In a 2025 survey of well being data organizations, solely 22% are already taking part within the nationwide Trusted Change Framework and Frequent Settlement (TEFCA), and 24 p.c proceed to say they aren’t positive if they may take part.
These have been among the many findings mentioned throughout a current Civitas Networks for Well being webinar that examined information from the 2025 Nationwide Survey of Well being Info Change Organizations.
The annual survey was performed by UCSF with help from the Assistant Secretary for Expertise Coverage (ASTP) in partnership with Civitas. The survey contains questions from previous HIO surveys associated to members, providers, challenges, monetary viability in addition to new matters reminiscent of TEFCA, requirements and data blocking. Seventy-seven organizations responded.
Julia Adler-Milstein, Ph.D., professor of drugs at UCSF, led members by means of the survey findings, joined by David Kendrick, M.D., M.P.H., who serves as a strategic advisor to Civitas Networks for Well being. He’s the chair of medical informatics on the College of Oklahoma College of Group Drugs and assistant provosts for strategic planning on the OU Well being Sciences Heart.
“Twenty 4 p.c remains to be a excessive quantity to say that they are not positive, in order that’s a pattern that we’ll proceed to observe to see if that quantity decreases,” Adler-Milstein stated.
The survey additionally requested by means of which QHIN they’re taking part, and eHealth Change is dominant there. “We requested what adjustments has your HIO made or planning to make in an effort to take part in TEFCA. What do it’s worthwhile to do to take part? Forty-seven p.c stated that they needed to do work with their authorized agreements or insurance policies, and 35% stated they’ve technical infrastructure work to do, whereas 24% stated they produce other infrastructure work,” she stated. “Twenty p.c made adjustments to the sorts of providers provided. This provides us a way of the funding that HIOs are dealing with as they’re attempting to make selections. That is on the associated fee facet of the equation.”
The survey additionally requested what quantity of HIO members are taking part in TEFCA by means of the HIO. “It’s one factor for the HIO to say, sure, we’re taking part, but when they don’t seem to be bringing alongside the vast majority of their members, that is clearly going to impair the worth of TEFCA participation,” Adler-Milstein stated. “At this level, 56% say that only some of their members are taking part. Solely a minority say that each one or most are taking part.” That is solely information from the 16 HIOs which might be already taking part. “This might simply be early information earlier than there’s actually had time for all of their HIO members to to have the ability to be part of. This will probably be a extremely essential one to trace over time,” she stated.
Of people who have had some engagement with a QHIN, 13% say they’re very happy, 21% say happy, and 31% are kind of impartial at this level. When requested about satisfaction with TEFCA difficulty response, nearly half of them say that they have not reported a problem but to the to the RCE. So there may be restricted expertise at this level with difficulty response.
“We’re actually curious to see in our subsequent administration of the survey the place these numbers are trending, as a result of I believe that is actually an early snapshot of experiences below TEFCA. I believe they’re actually attempting to know the associated fee/profit relationships,” Adler-Milstein stated.
Turning to monetary viability, Adler-Milstein stated the survey asks HIOs: Does earnings from members cowl your working bills? Utilizing that as a marker, a couple of third of HIOs report that they’re at that marker of economic viability.
Kendrick referred to a Well being Affairs article that got here out with the headline asserting one thing like HIEs are dying as a result of there are fewer of them than there have been a few years earlier than. “We all know that was not the by means of line. The by means of line was consolidation. The unique mannequin was let a thousand flowers bloom and see what survives. The true metric right here, I believe, could be one thing like: What p.c of People are served by a well being data group or what p.c of knowledge density is on the market there? Then with regard to the monetary viability, I simply wish to emphasize this for everyone who appears at that and says, ‘Holy cow, two-thirds of us are going away if we do not repair one thing.’ That is saying 35% of HIOs report they make the entire cash wanted to maintain themselves solely from participant charges, no Medicaid {dollars}, no grant {dollars}.”
The checklist of providers that HIOs present will get longer yearly as a result of HIOs are discovering new use circumstances. The dominant one which’s been on the prime of the checklist throughout many surveys is alerting and occasion notifications like ADTs. That is adopted by constructing a neighborhood medical or well being report by means of aggregating throughout a number of sources. Additionally towards the highest of the checklist is query-based alternate. About two-thirds of HIOs are saying that they are supporting providers across the Direct protocol, information normalization, outcomes supply, reworking different doc varieties or repositories into CDAs.
The survey additionally requested about some service choices which might be geared extra towards value-based fee fashions. Three-quarters of HIOs are offering information to permit evaluation by a community or supplier — a supplier profiling and efficiency use case, adopted by actions associated to high quality measurement, like producing, validating, and reporting out high quality measures. Towards the underside of the checklist are issues like registry providers. 1 / 4 of HIOs say that they’re supporting a use case round closed-loop referral monitoring.
Adler-Milstein stated that one stunning factor within the survey was that two-thirds of HIOs say that they are capturing information on meals safety, housing, transportation, after which to a lesser extent employment standing and interpersonal violence. “That is an space the place we’re seeing new worth add from capturing social wants information,” she added.
There wasn’t loads of exercise reported round use of FHIR, and Kendrick stated he wasn’t stunned. “In reality, I did not count on many organizations to be receiving FHIR in any respect. Most hospitals and clinics are simply not prepared, and even when their vendor claims to be prepared, that is not the model that is put in in most locations. I used to be stunned there wasn’t extra FHIR on the sending information facet, which means exposing a FHIR API. That is in all probability the core functionality of a well being information utility technical functionality that must be achieved within the subsequent spherical. So that is the one I will be watching to see if we are able to develop it.”
Mapping to LOINC codes
The survey requested a number of questions on LOINC and the way a lot work it’s taking for HIOs to map from non-standard laboratory take a look at outcomes to LOINC codes. A couple of third of HIOs report that they are having to do the mapping work, and 15% say that each one or most of their outcomes want that mapping work finished. Nearly half say that they are having to try this for no less than a few of the outcomes. “So there may be loads of friction and work nonetheless to get to standardized lab information,” Adler-Milstein stated. “Many report some challenges with the sources required to try this, to take care of mappings, or a lack of know-how to have the ability to do this mapping.”
Anecdotally, Kendrick stated that even some reference labs should not appropriately utilizing LOINC when sending ends in, “and that is only a vital drawback that has to get handled. There’s a want to lift the extent of consciousness of that at ASTP. The second factor that I’d say is that is in all probability an space that might be nice to determine a neighborhood of follow among the many networks, as a result of all of us ought to method fixing this drawback in an identical approach. I’d assume the information coming to us may be very related and coming from the identical distributors.”
