QHINs Will Help Shine a Light on Data Quality

There has been a lot of activity and news coverage of Qualified Health Information Networks, or QHINs, recently. But what are they? and do we need to pay attention to them?

As the industry gets ready to descend on Nashville for ViVE2023, we thought it would be helpful to get a primer on QHINs and discuss their potential impact. Healthcare IT Today had the chance to ask Charlie Harp, CEO of Clinical Architecture, for his perspective via email. Here is what he had to say.

Can you briefly describe TEFCA and QHINs?

TEFCA, or the Trusted Exchange Framework and Common Agreement, originated in the 21st Century Cures Act and is intended to establish the rules of the road for sharing information between healthcare settings in the United States. The Trusted Exchange Framework is the technical standard that governs the actual sharing of data, and the Common Agreement is the legal agreement that governs the obligations of those sharing the data. The Qualified Health Information Networks, or QHINs, are the actual networks that are Qualified to operate under the rules of TEFCA and move health information between exchange participants.

An analogy I use for people not steeped in healthcare is air travel. In this analogy, TEFCA is like the Federal Aviation Administration (FAA), which establishes the rules of air travel. QHINs are like the Airlines, which must operate under those rules, and the participating healthcare organizations are like airports, with people arriving and departing constantly. It’s not a perfect metaphor, but it gets the job done.

Why should the healthcare industry take note of QHINs?

The main reason is TEFCA is a nationally endorsed initiative. Hopefully, this means there will be a long-term commitment to its funding, adoption, and success. Having a national standard around healthcare data exchange, with minimal requirements, should make the meaningful exchange of information more attainable than previous initiatives, which were more limited in scope, being either regional or membership-based. We can extend my air travel metaphor and say that a nationwide network makes it easier for a traveler, in this case, patient data, to get from one end of the country to another safely and on time. Once TEFCA and the QHINs reach critical mass, we will be a much more connected health system.

Given QHINs do not have any incentives or penalties (yet), do you believe we will see adoption?

I think there are more than a few organizations excited to participate in TEFCA, and to receive data, you have to share data. I think there will be decent adoption. I also think, like many folks, that incentives are forthcoming. Organizations and vendors will at least start the work necessary to ensure they are prepared for when those incentives arrive.

What are the keys to success for QHINs?

Here the air travel analogy is solid. What makes a successful airline? You want to get the traveler to the correct destination safely, on time, and with all their luggage. For QHINs to be successful, they need to be a commodity at a minimum. As a traveler, I should have the same basic expectations regardless of QHIN. Some might offer first class or have better snacks, but if any QHIN fails to meet that basic expectation of a safe, timely journey, confidence in TEFCA will suffer. The only other thing is stability. Like standards, TEFCA and the QHINs have the potential to be the tail that wags the dog. Healthcare is a very busy industry; if we are supposed to comply with a standard, it should be stable and not require us to retool how we do things every two years. When that happens, it distracts the industry from dealing with high-value, practical challenges.

Do you think that TEFCA and the establishment of QHINs will solve data quality issues in healthcare ?

I think, initially, it will shine a light on the data quality problems. We have a non-trivial data quality problem in healthcare. Most enterprises are unsure of their own data’s accuracy and trust the data they get from other sources even less. TEFCA and the QHINs don’t clean the data; they just make moving it around easier. Once we start participating in TEFCA and organizations begin receiving data from more places, they will likely find that the data we are receiving is not wonderful. This will be due to patient data quality issues at the source, semantic code mapping quality issues, and transformational data loss. Most organizations will receive data from other organizations and allow providers to see it but not combine it with the data in their system. This will be a safer bet that will protect their environment. But it will fall short of the dream of a complete, accurate and reliable digital twin of every patient. Going back to our air travel analogy, what happens when you put a sick traveler on a plane? Too soon? I apologize. The bottom line is, doing a better job of sharing bad data is not the answer.

How do you ensure the quality and usability of the data being shared between QHINs or other organizations?

We have to fix the quality problems at the source. This requires that the organizations that create patient data change how they think about the data. Today the data is considered a byproduct of providing care, not an important product in and of itself, but it needs to be. Don’t get me wrong, providing excellent care is important, but we live in a time when it is increasingly difficult to provide good care cost-effectively without good data. So, we start by making data quality a part of our culture and providing best practices, standards, and solutions that enable us to make that a reality. An organization that produces accurate, current, reliable, harmonized data has data liquidity and is playing the game on an entirely different level. This type of evolution is a strategic objective and something we at Clinical Architecture have accomplished with many of our large health systems partners.

If we can’t achieve the Zen of reliable data in the short term, the next best thing is ensuring the data we receive from someone else is semantically correct. If you receive data that is not semantically interoperable, the best you can do is make it a readable document. I am waiting to see how and if the QHINs will be addressing semantic interoperability. We would love to work with them and have been specializing in direct semantic term mapping with some of the largest entities in the nation for the last thirteen years. Our approach is scalable, direct (there is no changing proprietary code in the middle) and completely controllable by the originating data source. On a personal level, I would love to put semantic interoperability in the rearview mirror so we can focus on something more interesting.

What are you excited for at ViVE2023?

VIVE is a great opportunity to connect with healthcare luminaries and thought leaders and get the pulse of things changing across our industry. This year there is an excellent lineup of speakers and sessions. As always, I appreciate the opportunity to meet other travelers on our collective journey to use technology and information to enable better healthcare.

Visit Clinical Architecture at ViVE2023 in Booth 2020 or at https://clinicalarchitecture.com/

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About the author

Colin Hung

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

   

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