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Data Exchange Partners and Networks
EMS providers can exchange data with other healthcare providers through existing networks.
The following frameworks govern how healthcare data is shared between networks in the United States.
The 21st Century Cures Act directed the Office of the National Coordinator for Health Information Technology (ONC) at the US Department of Health and Human Services to establish the Trusted Exchange Framework and Common Agreement (TEFCA). "The overall goal of the Trusted Exchange Framework and Common Agreement (TEFCA) is to establish a universal floor for interoperability across the country. The Common Agreement will establish the infrastructure model and governing approach for users in different networks to securely share basic clinical information with each other—all under commonly agreed-to expectations and rules, and regardless of which network they happen to be in. The Trusted Exchange Framework describes a common set of non-binding, foundational principles for trust policies and practices that can help facilitate exchange among HINs." The Sequoia Project is the "Recognized Coordinating Entity" funded by ONC to implement TEFCA. TEFCA has technical specifications and a common agreement for health information network interoperability. Under TEFCA, multiple Qualified Health Information Networks (QHINs) provide interoperability services, including network-to-network interoperability. The first QHINs were designated in December 2023, and data exchange under TEFCA began immediately thereafter. An overview of TEFCA is provided in the User’s Guide to the Trusted Exchange Framework and Common Agreement.
Carequality is an interoperability framework. It is similar to TEFCA, preceded TEFCA, and continues to function actively while TEFCA gets going. "The adopters of the Carequality Interoperability Framework – and their clients – benefit from accelerated, less costly health data sharing agreements, because they no longer need to develop one-off legal agreements between individual data sharing partners." Carequality has many implementers, which are health information networks that can share data network-to-network under the Carequality framework. Healthcare providers using different implementers can share data with each other because their implementers participate in the Carequality framework. Carequality provides a site search of Carequality-enabled providers.
Carequality publishes legal and governance documents and implementation guides. Generally, all participants that participate in Carequality must be able to respond to queries for data (the role referred to as "Query Responder") in additional to initiating queries ("Query Initiator"). However, The Carequality Framework Policies include a section (3.2.1.2) that exempts EMS providers from the requirement to be a Query Responder if they have another method of transmitting their reports electronically to destination facilities.
All of the examples listed here are both TEFCA QHINs and Carequality implementers.
eHealth Exchange "began as a federal program initiative under the Office of the National Coordinator for Health IT (ONC), which helped to incubate it as part of the NwHIN [Nationwide Health Information Network] efforts. eHealth Exchange is now an independent, non-profit health information network" connecting 77% of state and regional HIEs, 75% of hospitals, and five federal agencies. "Participating organizations mutually agree to support a common set of standards and specifications that enable the establishment of a secure, trusted, and interoperable connection among all participating Exchange organizations for the standardized flow of information..." All eHealth Exchange participants sign a single Data Use and Reciprocal Support Agreement (DURSA). Participants may be EMS provider agencies, state governments, software vendors, or federal agencies. eHealth Exchange maintains a published list of participants.
Commonwell Health Alliance is a multi-vendor association focused on health data interoperability. Commonwell also runs a national health information network, which includes a Record Locator Service (RLS). "The RLS allows a provider organization linked to CommonWell to search the entire nationwide network in real time to gather comprehensive patient data..." Anyone may become a Commonwell member. Software vendors may become Commonwell Service Adopters to offer Commonwell access to their customers.
Kno2 is a network integrator that provides a REST API to access Carequality member networks. Software vendors can contract with Kno2 to provide health information network connectivity to their customers.
Health Gorilla is a network integrator that provides a REST API to access Carequality member networks. Health Gorilla aggregates longitudinal patient data and maintains a master patient index (MPI). Software vendors can contract with Health Gorilla to provide health information network connectivity to their customers.