A New Era of Clinical Information Exchange: What Practice Leaders Need to Know About TEFCA and QHINs
November 20, 2025 • 22 mins
In this episode of the MGMA Insights Podcast, Sr. Editor and host Daniel Williams speaks with Justin McMartin, Director of Product Innovation at Surescripts, about one of the most important developments in U.S. healthcare interoperability: TEFCA and Qualified Health Information Networks (QHINs). They dig into what TEFCA is (and isn’t), how QHINs operate, what Surescripts is doing as a newly approved QHIN, and — most importantly — how practice leaders can use these tools to improve clinical decision-making, streamline workflows, reduce prior authorization pain, and support value-based care.
Justin’s insights translate a deeply technical topic into clear, practice-oriented guidance that helps healthcare administrators understand what’s changing, how it impacts their clinicians, and what steps they should take now.
Key Takeaways
- Justin’s background & the evolution of Surescripts beyond e-prescribing
00:58 — From EHR implementation during Meaningful Use to building national data exchange networks. - What Surescripts offers medical practices today
02:45 — Eligibility, medication history, real-time benefit tools, clinical messaging, record locator/exchange. - TEFCA explained: Why it exists and what it solves
04:59 — Preventing fragmented, state-by-state frameworks by establishing a single national standard. - QHINs & the Sequoia Project’s role as RCE
06:08 — How QHINs govern secure, standardized data exchange nationwide. - How Surescripts participates: InterConnect & QHIN approval
07:33 — Surescripts’ new QHIN subsidiary and what it means for practice connectivity. - Scope of data available: Billions of clinical documents exchanged
08:39 — How Carequality volume and TEFCA adoption are converging. - What TEFCA adds to existing practice workflows
10:33 — Access to CCDAs across care settings, improving completeness at the point of care. - Practical use cases for clinicians and practice managers
12:33 — ED episodes, chronic disease management, and value-based care coordination. - Why practices hesitate: Awareness, education, and workflow clarity
14:54 — Adoption barriers and how vendors can support practices. - Action steps for practice leaders
17:44 — Review InterConnect resources, understand state exchanges, and incorporate patient feedback on data access.
Resources Mentioned in the Episode
- Surescripts
- The Sequoia Project (TEFCA RCE)
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Daniel Williams (00:02):
Well, hi, everyone. I'm Daniel Williams,
senior editor at MGMA and hostof the MGMA Podcast Network. We
are here today with apartnership we're real proud of
at MGMA. We work very closelywith SureScripts. And today we
have their director of productinnovation, Justin McMartin.
(00:24):
Justin, first of all, I justwanna welcome you to the show.
Justin McMartin (00:27):
Yeah, thanks, Daniel. And yeah, we appreciate
that partnership with MGMA aswell. So excited to be here.
Daniel Williams (00:34):
Yeah, today we're going to be looking at a
new era of clinical informationexchange. We're going to dig
into that and look at some ofthe issues there related to it.
So before we do that, let's justget to know you a little bit,
Justin. Then we'll dig in alittle bit about SureScript and
(00:54):
then talk about that topic. Sotell us a little bit about your
background in healthcare.
Anything you wanna share withus.
Justin McMartin (01:01):
Yeah, happy to. So I've worked in the healthcare
industry now for shoot, justshort of twenty years. I started
working in healthcare by findingan electronic health record
vendor. And in that space, Iworked with provider practices
across the country to be able toimplement electronic health
records during that meaningfultime called Meaningful Use. And
(01:25):
in doing that, I was able toreally learn from providers and
physicians and the folks that weworked with in that space just
how useful technology could be,but also how disruptive it could
be in certain cases.
And then over my time working inthat electronic health record
space, transitioned into a rolereally working in the network
(01:46):
based industry, thinking aboutwhat SureScript operates. And at
that time was really the growthof things like our clinical
direct messaging solution atSureScripts. What that offered
was really an opportunity tosay, Hey, here's all this stuff
we've been putting into recordsat each of these practice
offices. Here's how we canultimately start to exchange
(02:07):
that information. And then mycareer path at SureScript has
grown really to be, as I like tojoke, the guy who doesn't do
anything with prescriptions whenyou think about it.
And so what that really means iswe're trying to find ways of
exchanging information know,outside of prescriptions, in
addition to the prescriptions ismaybe the better way of saying
(02:29):
it, to ensure that we'reconnecting healthcare from
beginning to end with all thevarious information that needs
to be exchanged. So that's whatbrings me to be the director of
our team that's really focusedin on that kind of broad
interoperability landscape.
Daniel Williams (02:45):
Okay. Thank you so much for filling us in on
that, and thanks for the workyou're doing there. Now, as far
as SureScripts, I could assumethat all of our listeners know
who SureScripts is and how theyimpact and integrate with
medical practices, but I'm notgoing to do that. I want you to
just give us maybe an elevatorpitch or a little bit of
(03:08):
background on SureScripts andreally through the lens of how
they can benefit and work withour listeners today.
Justin McMartin (03:16):
Sure. And so for those folks who didn't get
my joke, SureScripts really grewup being the network for
exchanging prescriptions. Soenabling the physician practices
and physicians, you know, acrosshealthcare settings to be able
to send an electronicprescription to their local
pharmacy. We've evolved thatorganization or that network
(03:38):
into doing so much more. So itincludes things like eligibility
for that prescriptioninformation, working with
pharmacy benefit managers.
In addition, we've added in ourmedication history solutions and
expanded how we can provide thatdata for med reconciliation into
providers and healthcareproviders throughout our
healthcare system in The UnitedStates. And then in addition to
(04:00):
that, over the course of thelast really ten years, we've
expanded, like I said, intothese broader aspects of
interoperability, launching ourpartnership with Direct Trust
and introducing our clinicaldirect messaging, expanding
prescription benefit informationinto the real time space to
provide that into the physicianpractices. And then most
recently expanding into kind ofthe request response data
(04:23):
exchange world for things likeour record locator and exchange
solution, working within thecare quality framework. And then
as a final piece, I think someof the really exciting things
that we're emerging into ispartnering better with our
providers to be able to solvethings like prior authorizations
in a real time manner, andreally trying to take the
(04:44):
friction out of that dataexchange that doesn't occur as
data exchange in today's worldand is much more of a manual
let's get on the phone process.So we really work across the
gamut there in finding ways toexchange data in healthcare.
Daniel Williams (04:59):
Okay. Now, today, we're gonna be talking a
lot about TEFCA and QualifiedHealth Information Networks, or
as you told me last week inanother call, QHENs. So if any
of our listeners have no ideawhat any of that terminology
means, or even if they do andyou want to shed even more light
(05:19):
on it, let's give a little briefbackground on TEFCA and those
QHENs as well.
Justin McMartin (05:26):
Yeah. So I will try to keep my professor jacket
off here and not go into toomuch detail. But it is important
to understand where the trustedexchange framework common
agreement or TEFCA comes from,which is, this goes all the way
back to 2016 when there was abipartisan bill passed through
(05:48):
the US Congress that introduceda host of changes to our
healthcare system. And one ofthem was this introduction of
the trusted exchange frameworkand common agreement. And the
idea, or really the drive behindit, why it got included in that
bill was to say, there's a lotof emerging opportunities to
exchange data.
(06:08):
If we don't try to consolidateor bring these things together,
it's going to be very costly toadopt 50 different ways that
states might want to do it, orhundreds of different ways that
different companies might wantto do this. So let's put this
out there kind of as a goldstandard to say, we want to see
a single framework for TheUnited States to make it as
(06:30):
efficient as possible. So that'swhere it came from. And since
then, it's really progressedthrough regulatory processes,
and then ultimately the creationor the identification of an
organization called theRecognized Coordinating Entity.
And that's a group called theSequoia Project, who we work
with in a number of differentsettings, who are really a
(06:50):
public interest group, beingable to focus in and say, how do
we exchange data better in thecountry?
So they were a perfect candidateto be selected in this way. And
they now partner with thefederal government to kind of
create the rules of the road forwhat a qualified health
information network is, or aQHIN, and who are participants
who can exchange data throughthis framework. And maybe even
(07:12):
more importantly, how can wecontinue to grow who those
participants are to reach kindof all the edges of who should
be able to get access toinformation safely, effectively,
and securely in our country? So,that's the framework under which
has been created and kind of alittle bit of history on how we
got to get here.
Daniel Williams (07:33):
Yeah, thanks for sharing that. Now, when we
think about QHENs, how doesSureScripts then work with them?
What is that relationship like?How does it come about?
Justin McMartin (07:45):
So thanks for asking. I think one of the other
exciting things that we've beenworking on here at SureScripts
is actually how do weparticipate in that trusted
exchange framework commonagreement? Obviously, you know,
all the things that I mentionedleading up to this, we've done a
lot to become a network that'strusted and exchanges data
within the healthcare setting.So it's kind of a logical next
(08:06):
step for us to be a QHIN in someway. And so we have actually
done that, through a subsidiarythat we created called the
SureScripts Health InformationNetwork.
And we've been qualified as aqualified health information
network or approved as aqualified health information
network so that we're startingto bring customers on board into
(08:26):
that space so that they canconnect to this broad framework
and exchange clinical data, youknow, with all the other
partners in in the that, varietyof care settings that they're
connected to.
Daniel Williams (08:39):
Us a little bit about the data then. Y'all
shared with me some informationabout how many clinicians are in
this network and how many links.Just give us the scope of this
because I think you could shedlight on this that I think would
be helpful to our listeners sothey'd go, Okay, this is pretty
(09:00):
broad here.
Justin McMartin (09:02):
Yeah. So there's kind of two different
things that get rolled into thatquestion, Daniel. So the first
one is, TEFCA is really a, I'mgoing to call it an upgrade on
what we've been doing in thisframework already. So I
mentioned this briefly earlierin my introduction around
working in the care qualityframework. So we've been working
(09:24):
in that space for almost tenyears now.
And in that time, we've grownand helped to support that
framework with other electronichealth record vendors and other
participants in that space to beable to exchange billions of
clinical records. Actually, it'sstarting to be a billion or more
clinical records on a monthlybasis. So we see massive volumes
(09:46):
of records that are gettingexchanged between providers
through frameworks like this.And so TEFCA as an upgrade to
that framework really intendsfor that transition to occur.
Now TEFCA isn't quite to thatscale, instead of the hundreds
of the over 100,000 providersand healthcare organizations
participating in care quality,we're about 15 to 20,000
(10:08):
organizations that are now kindof transitioning or kind of in a
dual space moving into thattrusted exchange framework,
exchanging millions and millionsof records in that space though.
So we're taking the things we'velearned there, making it better
and kind of moving it into thatframework, but fully expect
we're going be seeing thosebillions of transactions with
(10:28):
the Trust Exchange Framework inshort order here as folks
continue to onboard.
Daniel Williams (10:33):
Yeah. When I think about this, when we think
about this data that's availableto them, how is that different
than the data practice managersalready have in place? So tell
us about what the value add orthe benefit is here.
Justin McMartin (10:48):
Yeah. So I'm going to get a little technical
here to make sure that weunderstand exactly what it is.
So again, going back to mytalking about meaningful use,
one of the things that all theelectronic health records were
implementing at the time andhonestly carries forward into
some of the certificationcriteria that they still have
today. Some of that might bechanging, I guess, with the new
(11:10):
administration. We'll seeexactly how that rolls out, but
was the ability to create what'scalled a continuity of care
record or a continuity of caredocument and exchange it in a
particular format.
And that format is HL7. Andwithin HL7, have a particular
standard called CDA or theconsolidated CDA or CCDA. And so
(11:33):
what the care quality framework,as well as TEFCA really
leverages based on that is tosay, look, all these vendors
have that opportunity to be ableto generate those documents,
let's make them requestable.Let's make it so that we can
reach out and grab thatinformation at the point of care
so that I can reliably get myfingers on everything that a
(11:55):
patient has, or the most recentinformation at least that a
patient had from all sorts ofdifferent healthcare
organizations. So the real valueto get back to your question is
on ensuring that as a provideror as a physician, as I'm
sitting down in the office withthat patient, then I know I have
(12:15):
the most up to date andappropriate information so I can
make the right clinicaldecisions and care for that
patient.
So it's that comprehensivenessof what's available through this
type of a framework is probablythe thing that is top of mind
for any providers out therethinking about this.
Daniel Williams (12:33):
Okay. With all that said, do you have a case
study or any use cases? Anythingthat could shed even more light
on this for our listeners tosee, okay, that resonates with
me. We're experiencing that inour own practice.
Justin McMartin (12:49):
Yeah. Well, and I should also add to what I was
just mentioning. It's not justabout can I get access to that
information? It's also can Iensure that I'm sharing my
information back out so thatthat, you know, primary care
patient that I'm seeing in mypractice, when they're showing
up in the emergency room withchest pain, that they can see
that current list ofmedications, they can see the
(13:11):
patient's recent history ofproblems and allergies and all
of those things that get rolledup into that broader CCDA
document? So that's the firstthing I would add.
But the second to those usecases, obviously, I guess I used
one of the emergency rooms.Yeah. Right, but I think
especially in today'senvironment, one of the things
that I'm hearing from a lot ofour partners and customers and
(13:34):
talking about is not just how dowe access and kind of complete
that record for the patient,that's so critical and so
important, but also expandinginto broader use cases of, I
mentioned prior authorizationearlier, thinking maybe even
broader from that of how do weengage from a value based care
(13:55):
approach and make sure thatwe're sharing that information
across care teams to ensure thatpatient is getting that most,
the best and most comprehensiveset of care that they can when
they are working in thosemultiple settings. And so that
means not just bringing in andensuring that all these
providers are connected, whichis like I said, critical to the
(14:17):
patient's care, but it's alsoensuring that care management
organizations that we're allworking with today in time, and
the insurance companies thatwe're working with in terms of
those value based carearrangements are plugged into
it. And we're making not onlythe best care system, but the
most efficient system that'sbehind that to support it, that
at the end of the day, if we candrop cost of care and we can
(14:40):
lower those things, we'rewinning not only from patients
getting better care, but alsomaybe making it more affordable
at the end of the day.
So those are all things that wethink about when we think about
the opportunities within TEFCAfor providers and others.
Daniel Williams (14:54):
Okay. When you think about it from the lens of
the practice administrator, whatare the friction points? What
are the reasons to say, I don'tknow if I want to do that? I
mean, what would be theirchallenge? Why wouldn't they
just everything you're saying tome is going, Well, that's a no
brainer.
But is it awareness? Is it justgetting the platform right?
(15:16):
What's going on there?
Justin McMartin (15:18):
Yeah. Think first and foremost, there's an
awareness aspect of it. I thinkwhen we think about some of the
partners that we work with inthis space, whether it's
electronic health record vendorsor other technology services,
they're well aware of it. Butone of the common things I'm
hearing from those electronichealth record vendors is it's
(15:38):
not the top of mind for a lot ofthe providers we work
Daniel Williams (15:41):
with.
Justin McMartin (15:41):
And so I think there's that awareness aspect of
it is just really understandingit. I think the second one is it
goes the next layer down, whichis more of an education aspect
to really give the tangibleexamples of how it can benefit
my organization and why it isuseful and important. And it
(16:03):
typically means getting down tothose use cases where you're
thinking about that patientwho's showing up in the
emergency room and thatinformation is needed. Or you're
taking those examples whereyou've got an incredibly sick
patient with chronic diseases,or maybe catastrophic type
illnesses of cancer andotherwise, where they're trying
(16:23):
to coordinate their care andthey only have access to small
portions of it. And so there'sthat need to not just make sure
folks know about it, but alsoreally think through what are
those implications that aredownstream from this that may
not be the first reason why I'mthinking about it.
I think bring you holisticallyto make a decision to say, this
(16:44):
is the right thing for us to do.And then I think we're still
early on into some of thosephases, especially thinking
about a practice manager of howdo we not just benefit the
clinician at the point of carewith that patient, but also how
do we administratively simplifysome of those routines, like I
said, with prior authorizationor in a value based care
(17:07):
arrangement agreement, sharingthe appropriate information at
the right times and in the mostefficient way. I know there are
a lot of practice managers outthere listening to this going,
yeah, that's a lot of work. Andso I think finding and driving
both from that awarenessperspective and education, and
having that being brought upinto the electronic health
record vendors that, yeah, theseare really important things for
(17:28):
us to do. Because at the end ofthe day, we're not wanting to
see another system put in frontof providers in that space.
We wanna see these systems thatare already there evolve into,
and being able to support thistype of exchange throughout the
framework.
Daniel Williams (17:44):
Okay. As a final question then, is there
anything else we haven't talkedabout here that you think would
be a benefit to our MGMAlisteners that could help them
navigate the system, input theirown information, extract
information, anything else, I'llgive you a blank slate here to
work from.
Justin McMartin (18:05):
The first thing that I would encourage you all
to do is to head out to oursurescripts.com and find our
Interconnect product. I don'tthink I've mentioned that yet
today, but out on thatsurescripts.com, we have a
particular area of it that'sfocused on our qualified health
information network, and theproduct is our interconnect
service. And we've got a ton ofmaterials out there that are
really more focused on some ofthose education and awareness
(18:28):
aspects of it so that you canthink through and say, as a
provider, why are the reasonsthat I want to be able to be
plugged into this framework? Sothat would be the first thing I
would say. The second thing Iwould say is just make sure that
you're well aware of things thatare going on in your states.
Because I think there's a lot ofopportunities for provider
practices across the country tolean into some of the state
(18:50):
based exchange informationthat's being talked about, and
ensuring that they're reallythinking about not just how as a
state can we exchangeinformation effectively, but how
can we plug into this nationalframework to ensure that, again,
we're making it as efficient aspossible and not having to
recreate the wheel with eachlayer of exchange. And then the
(19:12):
third thing I would say isreally be thinking about and
talking to patients, because oneof the things that we're really
hearing is that patients arefrustrated with their lack of
ability to kind of exchangetheir information effectively.
And so understanding kind ofthose needs from a patient
perspective and how it overlapswith things like TEFCA, which
(19:32):
has an individual right ofaccess, I think is a really
great opportunity to kind ofalso dig into and understand
additional value and benefits toparticipating in a framework
like this.
Daniel Williams (19:45):
All right, great points there. So Justin
McMartin, Director of ProductInnovation at SureScripts, thank
you so much for joining ustoday.
Justin McMartin (19:54):
Yeah, appreciate the time. Thanks for
having me.
Daniel Williams (19:56):
Yeah, love this conversation. And for anybody
else who learned a lot today intoday's episode and want to know
even more, I want to providesome resources for you. They're
going be in the episode shownotes. So first up, we're going
to provide a link directly tosurescripts.com/qhinready. And
(20:21):
I'm going to provide a directlink so you can click right to
that.
I'm also going to provideseveral other resources that you
can go to, give you kind of atoolkit or toolbox for you so
you can access information andlearn more about it. So Justin,
I did want to ask you one morething. You provided one link. Is
there anywhere else or any othertool or FAQ or anything else on
(20:47):
SureScript or elsewhere that youthink might benefit our
listeners? That's one of thethings I know when I go to the
internet and I'm typing stuffin.
I mean, AI, it's very much morehelpful now, but there's still
you don't want to spend a lot oftime and get frustrated trying
to find what you're looking for.Anything else out there to point
them to? Yeah.
Justin McMartin (21:06):
So I mean, I think you pointed the link that
you provided is it takes you outto that resource hub where it's
got a whole list of othermaterials. If you're looking for
things outside of SureScript,you can access the recognized
coordinating entities website aswell. So that's again, out at
the Sequoia project. I don'thave the link right in front of
me, but I would encourage youalso to look there. They have a
(21:27):
lot of other materials aroundhow do providers get connected?
What are other things toconsider there? Just in case
you're questioning whether I'vegiven you all the facts, but I
think you'll find it's allthere.
Daniel Williams (21:38):
All right. Well, Justin, thank you again
for joining us. Appreciate you.Yeah. Thanks.
All right. And everybodylistening, thank you so much for
being MGMA podcast listeners.Again, we're going to put all
this information in the episodeshow notes. We're also gonna
create an article on our websitewhere you can go right to some
key points from thisconversation. Until then, thank
(22:00):
you so much, and look forward toconnecting with y'all in the
next MGMA podcast.
Well, hi, everyone. I'm Daniel Williams,
senior editor at MGMA and hostof the MGMA Podcast Network. We
are here today with apartnership we're real proud of
at MGMA. We work very closelywith SureScripts. And today we
have their director of productinnovation, Justin McMartin.
(00:24):
Justin, first of all, I justwanna welcome you to the show.
Justin McMartin (00:27):
Yeah, thanks, Daniel. And yeah, we appreciate
that partnership with MGMA aswell. So excited to be here.
Daniel Williams (00:34):
Yeah, today we're going to be looking at a
new era of clinical informationexchange. We're going to dig
into that and look at some ofthe issues there related to it.
So before we do that, let's justget to know you a little bit,
Justin. Then we'll dig in alittle bit about SureScript and
(00:54):
then talk about that topic. Sotell us a little bit about your
background in healthcare.
Anything you wanna share withus.
Justin McMartin (01:01):
Yeah, happy to. So I've worked in the healthcare
industry now for shoot, justshort of twenty years. I started
working in healthcare by findingan electronic health record
vendor. And in that space, Iworked with provider practices
across the country to be able toimplement electronic health
records during that meaningfultime called Meaningful Use. And
(01:25):
in doing that, I was able toreally learn from providers and
physicians and the folks that weworked with in that space just
how useful technology could be,but also how disruptive it could
be in certain cases.
And then over my time working inthat electronic health record
space, transitioned into a rolereally working in the network
(01:46):
based industry, thinking aboutwhat SureScript operates. And at
that time was really the growthof things like our clinical
direct messaging solution atSureScripts. What that offered
was really an opportunity tosay, Hey, here's all this stuff
we've been putting into recordsat each of these practice
offices. Here's how we canultimately start to exchange
(02:07):
that information. And then mycareer path at SureScript has
grown really to be, as I like tojoke, the guy who doesn't do
anything with prescriptions whenyou think about it.
And so what that really means iswe're trying to find ways of
exchanging information know,outside of prescriptions, in
addition to the prescriptions ismaybe the better way of saying
(02:29):
it, to ensure that we'reconnecting healthcare from
beginning to end with all thevarious information that needs
to be exchanged. So that's whatbrings me to be the director of
our team that's really focusedin on that kind of broad
interoperability landscape.
Daniel Williams (02:45):
Okay. Thank you so much for filling us in on
that, and thanks for the workyou're doing there. Now, as far
as SureScripts, I could assumethat all of our listeners know
who SureScripts is and how theyimpact and integrate with
medical practices, but I'm notgoing to do that. I want you to
just give us maybe an elevatorpitch or a little bit of
(03:08):
background on SureScripts andreally through the lens of how
they can benefit and work withour listeners today.
Justin McMartin (03:16):
Sure. And so for those folks who didn't get
my joke, SureScripts really grewup being the network for
exchanging prescriptions. Soenabling the physician practices
and physicians, you know, acrosshealthcare settings to be able
to send an electronicprescription to their local
pharmacy. We've evolved thatorganization or that network
(03:38):
into doing so much more. So itincludes things like eligibility
for that prescriptioninformation, working with
pharmacy benefit managers.
In addition, we've added in ourmedication history solutions and
expanded how we can provide thatdata for med reconciliation into
providers and healthcareproviders throughout our
healthcare system in The UnitedStates. And then in addition to
(04:00):
that, over the course of thelast really ten years, we've
expanded, like I said, intothese broader aspects of
interoperability, launching ourpartnership with Direct Trust
and introducing our clinicaldirect messaging, expanding
prescription benefit informationinto the real time space to
provide that into the physicianpractices. And then most
recently expanding into kind ofthe request response data
(04:23):
exchange world for things likeour record locator and exchange
solution, working within thecare quality framework. And then
as a final piece, I think someof the really exciting things
that we're emerging into ispartnering better with our
providers to be able to solvethings like prior authorizations
in a real time manner, andreally trying to take the
(04:44):
friction out of that dataexchange that doesn't occur as
data exchange in today's worldand is much more of a manual
let's get on the phone process.So we really work across the
gamut there in finding ways toexchange data in healthcare.
Daniel Williams (04:59):
Okay. Now, today, we're gonna be talking a
lot about TEFCA and QualifiedHealth Information Networks, or
as you told me last week inanother call, QHENs. So if any
of our listeners have no ideawhat any of that terminology
means, or even if they do andyou want to shed even more light
(05:19):
on it, let's give a little briefbackground on TEFCA and those
QHENs as well.
Justin McMartin (05:26):
Yeah. So I will try to keep my professor jacket
off here and not go into toomuch detail. But it is important
to understand where the trustedexchange framework common
agreement or TEFCA comes from,which is, this goes all the way
back to 2016 when there was abipartisan bill passed through
(05:48):
the US Congress that introduceda host of changes to our
healthcare system. And one ofthem was this introduction of
the trusted exchange frameworkand common agreement. And the
idea, or really the drive behindit, why it got included in that
bill was to say, there's a lotof emerging opportunities to
exchange data.
(06:08):
If we don't try to consolidateor bring these things together,
it's going to be very costly toadopt 50 different ways that
states might want to do it, orhundreds of different ways that
different companies might wantto do this. So let's put this
out there kind of as a goldstandard to say, we want to see
a single framework for TheUnited States to make it as
(06:30):
efficient as possible. So that'swhere it came from. And since
then, it's really progressedthrough regulatory processes,
and then ultimately the creationor the identification of an
organization called theRecognized Coordinating Entity.
And that's a group called theSequoia Project, who we work
with in a number of differentsettings, who are really a
(06:50):
public interest group, beingable to focus in and say, how do
we exchange data better in thecountry?
So they were a perfect candidateto be selected in this way. And
they now partner with thefederal government to kind of
create the rules of the road forwhat a qualified health
information network is, or aQHIN, and who are participants
who can exchange data throughthis framework. And maybe even
(07:12):
more importantly, how can wecontinue to grow who those
participants are to reach kindof all the edges of who should
be able to get access toinformation safely, effectively,
and securely in our country? So,that's the framework under which
has been created and kind of alittle bit of history on how we
got to get here.
Daniel Williams (07:33):
Yeah, thanks for sharing that. Now, when we
think about QHENs, how doesSureScripts then work with them?
What is that relationship like?How does it come about?
Justin McMartin (07:45):
So thanks for asking. I think one of the other
exciting things that we've beenworking on here at SureScripts
is actually how do weparticipate in that trusted
exchange framework commonagreement? Obviously, you know,
all the things that I mentionedleading up to this, we've done a
lot to become a network that'strusted and exchanges data
within the healthcare setting.So it's kind of a logical next
(08:06):
step for us to be a QHIN in someway. And so we have actually
done that, through a subsidiarythat we created called the
SureScripts Health InformationNetwork.
And we've been qualified as aqualified health information
network or approved as aqualified health information
network so that we're startingto bring customers on board into
(08:26):
that space so that they canconnect to this broad framework
and exchange clinical data, youknow, with all the other
partners in in the that, varietyof care settings that they're
connected to.
Daniel Williams (08:39):
Us a little bit about the data then. Y'all
shared with me some informationabout how many clinicians are in
this network and how many links.Just give us the scope of this
because I think you could shedlight on this that I think would
be helpful to our listeners sothey'd go, Okay, this is pretty
(09:00):
broad here.
Justin McMartin (09:02):
Yeah. So there's kind of two different
things that get rolled into thatquestion, Daniel. So the first
one is, TEFCA is really a, I'mgoing to call it an upgrade on
what we've been doing in thisframework already. So I
mentioned this briefly earlierin my introduction around
working in the care qualityframework. So we've been working
(09:24):
in that space for almost tenyears now.
And in that time, we've grownand helped to support that
framework with other electronichealth record vendors and other
participants in that space to beable to exchange billions of
clinical records. Actually, it'sstarting to be a billion or more
clinical records on a monthlybasis. So we see massive volumes
(09:46):
of records that are gettingexchanged between providers
through frameworks like this.And so TEFCA as an upgrade to
that framework really intendsfor that transition to occur.
Now TEFCA isn't quite to thatscale, instead of the hundreds
of the over 100,000 providersand healthcare organizations
participating in care quality,we're about 15 to 20,000
(10:08):
organizations that are now kindof transitioning or kind of in a
dual space moving into thattrusted exchange framework,
exchanging millions and millionsof records in that space though.
So we're taking the things we'velearned there, making it better
and kind of moving it into thatframework, but fully expect
we're going be seeing thosebillions of transactions with
(10:28):
the Trust Exchange Framework inshort order here as folks
continue to onboard.
Daniel Williams (10:33):
Yeah. When I think about this, when we think
about this data that's availableto them, how is that different
than the data practice managersalready have in place? So tell
us about what the value add orthe benefit is here.
Justin McMartin (10:48):
Yeah. So I'm going to get a little technical
here to make sure that weunderstand exactly what it is.
So again, going back to mytalking about meaningful use,
one of the things that all theelectronic health records were
implementing at the time andhonestly carries forward into
some of the certificationcriteria that they still have
today. Some of that might bechanging, I guess, with the new
(11:10):
administration. We'll seeexactly how that rolls out, but
was the ability to create what'scalled a continuity of care
record or a continuity of caredocument and exchange it in a
particular format.
And that format is HL7. Andwithin HL7, have a particular
standard called CDA or theconsolidated CDA or CCDA. And so
(11:33):
what the care quality framework,as well as TEFCA really
leverages based on that is tosay, look, all these vendors
have that opportunity to be ableto generate those documents,
let's make them requestable.Let's make it so that we can
reach out and grab thatinformation at the point of care
so that I can reliably get myfingers on everything that a
(11:55):
patient has, or the most recentinformation at least that a
patient had from all sorts ofdifferent healthcare
organizations. So the real valueto get back to your question is
on ensuring that as a provideror as a physician, as I'm
sitting down in the office withthat patient, then I know I have
(12:15):
the most up to date andappropriate information so I can
make the right clinicaldecisions and care for that
patient.
So it's that comprehensivenessof what's available through this
type of a framework is probablythe thing that is top of mind
for any providers out therethinking about this.
Daniel Williams (12:33):
Okay. With all that said, do you have a case
study or any use cases? Anythingthat could shed even more light
on this for our listeners tosee, okay, that resonates with
me. We're experiencing that inour own practice.
Justin McMartin (12:49):
Yeah. Well, and I should also add to what I was
just mentioning. It's not justabout can I get access to that
information? It's also can Iensure that I'm sharing my
information back out so thatthat, you know, primary care
patient that I'm seeing in mypractice, when they're showing
up in the emergency room withchest pain, that they can see
that current list ofmedications, they can see the
(13:11):
patient's recent history ofproblems and allergies and all
of those things that get rolledup into that broader CCDA
document? So that's the firstthing I would add.
But the second to those usecases, obviously, I guess I used
one of the emergency rooms.Yeah. Right, but I think
especially in today'senvironment, one of the things
that I'm hearing from a lot ofour partners and customers and
(13:34):
talking about is not just how dowe access and kind of complete
that record for the patient,that's so critical and so
important, but also expandinginto broader use cases of, I
mentioned prior authorizationearlier, thinking maybe even
broader from that of how do weengage from a value based care
(13:55):
approach and make sure thatwe're sharing that information
across care teams to ensure thatpatient is getting that most,
the best and most comprehensiveset of care that they can when
they are working in thosemultiple settings. And so that
means not just bringing in andensuring that all these
providers are connected, whichis like I said, critical to the
(14:17):
patient's care, but it's alsoensuring that care management
organizations that we're allworking with today in time, and
the insurance companies thatwe're working with in terms of
those value based carearrangements are plugged into
it. And we're making not onlythe best care system, but the
most efficient system that'sbehind that to support it, that
at the end of the day, if we candrop cost of care and we can
(14:40):
lower those things, we'rewinning not only from patients
getting better care, but alsomaybe making it more affordable
at the end of the day.
So those are all things that wethink about when we think about
the opportunities within TEFCAfor providers and others.
Daniel Williams (14:54):
Okay. When you think about it from the lens of
the practice administrator, whatare the friction points? What
are the reasons to say, I don'tknow if I want to do that? I
mean, what would be theirchallenge? Why wouldn't they
just everything you're saying tome is going, Well, that's a no
brainer.
But is it awareness? Is it justgetting the platform right?
(15:16):
What's going on there?
Justin McMartin (15:18):
Yeah. Think first and foremost, there's an
awareness aspect of it. I thinkwhen we think about some of the
partners that we work with inthis space, whether it's
electronic health record vendorsor other technology services,
they're well aware of it. Butone of the common things I'm
hearing from those electronichealth record vendors is it's
(15:38):
not the top of mind for a lot ofthe providers we work
Daniel Williams (15:41):
with.
Justin McMartin (15:41):
And so I think there's that awareness aspect of
it is just really understandingit. I think the second one is it
goes the next layer down, whichis more of an education aspect
to really give the tangibleexamples of how it can benefit
my organization and why it isuseful and important. And it
(16:03):
typically means getting down tothose use cases where you're
thinking about that patientwho's showing up in the
emergency room and thatinformation is needed. Or you're
taking those examples whereyou've got an incredibly sick
patient with chronic diseases,or maybe catastrophic type
illnesses of cancer andotherwise, where they're trying
(16:23):
to coordinate their care andthey only have access to small
portions of it. And so there'sthat need to not just make sure
folks know about it, but alsoreally think through what are
those implications that aredownstream from this that may
not be the first reason why I'mthinking about it.
I think bring you holisticallyto make a decision to say, this
(16:44):
is the right thing for us to do.And then I think we're still
early on into some of thosephases, especially thinking
about a practice manager of howdo we not just benefit the
clinician at the point of carewith that patient, but also how
do we administratively simplifysome of those routines, like I
said, with prior authorizationor in a value based care
(17:07):
arrangement agreement, sharingthe appropriate information at
the right times and in the mostefficient way. I know there are
a lot of practice managers outthere listening to this going,
yeah, that's a lot of work. Andso I think finding and driving
both from that awarenessperspective and education, and
having that being brought upinto the electronic health
record vendors that, yeah, theseare really important things for
(17:28):
us to do. Because at the end ofthe day, we're not wanting to
see another system put in frontof providers in that space.
We wanna see these systems thatare already there evolve into,
and being able to support thistype of exchange throughout the
framework.
Daniel Williams (17:44):
Okay. As a final question then, is there
anything else we haven't talkedabout here that you think would
be a benefit to our MGMAlisteners that could help them
navigate the system, input theirown information, extract
information, anything else, I'llgive you a blank slate here to
work from.
Justin McMartin (18:05):
The first thing that I would encourage you all
to do is to head out to oursurescripts.com and find our
Interconnect product. I don'tthink I've mentioned that yet
today, but out on thatsurescripts.com, we have a
particular area of it that'sfocused on our qualified health
information network, and theproduct is our interconnect
service. And we've got a ton ofmaterials out there that are
really more focused on some ofthose education and awareness
(18:28):
aspects of it so that you canthink through and say, as a
provider, why are the reasonsthat I want to be able to be
plugged into this framework? Sothat would be the first thing I
would say. The second thing Iwould say is just make sure that
you're well aware of things thatare going on in your states.
Because I think there's a lot ofopportunities for provider
practices across the country tolean into some of the state
(18:50):
based exchange informationthat's being talked about, and
ensuring that they're reallythinking about not just how as a
state can we exchangeinformation effectively, but how
can we plug into this nationalframework to ensure that, again,
we're making it as efficient aspossible and not having to
recreate the wheel with eachlayer of exchange. And then the
(19:12):
third thing I would say isreally be thinking about and
talking to patients, because oneof the things that we're really
hearing is that patients arefrustrated with their lack of
ability to kind of exchangetheir information effectively.
And so understanding kind ofthose needs from a patient
perspective and how it overlapswith things like TEFCA, which
(19:32):
has an individual right ofaccess, I think is a really
great opportunity to kind ofalso dig into and understand
additional value and benefits toparticipating in a framework
like this.
Daniel Williams (19:45):
All right, great points there. So Justin
McMartin, Director of ProductInnovation at SureScripts, thank
you so much for joining ustoday.
Justin McMartin (19:54):
Yeah, appreciate the time. Thanks for
having me.
Daniel Williams (19:56):
Yeah, love this conversation. And for anybody
else who learned a lot today intoday's episode and want to know
even more, I want to providesome resources for you. They're
going be in the episode shownotes. So first up, we're going
to provide a link directly tosurescripts.com/qhinready. And
(20:21):
I'm going to provide a directlink so you can click right to
that.
I'm also going to provideseveral other resources that you
can go to, give you kind of atoolkit or toolbox for you so
you can access information andlearn more about it. So Justin,
I did want to ask you one morething. You provided one link. Is
there anywhere else or any othertool or FAQ or anything else on
(20:47):
SureScript or elsewhere that youthink might benefit our
listeners? That's one of thethings I know when I go to the
internet and I'm typing stuffin.
I mean, AI, it's very much morehelpful now, but there's still
you don't want to spend a lot oftime and get frustrated trying
to find what you're looking for.Anything else out there to point
them to? Yeah.
Justin McMartin (21:06):
So I mean, I think you pointed the link that
you provided is it takes you outto that resource hub where it's
got a whole list of othermaterials. If you're looking for
things outside of SureScript,you can access the recognized
coordinating entities website aswell. So that's again, out at
the Sequoia project. I don'thave the link right in front of
me, but I would encourage youalso to look there. They have a
(21:27):
lot of other materials aroundhow do providers get connected?
What are other things toconsider there? Just in case
you're questioning whether I'vegiven you all the facts, but I
think you'll find it's allthere.
Daniel Williams (21:38):
All right. Well, Justin, thank you again
for joining us. Appreciate you.Yeah. Thanks.
All right. And everybodylistening, thank you so much for
being MGMA podcast listeners.Again, we're going to put all
this information in the episodeshow notes. We're also gonna
create an article on our websitewhere you can go right to some
key points from thisconversation. Until then, thank
(22:00):
you so much, and look forward toconnecting with y'all in the
next MGMA podcast.
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