TEFCA: Accelerating Government Benefits Determination for a Better Tomorrow

Individuals seeking government benefits such as Social Security Disability Insurance spend a lot of time waiting. In particular, the Social Security Administration (SSA) estimates it takes over 200 days for an initial disability claim to be processed. Part of that time delay includes SSA's efforts to find out where relevant medical records may be, request them from your health care provider(s), and the time it takes your providers to respond. Ultimately, it costs SSA (and thus taxpayers) over 500 million dollars a year to collect and create medical evidence for applicants.

It doesn't have to be this way. The Trusted Exchange Framework and Common Agreement™ (TEFCA™) includes Government Benefits Determination as one of the six authorized Exchange Purposes and seeks to automate this records request process. Doing so will make it possible for SSA and other similar agencies to more quickly get the information they need and less burdensome for health care providers to respond. In fact, the SSA estimates that on average it "identifies allowances nearly 60 percent faster when processing applications with only health IT records." By leveraging the scale and connectivity TEFCA offers, it will be possible for individuals to get more timely responses from government agencies. Put simply, for patients this means quicker disability coverage, and for providers this means less uncompensated care.

The TEFCA Recognized Coordinating Entity^® (RCE^®) is planning to release an important update to TEFCA's underlying technical specifications. The Qualified Health Information Network® (QHIN^TM) Technical Framework is being updated to more clearly support directed queries, which allow for more precise requests for medical records to be issued across QHINs. These updates will be implemented by the 10 designated QHINs and will help ensure that government benefits determination requests are efficiently routed, thus eliminating unnecessary queries across the network. These changes will also support those participating in TEFCA that are implementing Health Level Seven® (HL7®) Fast Healthcare Interoperability Resources® (FHIR®) APIs. Additional implementation specifications will be established in the forthcoming Government Benefits Determination Standard Operating Procedure.

We are just getting started! TEFCA is expanding to support the needs of the broader care community, and we are thrilled to work with our federal partners to make that possible.