The healthcare industry is continuing to make slow but steady progress toward the long-sought-after goal of interoperability, but much of that progress has been uneven. For example, small hospitals lag their large counterparts in interoperability, as do independent hospitals versus system affiliates, as well as rural hospitals compared with urban and suburban hospitals.
Qualified health information networks, or QHINs, are networks of networks – stood up under the federal Trusted Exchange Framework and Common Agreement, or TEFCA – that healthcare organizations join to share information with other healthcare entities. They’re emerging as a key means by which to advance interoperability.
Solving a persistent data challenge
At a very high level, QHINs are designed to solve the persistent challenge of fragmented health data, said Bob Watson, executive chairman of Health Gorilla, which is, along with several other organizations, a QHIN.
“For too long, patient information has been scattered across various systems, hindering care coordination and increasing administrative burdens,” he explained. “This lack of interoperability has led to inefficiencies, potential errors and a less-than-ideal patient experience.
“QHINs work by establishing a secure, standardized framework for health information exchange,” he continued. “They act as trusted intermediaries, connecting different health information networks and enabling the seamless flow of data between them. This allows for a network of networks where authorized entities can securely access and share patient information for purposes like treatment, payment and public health.”
Within the established architecture of TEFCA, QHINs are the on-ramps that all participants must use to participate in nationwide healthcare data exchange. Similar to the established national networks and the existing Carequality framework, participants can connect to the TEFCA framework directly through a QHIN or as a sub-participant of another participant.
Additional data exchange purposes
TEFCA itself has been designed and implemented to expand the exchange of health information beyond the treatment exchange purpose. As TEFCA moves forward there will be progressive use of additional exchange purposes including individual access services (IAS), public health exchange, healthcare operations, payment, public benefits determination and likely research.
“The process of becoming a QHIN involves meeting stringent requirements set by the federal government and demonstrating the ability to securely and reliably exchange health information,” Watson explained. “It includes a rigorous application and review process, ensuring only qualified organizations with robust technical and security capabilities are approved.
“We’re proud to be among the first organizations approved for onboarding as a QHIN applicant, which speaks to our commitment to data security and interoperability,” he added.
Health Gorilla relies on a secure cloud-based infrastructure to operate its network upon. This infrastructure is secure, closely monitored, and scales dynamically to accommodate the traffic surges it sees on a daily basis.
FHIR and HL7 lend a hand
“Additionally, we provide an interoperability layer that presents an extensive set of APIs to the outside world,” Watson explained. “This layer supports FHIR – generally how our participants interact with us – and HL7 V3 XCA – generally how QHINs interact with each other. These APIs are secured using robust authentication and authorization auditing frameworks to protect the sensitive electronic health information being exchanged.
“Internal to our platform we have built a record locator service and master patient index to maximize our ability to find the right patient information and minimize the chance of finding the wrong patient data,” he continued. “We also have data orchestration, processing and storage capabilities that allow our system to manage millions of queries across thousands of sources and process all the retrieved information into comprehensive patient-centric summaries about individual patients.”
So what is someone at a hospital doing that initiates a call to this QHIN to gather data, and how does the data get back to them? Watson spelled it out.
“Let’s break down how a data request might work in a typical hospital setting,” he said. “Imagine a patient has just arrived in the hospital’s emergency department. First, the hospital’s electronic health record initiates a request for the patient’s records on behalf of the provider. This request is often triggered when the patient first registers at the hospital.
“The EHR system, which is the hospital’s vendor in this scenario, then uses secure API calls to communicate with our QHIN platform,” he continued. “These APIs are standardized, ensuring the request is formatted correctly and securely.”
Connecting with other QHINs
Next, the QHIN platform receives this request. It verifies the requestor’s authorization and then sends the request to each connected QHIN, while also checking its MPI to see if that patient has data with any of Health Gorilla’s own QHIN participants.
These connected QHINs check if their participants hold data about the patient in question, and if they do, they present Gorilla with whatever information is available.
“We typically retrieve all available information within minutes or even seconds to provide the most comprehensive patient overview,” Watson noted. “Once we’ve gathered all the necessary information, we compile it into a secure, consolidated and deduplicated format.
“Finally, we send this consolidated data back to the originating hospital’s EHR system via secure APIs,” he continued. “Providers then can access the complete patient record within their familiar EHR interface, enabling them to provide the best possible care. In summary, it’s a coordinated, secure flow from the hospital’s EHR, through our QHIN platform, to other TEFCA participating organizations, and back again.”
Encouraging indicators
Health Gorilla received designation as a QHIN in December 2023 and went live in the first quarter of 2024. While it is still in the early phases of QHIN operations, it already is seeing some encouraging indicators.
“Since going live, we’ve seen query volume growth of more than 21% per month, growing from about 200,000 to more than 66 million in March 2025,” Watson reported. “One key metric we’re tracking is the number of successful data exchanges facilitated through our platform. We’re seeing a steady increase in these exchanges, which demonstrates the growing connectivity and trust within our network.
“Another important measure is the reduction in time it takes for healthcare providers to access patient information,” he continued. “Historically, this process could take hours or even days, involving phone calls, faxes and manual data entry. With our QHIN, we’re seeing a significant decrease in this time, often bringing retrieval down to minutes, or even seconds. This translates directly to faster decision making and improved patient care.”
It’s also important to note that Health Gorilla is seeing tangible results in terms of client feedback.
“Customers are reporting significant reductions in manual workloads, fewer errors related to missing data, and improved automation of data retrieval,” Watson concluded. “This anecdotal evidence, combined with the quantitative metrics we’re tracking, paints a clear picture of the positive impact our QHIN is having on solving the interoperability challenge.”
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Email him: bsiwicki@himss.org
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