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WASHINGTON -- Five healthcare companies took another step toward becoming part of a nationwide network to exchange patient health information on Tuesday.

"I feel like we're watching the Big Bang occur in 2023," HHS Secretary Xavier Becerra said during an event held at HHS headquarters here. He congratulated "the entities who stepped up early to help us bring together everyone and are now going to help share -- on a platform that most people would say would never happen, yet it's open, it's available; it's a private-public partnership bringing together experienced, established, and new players who know how to make sure that we are working with the interoperable healthcare information system, kudos to you. You are those big universes that are establishing themselves as the light in the sky. It is great to see you come forward."

The five companies -- eHealth Exchange, Epic Nexus, Health Gorilla, KONZA, and MedAllies -- became the first qualified health information networks (QHINs) to meet the criteria for participating in the Trusted Exchange Framework and Common Agreement (TEFCA), a network the federal government is building to make it easier for health plans, providers, public health agencies, and patients to exchange health information. Executives from the companies all participated in a signing ceremony on Tuesday.

Live transactions on the new network began on Tuesday, a few hours after the companies signed the Common Agreement. Those transactions are occurring under a version of the agreement that was previously approved, even as a new version is underway. "Common Agreement Version 2.0 ... is actively under development and scheduled to be adopted by the QHINs within the first quarter of 2024," according to a from the Office of the National Coordinator for Health Information Technology (ONC).

"A complete and accurate medical record is essential to high-quality care," said Rob Klootwyk, director of interoperability for Epic Nexus, in Verona, Wisconsin. "When clinicians can easily exchange information, they can see the full medical history of their patients and provide the best care. TEFCA is bringing clarity to this country by aligning all the regional efforts under a federally enforced Big Bang ... But there are still gaps in us achieving that universal interoperability, and collectively, we all need to continue those efforts to close those gaps by engaging every physician in this country to become a participant in TEFCA."

"For them, that will be the single on-ramp to nationwide interoperability," he continued. "As of this week, over 200 hospitals and 3,000 clinics that use Epic plan to be early adopters of this framework ... At full rollout we do expect to help around 2,700 hospitals and 70,000 clinics to go live on TEFCA. And to me, a critical mass of providers adopting TEFCA as soon as possible is the key to TEFCA's success. So, I'm excited for the day when every provider in this country can answer the question 'Are you part of TEFCA?' with a resounding 'Yes.'"

ONC head Micky Tripathi, PhD, MPP, also urged providers to come on board, saying that forward movement on TEFCA "will hopefully allow all of those who are on the sidelines, the HIEs [health information exchanges] who aren't getting connected up with each other, the vendors who haven't yet joined, and the physicians and smaller hospitals who weren't aware that this is going on, or don't have the resources or haven't made it a priority ... Hopefully, this will give them all the clarity to say, 'Yeah, I need to do that thing.'"

One thing the common agreement doesn't include is a unique patient identifier for each patient whose data is being shared. Tripathi told 番茄社区app that he didn't think that would be an issue. "It certainly would be helpful, but it's not required," he said in a brief interview, adding that because Congress has long prohibited establishment of such an identifier, "the industry has just had to adapt. It's certainly a fair question to say 'Would it improve things?' but I'd just say it's not necessary because we've done so much other work" in terms of patient identification.

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