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I was preparing to do a show on the essentials of TEFCA and I found myself pulling much of the information from this clip with Micky Tripathi. So instead of paraphrasing, I thought I would just share it. Here is TEFCA straight from the ONC.


Today in health, it a Tesco primer from none other than Micky Tripathi. My name is bill Russell. I'm a former CIO for a 16 hospital system and creator of this week health, a set of channels dedicated to keeping health it staff current. And engaged. We want to thank our show sponsors or investing in developing the next generation of health leaders, Gordian dynamics, Quill health tau site nuance, Canon medical, and Kern health. Check them out at this week. So yesterday chime did a webinar that I wasn't able to attend on Tesco and tifca is coming fast towards us and has a lot of implications.

And we did an interview with making sure Pathi earlier in the year, and we asked them a lot of questions about this. We did about. 10 minutes on it. And we discuss, you know, what is Tamika. Uh, what does it mean for health systems? We even went as far as to talk about what it means for patients. So I wanted to share that with you. So here it is.

What do we need to know about TEFCA at this point?

Yeah. So I think the most important thing to know about TEFCA is A, that it's now available for networks to participate in. And then the question is, well, what the heck does that mean? Imagine a world where you think about your cell phone and think about cell phone systems and let's say that AT&T and Verizon and T-Mobile, weren't connected. All of them great nationwide networks, but each of them kind of a private network.

So if I wanted to call you Bill, I would need to know, well, I'm on Verizon. Oh, you're on T Mobile, we can't talk or we can only text, but we can't talk for example. Now with AT&T it's like, well, I can call, but I can't text. That's a little bit of the situation that we have today in the clinical interoperability world with respect to networks. That there are lots of networks out there and the private sector has done a tremendous job, I think moving forward and putting together networks, but because it's the private sector each of them has got its own sort of peculiarities and its own uniqueness.

And so they don't seamlessly connect in the same way that cell phones, for example, or electricity grid across the country. May a lot of people may not know that our electricity grid, isn't a single grid. It's a whole bunch of subsystems that are connected together. And we experience it as a single system, just like we do with cell phones, but it's actually a bunch of sub networks that are connected up.

So what the 21st Century Cures act did is say to ONC create a governance model and a model for connecting up those networks so that we have that same kind of experience as a user. Whether you're a provider or a patient or a public health agency how do we create that backbone infrastructure so that you can connect with anyone regardless of which network they're on.

And you'll experience that as being in the same network and you won't have to worry about what's going on in the back in the backend. So that's really the most important part of that I think. And the analogy, another analogy I would use is think about the way that bank systems work today.

The ATM's, that's where I was going to go is interesting. You use cell phones and not ATM's cause TEFCA would be like that, that common ATM framework that started to come together. At some point, which allowed us to go to any ATM and, and.

Right. You and I are old enough to remember when you have to look at your card and it's like, ah, this is a Cirrus. I'm in a Cirrus network. I have to go find a Cirrus ATM. So my kids, they're kind of like, well, my kids are like, what's an ATM. They're just, they're just, they're just using Venmo. But but yeah, I mean, I think that's the same analogy. But and one of the things that, you know, that. TEFCA is more about the backend structure.

So how do we, how do the banks have a system where I take money out of an ATM with the ATM that's right down the street here, which isn't my bank's ATM, but as soon as I log into my bank's portal, that's up to date. Right. It actually has the transaction there. There is a backend system that makes sure that your information is accurate, reliable, and up-to-date, and that's what we want TEFCA to be able to do for medical records so that when you show up at your provider, there's the backend system that makes sure that to the greatest and possible the medical records that that provider has access to are up-to-date and reliable so that they have the best information available for them.

If people want the details about TEFCA Micky and I had a conversation last year, you can go look at that show. And we went into details of the Sequoia project and their role in it and a bunch of other things. They can really get the deep dive into it at that point, if they want the details.

There's even mpre details now available on the website, because now that we're able to release it. That's all out there now.

I want to get into the pragmatic. So healthcare providers, what are they going to need to do? Or what should they be doing now in preparation for connecting, participating in the TEFCA framework, or as we said in the analogy, the ATM framework, so that the medical records, as somebody gets a lab drawn over there is it shows up over here instead of the point to point connections that exist. I imagine TEFCA can act as a way to get it from a lot more sources.

Sure. So there's a couple of things. I think for the vast majority of people using certified electronic health record systems or electronic health record systems in general. Right now they probably don't need to do anything. What they need to do is wait for their network which is either CommonWell or the e-health exchange or care quality, which is a different one.

Their network is going to figure it out what their participation is because TEFCA is for the networks to participate in. So if you're a participant in a network, like you're already in the, as a part of that network at some point they will sort of make a plan to connect to the broader TEFCA network. And for you as a provider, you will be asked to sign an additional agreement, or it'll be a rider on the other contract you've already signed. And then after that, your vendor should enable that within the system, within your EHR. So you actually won't really even have to do anything. You'll at some point just experience that wow. I can connect to more people than I was able to before. And that's kind of cool. For those who aren't yet a part of those networks right now, then I think that it's the idea is to either connect with one of those networks. Now, if that was if you, for some reason felt like I wasn't gonna get any value from those networks, it may be that once they sort of join TEFCA that you feel like, oh, that's the point at which it makes sense for me to join that network now because it connects to any other network and I can choose which one makes most sense to me. Because I don't have to worry about, well, who is that particular network connected to because there'll be connected to every other every other network that's participating.

So if you're not a part of the network there's either, if you have the opportunity to join one of those, you may, you may want to wait and see what happens with their TEFCA participation and then join them or to see if there are any new networks that either get formed or are joined and then deciding which ones of those you want to participate in.

If we anticipate there'll be some new ones, I mean, this TEFCA is certainly about connecting the existing networks, but we also expect that it's going to be a motivator for new new networks to form and for really innovative approaches to this.

Is this going to replace the HIE? So if I have a regional HIE, Southern California, we had a regional HIE in Southern California. And it struggled from time to time for funding. And some other things. Is this going to provide the backstop for that? That I was always worried that that thing was not going to be funded and all of a sudden we weren't going to be able to exchange records?

Yeah. So

it's know you raised a couple of issues there and it certainly shouldn't replace HIEs. The idea would be that HIEs can connect to this network and then you're in Southern California now. You're not only connected to the those folks who were in that HIE in Southern California but you're connected to everyone else in the country and that HIE doesn't have to do any more work. At that point they're just connected to everyone else. So conceptually and I think what we've seen in other network industries is that that actually adds value.

People think that, oh, one network conquers another one. Well, what actually happens is that participation rises in both. Because of the network effects that everyone feels like, oh, I'm actually getting great local stuff in my local network that I didn't want to lose by by joining some other bigger thing that maybe didn't provide that.

Now I get all of that through that local network. So actually you see people sort of join participate in. We've seen that in the private sector with different networks to connect care quality and CommonWell, which were seen historically as competitors, it turns out that once they connected at some level participation in both rose. It was a win-win or a positive sum game. It wasn't a negative

sum game.

We're going to get to information blocking, but before I get there talk to me about how TEFCA is going to impact the patient experience.

Yeah. So it should be in a couple ways. One first is the backend experience, which is to say that and that may be an indirect benefit, but you know, the patients only sort of indirectly notice which is to say that they should have the experience that their providers have more access and easier access to their records than they have before. So they're not being asked to lug records from one provider to another, for example, paper records. They're not being asked as many people have to do, which is I've just got imaging done at that hospital down the street, and you're telling me I have to come in in person to pick up a CD rom and bring it to that hospital down the street, that it should take away a whole bunch of that stuff.

And then as I said, that's indirect, right? For a lot of us, we may not actually notice that cos you know these things happen incrementally. Right. And then, so at some point it's like, oh, I didn't have to do that. Great. But that's that's people's expectations. So in some ways they don't celebrate it.

They're like, well, that's what I expected anyway, was that that was going to be happening. So that should be happening in the background. They also will have the opportunity to connect to the network themselves through a vendor. And what that will allow them to do is just like they connect to a patient portal today.

For example, you may log into the patient portal at your provider right now that just gives you the information from that provider. But with the TEFCA network, individual access is a required purpose, meaning that there, there are vendors who could be certified to be on the network and once they're on the network, you could use one of those vendors to basically ask for your records from any provider. Not just the provider that you know, that is connected or is providing you with that portal. So for those patients who choose to do that, it should be easier for them to gather their information, regardless of where which provider they go to.

As we know, like Medicare patients they often see 5, 6, 7, 8 different providers. And so that could be a real convenience.

It's interesting. As I was preparing for the show, I was thinking I'm going to do this big primer on Topeka and whatnot. And I realized it's not nearly going to be as good as what Mickey had done. So I thought I'd pull this clip out. I might do that from time to time. We interviewed some great guests over on the conference channel and on the new state channel and sometimes their explanations and things they're talking about are far better.

Then I'm going to be able to do by giving you a book report of what Mickey said. So. Uh, straight from the office of the national coordinator, Micky Tripathi. This is what Tasca means. I hope you appreciate it. That's all for today. If you know someone that might benefit from our channel, please forward them a note. They can subscribe on our website this week, or wherever you listen to podcasts, apple, Google, overcast, Spotify, Stitcher.

You get the picture. We are everywhere. We want to thank our channel sponsors who are investing in our mission to develop the next generation of health leaders, Gordian dynamics, Quill health tau site nuance, Canon medical, and 📍 current health. Check them out at this week. Thanks for listening. That's all for now.

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