In a 2025 survey of well being info organizations, solely 22% are already taking part within the nationwide Trusted Trade Framework and Widespread Settlement (TEFCA), and 24 p.c proceed to say they aren’t positive if they are going to 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 Trade Organizations.
The annual survey was carried out by UCSF with help from the Assistant Secretary for Know-how Coverage (ASTP) in partnership with Civitas. The survey consists of questions from previous HIO surveys associated to individuals, providers, challenges, monetary viability in addition to new matters similar to TEFCA, requirements and knowledge blocking. Seventy-seven organizations responded.
Julia Adler-Milstein, Ph.D., professor of drugs at UCSF, led individuals via 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 Faculty of Group Drugs and assistant provosts for strategic planning on the OU Well being Sciences Middle.
“Twenty 4 p.c continues to be a excessive quantity to say that they don’t seem to be positive, in order that’s a development that we will proceed to observe to see if that quantity decreases,” Adler-Milstein stated.
The survey additionally requested via which QHIN they’re taking part, and eHealth Trade 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 essential 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 forms of providers supplied. This provides us a way of the funding that HIOs are going through as they’re making an attempt to make choices. That is on the fee facet of the equation.”
The survey additionally requested what quantity of HIO members are taking part in TEFCA via the HIO. “It’s one factor for the HIO to say, sure, we’re taking part, but when they are not bringing alongside the vast majority of their individuals, that is clearly going to impair the worth of TEFCA participation,” Adler-Milstein stated. “At this level, 56% say that just a few 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 can 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 a part of. This shall be a very necessary one to trace over time,” she stated.
Of those who have had some engagement with a QHIN, 13% say they’re very happy, 21% say happy, and 31% are type of impartial at this level. When requested about satisfaction with TEFCA difficulty response, virtually half of them say that they have not reported a problem but to the to the RCE. So there’s 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 making an attempt to know the fee/profit relationships,” Adler-Milstein stated.
Turning to monetary viability, Adler-Milstein stated the survey asks HIOs: Does earnings from individuals cowl your working bills? Utilizing that as a marker, a few third of HIOs report that they’re at that marker of monetary viability.
Kendrick referred to a Well being Affairs article that got here out with the headline saying 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 via line. The via 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 info group or what p.c of knowledge density is out there there? Then with regard to the monetary viability, I simply wish to emphasize this for everyone who seems to be 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 all the cash wanted to maintain themselves fully 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 instances. The dominant one which’s been on the high of the checklist throughout many surveys is alerting and occasion notifications like ADTs. That is adopted by constructing a group medical or well being report via aggregating throughout a number of sources. Additionally towards the highest of the checklist is query-based change. About two-thirds of HIOs are saying that they are supporting providers across the Direct protocol, information normalization, outcomes supply, reworking different doc sorts or repositories into CDAs.
The survey additionally requested about some service choices which can be geared extra towards value-based cost 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 shocking 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 plenty of exercise reported round use of FHIR, and Kendrick stated he wasn’t stunned. “The truth is, I did not anticipate 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, that means exposing a FHIR API. That is most likely 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 few 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 carried out. Nearly half say that they are having to do this for at the very least a number of the outcomes. “So there’s plenty of friction and work nonetheless to get to standardized lab information,” Adler-Milstein stated. “Many report some challenges with the sources required to do this, to take care of mappings, or a lack of information to have the ability to try this mapping.”
Anecdotally, Kendrick stated that even some reference labs are usually not appropriately utilizing LOINC when sending ends in, “and that is only a important downside that has to get handled. There’s a want to lift the extent of consciousness of that at ASTP. The second factor that I might say is that is most likely an space that might be nice to ascertain a group of follow among the many networks, as a result of all of us ought to method fixing this downside in an analogous means. I might suppose the information coming to us may be very comparable and coming from the identical distributors.”
