In a 2025 survey of well being info organizations, solely 22% are already collaborating within the nationwide Trusted Alternate Framework and Widespread Settlement (TEFCA), and 24 % proceed to say they aren’t positive if they are going to take part.
These had 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 Alternate 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 members, companies, challenges, monetary viability in addition to new matters similar to TEFCA, requirements and data blocking. Seventy-seven organizations responded.
Julia Adler-Milstein, Ph.D., professor of medication at UCSF, led members 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 % continues to be a excessive quantity to say that they are not positive, in order that’s a development that we’ll proceed to observe to see if that quantity decreases,” Adler-Milstein stated.
The survey additionally requested via which QHIN they’re collaborating, and eHealth Alternate is dominant there. “We requested what adjustments has your HIO made or planning to make with a purpose to take part in TEFCA. What do it’s good to do to take part? Forty-seven % 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 % made adjustments to the sorts of companies provided. This provides us a way of the funding that HIOs are dealing with as they’re attempting to make choices. That is on the price facet of the equation.”
The survey additionally requested what quantity of HIO members are collaborating in TEFCA via the HIO. “It’s one factor for the HIO to say, sure, we’re collaborating, but when they don’t seem to be bringing alongside the vast majority of their members, 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 collaborating. Solely a minority say that each one or most are collaborating.” That is solely information from the 16 HIOs which can be already collaborating. “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 part of. This will probably be a very essential 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 subject 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 subject 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 feel that is actually an early snapshot of experiences beneath TEFCA. I feel they’re actually attempting to grasp the price/profit relationships,” Adler-Milstein stated.
Turning to monetary viability, Adler-Milstein stated the survey asks HIOs: Does revenue from members cowl your working bills? Utilizing that as a marker, a few third of HIOs report that they’re at that marker of economic 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 actual metric right here, I feel, can be one thing like: What % of Individuals are served by a well being info group or what % of knowledge density is offered there? Then with regard to the monetary viability, I simply wish to emphasize this for everyone who appears 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 totally from participant charges, no Medicaid {dollars}, no grant {dollars}.”
The listing of companies that HIOs present will get longer yearly as a result of HIOs are discovering new use circumstances. The dominant one which’s been on the high of the listing throughout many surveys is alerting and occasion notifications like ADTs. That is adopted by constructing a neighborhood medical or well being file via aggregating throughout a number of sources. Additionally towards the highest of the listing is query-based trade. About two-thirds of HIOs are saying that they are supporting companies 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 fee 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 listing are issues like registry companies. 1 / 4 of HIOs say that they’re supporting a use case round closed-loop referral monitoring.
Adler-Milstein stated that one stunning 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 a whole lot 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 in all probability 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 check outcomes to LOINC codes. A couple of 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 accomplished. Nearly half say that they are having to do this for no less than a number of the outcomes. “So there’s a whole lot of friction and work nonetheless to get to standardized lab information,” Adler-Milstein stated. “Many report some challenges with the assets required to do this, to take care of mappings, or a lack of knowledge to have the ability to try this mapping.”
Anecdotally, Kendrick stated that even some reference labs are usually not appropriately utilizing LOINC when sending leads to, “and that is only a vital drawback that has to get handled. There’s a want to lift the extent of consciousness of that at ASTP. The second factor that I’d say is that is in all probability an space that will be nice to ascertain a neighborhood of apply among the many networks, as a result of all of us ought to method fixing this drawback in an identical method. I’d assume the information coming to us may be very related and coming from the identical distributors.”
