A Unified Approach to Health Data Exchange: A Report From the US DHHS

Abstract

Importance: Health information technology, such as electronic health records (EHRs), has been widely adopted, yet accessing and exchanging data in the fragmented US health care system remains challenging. To unlock the potential of EHR data to improve patient health, public health, and health care, it is essential to streamline the exchange of health data. As leaders across the US Department of Health and Human Services (DHHS), we describe how DHHS has implemented fundamental building blocks to achieve this vision.

Observations: Across DHHS, we have implemented 3 foundational building blocks called for by the 2016 21st Century Cures Act to create a unified approach for secure, high-quality, and timely exchange of health data across the health care system. The United States Core Data for Interoperability provides a minimum baseline for data elements that must be available in federally regulated health information technology systems such as certified EHRs. These data elements now must be accessible using Fast Healthcare Interoperability Resources-a secure, flexible, and open-industry standard for health data exchange. The Trusted Exchange Framework and Common Agreement provides a network to securely exchange health data across the country. The 3 building blocks of United States Core Data for Interoperability, Fast Healthcare Interoperability Resources, and Trusted Exchange Framework and Common Agreement are now in place thanks to diligent public and private sector work over 2 administrations. Across DHHS, we are working to refine these building blocks and increase their adoption through regulatory authorities, grants, and public-private partnerships.

Conclusions and relevance: The technological building blocks described in this article are creating a unified approach to health data exchange for patient access, clinical care, quality improvement, scientific research, public health, and other uses of health data. Collaborations between the public, nonprofit, and private sectors are needed to maximize their potential. By unlocking the potential of health data, these building blocks are the foundation of a 21st-century digital health care system that will improve the experience of patients and clinicians and result in better health outcomes.

Figure.

The Building Blocks for a Unified Approach to Health Data The building blocks create common baseline capabilities for health data exchange across the health care system. USCDI provides the minimum data elements that have to be accessible through standardized electronic requests in the electronic health record. The US Core Implementation Guide describes how the data elements in USCDI can be represented in using FHIR resources, which provide a flexible, open-industry data format for transfer and exchange. TEFCA has created a nationwide system of interconnected networks for health data interoperability, which supports exchange in Consolidated Clinical Document Architecture (a structured document format) or FHIR.