John Blair, MD, CEO of MedAlllies

Like tales of Bigfoot and UFO sightings, talk of Qualified Health Information Networks (QHINs) has been met around the health industry with some skepticism, with some in health IT asking, “Are QHINs real?

Though the question was posed partly in jest, doubts about the reality of QHINs have been somewhat understandable. QHINs were created as part of the Trusted Exchange Framework and Common Agreement (TEFCA), a set of regulations designed to improve healthcare interoperability by establishing standards and infrastructure to ease data exchange among key stakeholders such as providers, payers,  and their information technology partners. 

The first draft of the TEFCA was unveiled all the way back in January 2018 by the U.S. Department of Health and Human Services (HHS), through the Office of the National Coordinator for Health Information Technology (ONC) – leading many to wonder whether QHINs would ever see the light of day. 

Now, however, those doubts can be laid to rest, as a result of a major milestone the healthcare IT industry reached as HHS announced in December 2023: TEFCA is now operational and QHINs are finally real. 

What are QHINs?
QHINs are a centerpiece of TEFCA. QHINS are networks of organizations that work together to share data and connect directly to each other to ensure interoperability between the networks they represent.

“QHINs are the pillars of TEFCA network-to-network exchange, providing shared services and governance to securely route queries, responses, and messages across networks for eligible participants including patients, providers, hospitals, health systems, payers, and public health agencies,” according to ONC. 

The ONC’s December announcement noted that five organizations have been officially designated as QHINs after undergoing a rigorous onboarding process: MedAllies, eHealth Exchange, Epic Nexus, Health Gorilla, and KONZA. As a result of the designation, these QHINs can begin supporting healthcare data exchange under TEFCA’s technical requirements and policies. 

These five QHINs, as well as two QHIN candidates working through the implementation process, operate networks that cover most U.S. hospitals and tens of thousands of providers and process billions of annual transactions across all 50 states, ONC stated

What QHINs will do for interoperability
Designating official QHINs, however, was just an early step in getting TEFCA off the ground. The real value of TEFCA will accrue as QHINs onboard more and more customers, and those customers realize the benefits of seamless healthcare data exchange. Here are four ways that QHINs will improve healthcare interoperability: 

  1. Connect more healthcare organizations: It’s estimated that around 70% of hospitals and more than half of ambulatory providers are connected to a national network. While most large provider groups across the country are connected, smaller rural providers and non-traditional providers such as post-acute care and home health have lagged. As QHINs streamline the technical requirements and reduce potential legal burdens of data sharing, more health entities will establish connections with national networks. 
  2. Increase the usability of healthcare data: One of the greatest barriers to widespread interoperability has been the challenge of messy healthcare data, which is often incomplete, inconsistent in terminology, and fragmented across multiple information systems. TEFCA and QHINs will help solve this problem by providing technical standards and framework to underpin health data exchange. With more accurate, complete, and up-to-date data, physicians can make better decisions to generate better health outcomes. 
  3. Expand the use cases for healthcare data: The major use case of improving patient care and treatment through better healthcare data sharing has been well-established to date. However, QHINs are expected to support several emerging use cases, including individual access service, public health, benefits determination, and payment and operations. Many health IT stakeholders are still working through the details of these additional use cases. 
  4. Break down industry siloes: The more complete and accurate flow of information between healthcare entities will allow QHIN participants to improve collaboration and care coordination, breaking down many of the siloes that continue to affect the industry. With more comprehensive patient information at their fingertips, providers can make better diagnosis and treatment decisions, reduce unnecessary and duplicative tests and procedures, and more productively work together across different areas of medicine. 

The tongue-in-cheek debate is finally over and QHINs are indeed real – and well-positioned to drive legitimate, tangible progress toward achieving the elusive goal of interoperability by driving better usability and broader uses of healthcare data.


About  John Blair, MD

A. John Blair, III, MD, F.A.C.S., III, MD, F.A.C.S. is the CEO of MedAllies, a national healthcare connectivity services provider. He is a health care and technology executive with broad experience across the health care industry including clinical practice, hospital planning and governance, revenue cycle management, managed care, public health and health care informatics. Prior to establishing MedAllies in 2001, Dr. Blair worked as a general surgeon for twenty years before becoming the President of the Taconic Independent Practice Association (TIPA), a network of over 5,000 physician members.

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