In the rush to implement EHR and meaningful use, did we forget about interoperability? Congress thinks there should be more to show for the billions of dollars already spent on EHR. Now, they’ve asked the Office of the National Coordinator (ONC) to give guidance for the future. On this episode, Shahid and I sit down with Niam Yaraghi to discuss what TEFCA is and what it means for interoperability and the business of healthcare.

The problem with all this is that no one can clearly articulate what interoperability (or data blocking for that matter) is. In reality, healthcare has already solved interoperability about as well as any other industry. If you show me two parties who want to exchange data, and are willing and able to fund the effort, then I’ll show you interoperability.

Further, there are robust regional Health Information Exchanges (HIE) throughout the U.S. And as I have said many times before, the regional HIE is the only near-term option to solving for interoperability in a way that resembles what everyone seems to be looking for.

TEFCA, in many ways, assumes these things aren’t already working. And because of that it may actually impede efforts that are already on the path to success.


1:20 What is TEFCA (Trust Exchange Framework and Common Agreement) and where did it come from? History lesson and overview.

5:40 Reaction to TEFCA may be based on your political tendencies.

7:37 There is an unreasonable expectation that the problem should have been solved even though no one can clearly articulate what interoperability means

9:15  Data integration happens because of BUSINESS interoperability between 1 or more workflows across organizations.

11:15 There is no business model in healthcare for businesses to do the right thing, so we have to create it.

13:05 The economic effects of not charging for sharing data.

16:17 Interoperability causes fears of patient leakage. It only works if groups come together with a common interest.

19:28 New York is an example of a healthy HIE market. Here is how TEFCA might change that.

21:55 HIEs are currently working best in markets that have a certain level of trust.

25:55 The best business models for TEFCA. Since the vast majority of healthcare is local, what are the costs and benefits of a regional vs national exchange?

30:45 Unreasonable expectations doomed TEFCA. Cut healthcare some slack.

33:08 Who pays your bills? If your patients are mostly Medicare, get ready to share your data. If you remember what happened after HIPAA, you know you need to hurry.

36:00 What should small and medium size businesses do about TEFCA?

40:28 What would Medicare for All mean for TEFCA? What if patients continue to pay a larger percentage? What if nothing changes? No matter what you’re going to need to share your data.

43:55 Do we even need a national network?

46:46 When we align priorities and incentives you’re going to be more profitable and no one will need to tell you to do the right thing.

49:40 The ONC should pick a small use case to show the industry how it’s done. Don’t try to solve this all at once.

Listen to the interview:

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Our last episode with Niam Yaraghi

About Niam YaraghiNiam Yaraghi niamyaraghi

Niam Yaraghi s an assistant professor of Operations and Information Management at the University of Connecticut’s School of Business and a non-resident fellow in the Brookings Institution’s Center for Technology Innovation. His research is focused on the economics of health information technologies. In particular, Niam studies the business models and policy structures that incentivize transparency, interoperability and sharing of health information among patients, providers, payers and regulators. He empirically examines the subsequent impact of such efforts on cost and quality of care. Niam’s ongoing research topics include health information exchange platforms, patient privacy, and healthcare evaluation and rating systems.

He has a B.Sc in Industrial Engineering from the Isfahan University of Technology in Iran, and a M.Sc from the Royal Institute of Technology in Sweden. He received his Ph.D. in Management Science & Systems from the State University of New York at Buffalo.


Related and/or Mentioned on the Show

Our last episode with Niam Yaraghi

Drivers of information disclosure on health information exchange platforms: insights from an exploratory empirical study

An empirical analysis of the financial benefits of health information exchange in emergency departments

Network Effects in Health Information Exchange Growth

The benefits of health information exchange platforms: Measuring the returns on a half a billion dollar investment

A Sustainable Business Model for Health Information Exchange Platforms: The Solution to Interoperability in Health Care IT


Previous Episode Discussion Data Fidelity


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