In my previous post in the series, while exploring the role blockchain could play in clinical trials, I touched upon the topic of “Trusted Data Sharing and Enhanced Collaboration”. In this second part of the series, I will continue to look into how blockchain can go beyond clinical trials and help with trust and collaboration across the entire healthcare industry by diving into the potential for using the technology within the Trusted Exchange Framework and Common Agreement or TEFCA.
However, before we dive into how and why blockchain can help, we must first dive into what TEFCA is and what it hopes to achieve.
TEFCA is an initiative by the Office of the National Coordinator for Health Information Technology (ONC) that aims at improving collaboration within healthcare across the entire United States and providing patients better access of their own health data. It provides a way to ensure secure exchange of electronic health information across various healthcare organizations.
It is primarily made up of two components - the Trusted Exchange Framework which is a set of principles to establish trusted data exchange between Health Information Networks (HINs); and the Common Agreement (CA) which is a legal framework defining the technical standards and procedures for data exchange by a Qualified Health Information Network (QHIN).
At its core, TEFCA has three goals:
Improved Connectivity between healthcare providers through secure information exchange
Patient Empowerment with better access and control over one’s own healthcare information,
Enhanced Public Health support through availability of necessary data and health trends.
To any blockchain enthusiast, it is immediately apparent how the ledger-based technology can play a vital role in accomplishing these goals. Not only does the idea of building a trusted network align with the core ideology of blockchain, the decentralized nature of the technology can provide an easy way to ensure patient empowerment as well as enforcement of the CA standards across the participating health organizations.
The Trusted Exchange Framework primarily outlines seven non-binding principles for establishing trust among HINs. Below is a brief look into each of these principles and how blockchain aligns with them:
Standardization - This principle aims at setting up technical standards, procedures, and best practices all of which are easily done by having a blockchain network govern the policies of data sharing.
Openness and Transparency - True trust and collaboration is only possible in a network where transparency exists. Given the trustless nature of blockchains, there is no need to dive into details of how the technology can help achieve transparency of operations.
Cooperation and Non-Discrimination - The essence of this principle is to ensure that collaboration is maintained at the core of the TEFCA framework irrespective of business goals. A decentralized network can help in establishing better cooperation and ensuring equal opportunity for all.
Privacy, Security, and Safety - Ensuring the privacy and safety of patient data is one of the biggest concerns of the healthcare industry in general and the combination of ledger-based networks and encrypted data is a strong approach of ensuring data integrity as well as de-identifying data to protect privacy.
Access - Controlling access of data to allow individuals to authorize their caregivers or healthcare providers to have access to their health records is a major component of patient empowerment that TEFCA hopes to achieve. Smart Contracts can easily help track not only who has access and for how long, but also the purpose of data sharing and the parameters for its usage.
Equity - When dealing with digital solutions, keeping the impact on different populations in mind is key to ensuring health equity. Similar to the establishment of equal collaborative opportunities for healthcare organizations, blockchain can be used to design processes that can help adapt to different demographics.
Public Health - One of the primary goals for the framework is to support the advancement of Public Health support and create a health system that can learn and improve the quality of healthcare. The unique nature of blockchain can allow for sharing of research data, learnings, and experiences without having to compromise on privacy and security. These factors that aid collaboration also ensure that this goal of improved public health quality is achieved seamlessly through the system.
Beyond the principles for the exchange framework, the establishment of QHINs and the signed Common Agreement form the basis of the trusted network defined under TEFCA. These entities have to meet pre-defined standards and regulations in order to be able to carry out data exchange with other healthcare organizations. These regulations and standards can be managed and efficiently enforced via a blockchain network governed by smart contracts. These smart contracts can be designed to reflect the essence of the CA as well as to audit QHINs regularly to ensure the agreed upon standards are being met.
Overall, with TEFCA v2.0 being released earlier this year and the increasing number of healthcare organizations working towards becoming QHINs, the future of healthcare lies in trusted data sharing and collaboration. And blockchain makes a strong case for itself as an ideal implement for TEFCA given the core values of the technology - decentralization and trustless collaboration. Through its unique blend of data security, privacy, and transparency this technology is one that more of us should be looking at with a deeper interest.
Useful Links (TEFCA):
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