Qualified Health Information Network (QHIN) updates

Surescripts, through its subsidiary Surescripts Health Information Network LLCTM, has applied to become a QHINTM under the Trusted Exchange Framework & Common AgreementTM (TEFCATM). Our candidate QHIN is preparing to help you make the most of TEFCA with Interconnect. Here’s where we’ll share announcements, FAQs and other resources to keep you in the loop.

Overview

Simplifying your path to nationwide interoperability

Realize the power of TEFCA by partnering with Surescripts and our candidate QHIN. If designated a QHIN and approved for onboarding, Surescripts Health Information Network will be able to help organizations like yours expand access to data across healthcare via Interconnect. Explore the benefits of partnering with an experienced leader in nationwide interoperability.

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Leading in interoperability

Surescripts has a long history of participating in industry organizations to make healthcare interoperability a reality, including implementing Carequality as a founding member.

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Standards, scale & security

Our highly secure solutions promote and apply FHIR HL7 and NCPDP standards and the Carequality framework. Our Master Patient Index covers virtually every U.S. patient, and our directories link nearly 2 million healthcare professionals and organizations.

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Workflow integration expertise

Surescripts delivers critical healthcare intelligence when and where it’s needed most. A wide range of clinical and care management scenarios benefit from flexible functionality like record location and Direct messaging.

How will TEFCA and QHINs work?

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Tap into a single, powerful QHIN connection

A new era of clinical information exchange is coming. As a QHIN candidate, Surescripts Health Information Network is preparing to help you make the most of it with Interconnect.

FAQs

 Find out more about TEFCA and Surescripts Health Information Network’s QHIN candidacy

What types of organizations can connect to a QHIN?

Most (if not all) Surescripts Network Alliance participants can connect to a QHIN. QHIN participants can include medical practices, health systems, pharmacies, health plans, accountable care and other care management organizations, and PBMs, among others. Our team can help assess how a QHIN connection could benefit your organization.

Why would I want to exchange data through a QHIN?

Key benefits include: 

  • A simpler approach to data exchange with less need for one-off connections 
  • The ability to exchange information for different types of purposes 
  • Reduce barriers to connection and improve access to information 
  • Exchange data with a broader range of health care organizations 
How could this help healthcare providers?

TEFCA establishes a set of technical, data access and security requirements to create the trust needed for providers to confidently send and receive clinical information. This could help healthcare providers: 

  • Efficiently access more complete clinical records, allowing them to make more informed decisions, reduce duplicative tests and better coordinate care 
  • Ensure that primary care providers are notified about hospital admissions, discharges and other healthcare interactions outside their practice 
  • Reduce the administrative burden of sharing data with public health agencies, which often have unique reporting requirements and connection method 

For more on the opportunities that come with connecting to a QHIN, read our QHIN Use Case Guide.

How could this help health plans and pharmacy benefit managers?

TEFCA will enable easier access to clinical and administrative information that can help health plans and pharmacy benefit managers improve care for their members more efficiently. Connecting to a QHIN could help them:

  • Gain a more holistic view of their members’ clinical history, helping identify and close care gaps while supporting the industry's shift towards value-based care
  • Leverage TEFCA’s payment and healthcare operations use cases to power care management, population health and risk adjustment programs
  • Reduce dependency on outdated technology such as faxes and phone calls to providers, easing administrative burden
  • Inform prior authorization and other processes intended to help ensure appropriate, affordable and safe care
  • Exchange data with public health agencies, helping manage public health emergencies in a more efficient and collaborative manner

For more on the opportunities that come with connecting to a QHIN, read our QHIN Use Case Guide.

How could this help pharmacies?
  • Reduce dependency on outdated technology such as faxes and phone calls to providers, easing administrative burden
  • Gain a more holistic view of their patients’ clinical history, helping identify and close care gaps while supporting the industry's shift towards value-based care
  • Inform medication therapy management and other processes intended to help ensure appropriate, affordable and safe care
  • Exchange data with public health agencies, helping manage public health emergencies in a more efficient and collaborative manner

For more on the opportunities that come with connecting to a QHIN, read our QHIN Use Case Guide.

What information exchange purposes does the Common Agreement cover?

Initially, the Common Agreement will require health information exchange among QHINs for the purposes of: 

  • Treatment includes the provision, coordination or management of healthcare by one or more healthcare providers. It also includes the coordination or management of healthcare by a third-party provider, a consultation between providers treating a common patient, or the referral of a patient from one provider to another. 
  • Individual (patient) access services allow patients to receive a copy of their electronic health records and give them the ability to direct a copy of their records to another provider or entity authorized by the individual.  

In the future, health information exchange by QHINs will also include the purposes of: 

  • Payment includes the activities that healthcare organizations use to obtain payment or reimbursement for healthcare services, including health plans acquiring premiums to satisfy their coverage responsibilities. 
  • Healthcare operations include administrative, financial, legal and quality improvement functions that a covered entity needs to run its business and support treatment and payment activities. 
  • Public health refers to any request, use, disclosure, or response authorized under HIPAA regulations or other applicable laws regulating public health activities. 
  • Benefits determination helps federal or state government agencies decide whether a person is eligible for federal or state benefits for any reason other than healthcare. 
To be a QHIN participant, will my organization need to share data?

Yes. TEFCA is a reciprocal partnership. Within the parameters set forth in the Common Agreement and in accordance with applicable law, QHIN participants must generally contribute data in order to receive data. The Common Agreement and applicable Standard Operating Procedures set forth the requirements for TEFCA Exchange activities, including the authorized Exchange Purposes for which information can be requested or shared via TEFCA, as well as requirements around use, disclosure and response to requests for such information.

Do I have to sign my organization up for more than one QHIN?

No. If Surescripts Health Information Network is designated as a QHIN, you’ll be able to access patient and clinical information from any other QHIN once you connect.

What is the difference between QHINs? What should I be looking for to make the best decision?

To make a QHIN decision, we recommend starting with two high-level questions:

  1. How easy will it be for participants to establish and maintain their connection to this QHIN?
  2. Is this QHIN equipped to go beyond basic connectivity to innovate and solve larger challenges over time?

For more criteria to evaluate, read our QHIN Readiness guide.

Could exchanging information through a QHIN help organizations comply with the 21st Century Cures Act’s information blocking rule?

Possibly. Currently, some organizations struggle to respond to various requests in accordance with the information blocking rule. These organizations could potentially meet certain parts of their obligations by making the data available to a QHIN, which is required to make the health information available to requestors in compliance with TEFCA’s standards.  

However, TEFCA participation alone does not provide a formal exception to information blocking or create a safe harbor.

Why has Surescripts, through its subsidiary Surescripts Health Information Network LLC, applied to become a QHIN?

We believe that participating in the QHIN process is the best way we can reinforce the interoperability we enable today and support the nation’s progress toward greater healthcare interoperability. We also expect that this will help unlock even more efficiency and value from our network for Surescripts Network Alliance® participants.

How might this benefit Surescripts customers?

If designated, a QHIN would add more clinical endpoints to the Surescripts network, helping locate and exchange more records. TEFCA also provides for payment and exchange use cases that could power additional functionality such as care coordination, care management, quality measurement and risk adjustment.

Surescripts Health Information Network LLC also anticipates helping to shape the future development of TEFCA by joining the Governing Council—one more avenue to surface the needs and perspectives of Surescripts Network Alliance participants across the industry.

Resources

Explore QHIN news & insights