on a monthly basis. So we see massive volumes of records that are getting exchanged between providers through frameworks like this. And so TEFCA as an upgrade to that framework really intends for that transition to occur. Now TEFCA isn't quite to that scale, instead of the hundreds of the over 100,000 providers and healthcare organizations participating in care quality, we're about 15 to 20,000 organizations that are now kind of transitioning or kind of in a dual space moving into that trusted exchange framework, exchanging millions and millions of records in that space though.
Justin McMartin:So we're taking the things we've learned there, making it better and kind of moving it into that framework, but fully expect we're going be seeing those billions of transactions with the Trust Exchange Framework in short order here as folks continue to onboard.
Daniel Williams:Yeah. When I think about this, when we think about this data that's available to them, how is that different than the data practice managers already have in place? So tell us about what the value add or the benefit is here.
Justin McMartin:Yeah. So I'm going to get a little technical here to make sure that we understand exactly what it is. So again, going back to my talking about meaningful use, one of the things that all the electronic health records were implementing at the time and honestly carries forward into some of the certification criteria that they still have today. Some of that might be changing, I guess, with the new administration. We'll see exactly how that rolls out, but was the ability to create what's called a continuity of care record or a continuity of care document and exchange it in a particular format.
Justin McMartin:And that format is HL7. And within HL7, have a particular standard called CDA or the consolidated CDA or CCDA. And so what the care quality framework, as well as TEFCA really leverages based on that is to say, look, all these vendors have that opportunity to be able to generate those documents, let's make them requestable. Let's make it so that we can reach out and grab that information at the point of care so that I can reliably get my fingers on everything that a patient has, or the most recent information at least that a patient had from all sorts of different healthcare organizations. So the real value to get back to your question is on ensuring that as a provider or as a physician, as I'm sitting down in the office with that patient, then I know I have the most up to date and appropriate information so I can make the right clinical decisions and care for that patient.
Justin McMartin:So it's that comprehensiveness of what's available through this type of a framework is probably the thing that is top of mind for any providers out there thinking about this.
Daniel Williams:Okay. With all that said, do you have a case study or any use cases? Anything that could shed even more light on this for our listeners to see, okay, that resonates with me. We're experiencing that in our own practice.
Justin McMartin:Yeah. Well, and I should also add to what I was just mentioning. It's not just about can I get access to that information? It's also can I ensure that I'm sharing my information back out so that that, you know, primary care patient that I'm seeing in my practice, when they're showing up in the emergency room with chest pain, that they can see that current list of medications, they can see the patient's recent history of problems and allergies and all of those things that get rolled up into that broader CCDA document? So that's the first thing I would add.
Justin McMartin:But the second to those use cases, obviously, I guess I used one of the emergency rooms. Yeah. Right, but I think especially in today's environment, one of the things that I'm hearing from a lot of our partners and customers and talking about is not just how do we access and kind of complete that record for the patient, that's so critical and so important, but also expanding into broader use cases of, I mentioned prior authorization earlier, thinking maybe even broader from that of how do we engage from a value based care approach and make sure that we're sharing that information across care teams to ensure that patient is getting that most, the best and most comprehensive set of care that they can when they are working in those multiple settings. And so that means not just bringing in and ensuring that all these providers are connected, which is like I said, critical to the patient's care, but it's also ensuring that care management organizations that we're all working with today in time, and the insurance companies that we're working with in terms of those value based care arrangements are plugged into it. And we're making not only the best care system, but the most efficient system that's behind that to support it, that at the end of the day, if we can drop cost of care and we can lower those things, we're winning not only from patients getting better care, but also maybe making it more affordable at the end of the day.
Justin McMartin:So those are all things that we think about when we think about the opportunities within TEFCA for providers and others.
Daniel Williams:Okay. When you think about it from the lens of the practice administrator, what are the friction points? What are the reasons to say, I don't know if I want to do that? I mean, what would be their challenge? Why wouldn't they just everything you're saying to me is going, Well, that's a no brainer.
Daniel Williams:But is it awareness? Is it just getting the platform right? What's going on there?
Justin McMartin:Yeah. Think first and foremost, there's an awareness aspect of it. I think when we think about some of the partners that we work with in this space, whether it's electronic health record vendors or other technology services, they're well aware of it. But one of the common things I'm hearing from those electronic health record vendors is it's not the top of mind for a lot of the providers we work
Daniel Williams:with.
Justin McMartin:And so I think there's that awareness aspect of it is just really understanding it. I think the second one is it goes the next layer down, which is more of an education aspect to really give the tangible examples of how it can benefit my organization and why it is useful and important. And it typically means getting down to those use cases where you're thinking about that patient who's showing up in the emergency room and that information is needed. Or you're taking those examples where you've got an incredibly sick patient with chronic diseases, or maybe catastrophic type illnesses of cancer and otherwise, where they're trying to coordinate their care and they only have access to small portions of it. And so there's that need to not just make sure folks know about it, but also really think through what are those implications that are downstream from this that may not be the first reason why I'm thinking about it.
Justin McMartin:I think bring you holistically to make a decision to say, this is the right thing for us to do. And then I think we're still early on into some of those phases, especially thinking about a practice manager of how do we not just benefit the clinician at the point of care with that patient, but also how do we administratively simplify some of those routines, like I said, with prior authorization or in a value based care arrangement agreement, sharing the appropriate information at the right times and in the most efficient way. I know there are a lot of practice managers out there listening to this going, yeah, that's a lot of work. And so I think finding and driving both from that awareness perspective and education, and having that being brought up into the electronic health record vendors that, yeah, these are really important things for us to do. Because at the end of the day, we're not wanting to see another system put in front of providers in that space.
Justin McMartin:We wanna see these systems that are already there evolve into, and being able to support this type of exchange throughout the framework.
Daniel Williams:Okay. As a final question then, is there anything else we haven't talked about here that you think would be a benefit to our MGMA listeners that could help them navigate the system, input their own information, extract information, anything else, I'll give you a blank slate here to work from.
Justin McMartin:The first thing that I would encourage you all to do is to head out to our surescripts.com and find our Interconnect product. I don't think I've mentioned that yet today, but out on that surescripts.com, we have a particular area of it that's focused on our qualified health information network, and the product is our interconnect service. And we've got a ton of materials out there that are really more focused on some of those education and awareness aspects of it so that you can think through and say, as a provider, why are the reasons that I want to be able to be plugged into this framework? So that would be the first thing I would say. The second thing I would say is just make sure that you're well aware of things that are going on in your states.
Justin McMartin:Because I think there's a lot of opportunities for provider practices across the country to lean into some of the state based exchange information that's being talked about, and ensuring that they're really thinking about not just how as a state can we exchange information effectively, but how can we plug into this national framework to ensure that, again, we're making it as efficient as possible and not having to recreate the wheel with each layer of exchange. And then the third thing I would say is really be thinking about and talking to patients, because one of the things that we're really hearing is that patients are frustrated with their lack of ability to kind of exchange their information effectively. And so understanding kind of those needs from a patient perspective and how it overlaps with things like TEFCA, which has an individual right of access, I think is a really great opportunity to kind of also dig into and understand additional value and benefits to participating in a framework like this.
Daniel Williams:All right, great points there. So Justin McMartin, Director of Product Innovation at SureScripts, thank you so much for joining us today.
Justin McMartin:Yeah, appreciate the time. Thanks for having me.
Daniel Williams:Yeah, love this conversation. And for anybody else who learned a lot today in today's episode and want to know even more, I want to provide some resources for you. They're going be in the episode show notes. So first up, we're going to provide a link directly to surescripts.com/qhinready. And I'm going to provide a direct link so you can click right to that.
Daniel Williams:I'm also going to provide several other resources that you can go to, give you kind of a toolkit or toolbox for you so you can access information and learn more about it. So Justin, I did want to ask you one more thing. You provided one link. Is there anywhere else or any other tool or FAQ or anything else on SureScript or elsewhere that you think might benefit our listeners? That's one of the things I know when I go to the internet and I'm typing stuff in.
Daniel Williams:I mean, AI, it's very much more helpful now, but there's still you don't want to spend a lot of time and get frustrated trying to find what you're looking for. Anything else out there to point them to? Yeah.
Justin McMartin:So I mean, I think you pointed the link that you provided is it takes you out to that resource hub where it's got a whole list of other materials. If you're looking for things outside of SureScript, you can access the recognized coordinating entities website as well. So that's again, out at the Sequoia project. I don't have the link right in front of me, but I would encourage you also to look there. They have a lot of other materials around how do providers get connected?
Justin McMartin:What are other things to consider there? Just in case you're questioning whether I've given you all the facts, but I think you'll find it's all there.
Daniel Williams:All right. Well, Justin, thank you again for joining us. Appreciate you. Yeah. Thanks.
Daniel Williams:All right. And everybody listening, thank you so much for being MGMA podcast listeners. Again, we're going to put all this information in the episode show notes. We're also gonna create an article on our website where you can go right to some key points from this conversation. Until then, thank you so much, and look forward to connecting with y'all in the next MGMA podcast.
