Enabling the Secure Exchange of Electronic Health Information

Today, health information is shared electronically at an accelerated pace. Advanced technologies have made it easier than ever to move data from network to network. Mariann Yeager, CEO of the Sequoia Project, developed an affinity for health information technology early on in her career, which set her on a path to impact the way public and private sector moderate the exchange of information.

“My experience is more broadly in health information technology,” Yeager says. “I got my start at a health plan and was working on an IT project to automate a process that was manual at the time. I fell in love with the technology side of things and found I had a genuine interest in it. I wasn’t sure how my career would unfold, but the common denominator in everything I did was related to IT.”

Pursuing a Public Mission

Yeager served as a government contractor at the Office of the National Coordinator for Health Information Technology (ONC) from 2006 to 2011 and became involved with a project called the Nationwide Health Information Network (NHIN). Her work on NHIN would later spur the idea for the Sequoia Project.

“There were health records being exchanged among different governmental agencies and private sector organizations in production,” Yeager says. “I was working with the group to determine whether they wanted to continue supporting that activity in the private sector, and the stakeholders did. So, I worked with them to write a business plan that led to the formation of the Sequoia Project.”

Yeager’s organization chartered the Sequoia Project as a nonprofit with a public good mission focused on advancing secure, interoperable health information exchange on a nationwide basis. As CEO, Yeager has brought together both stakeholders from the government and from the private sector to solve real world interoperability issues.

“Through our work on the Nationwide Health Information Network, we were able to lay a foundation for what is now called the eHealth Exchange,” Yeager says. “We always assumed there would be a need for an organization that could work in close collaboration with policymakers to extend the role of government and advance our public mission.”

Partnering with TEFCA

Yeager and her team aligned with the Trusted Exchange Framework and Common Agreement (TEFCA), which outlines a common set of principles, terms, and conditions to enable the nationwide exchange of electronic health information across disparate health information networks. The handshake between the Sequoia Project and TEFCA stands to improve information sharing on a broader scale.

“What we are doing with TEFCA is really building on the pretty intensive experience we’ve had over the past decade of working on legal agreements and governance, as well as facilitating and supporting initiatives that enable the sharing of information,” Yeager says. “There’s not a mandate to support TEFCA, so we’ve been reaching out to various stakeholders to encourage cooperation, which would allow us to more easily reach our goals.”

In August 2019, Yeager began collaborating with the ONC to develop the components needed to operationalize TEFCA and build a sustainable framework.

“The framework is endorsed by the government,” Yeager says. “Qualifying networks come to us to be designated as TEFCA compliant, at which point we’d verify that the network meets the established requirements.”

At present, specific governance processes and committees oversee the exchange of activities relative to TEFCA in order to maintain the framework on an ongoing basis.

Changing the Health Data Landscape

Access to new technologies allows for greater efficiencies in health information sharing; however, with these efficiencies comes the need for enforceable rules of engagement. Yeager and her team aid in the reinforcement of the established rules and expectations to preserve data integrity as it is shared from network to network.

“TEFCA sets forth a foundational set of policies, technical requirements, and governance that participants abide by,” Yeager says. “We’re trying to identify policy gaps and bridge those gaps to better safeguard the health information ecosystem.”

Over the course of the last several years, the private sector has made tremendous strides in facilitating the exchange of information between networks for treatment purposes. However, the COVID-19 pandemic elicited a critical need to address information access as it pertains to responses to a public health crisis, something Yeager believes will be improved through federal support.

“Having federal leadership promote a consistent approach has been game changing and creates a tremendous opportunity,” Yeager says. “We’ve already made progress, so federal leadership and support will only accelerate that progress.”

A Secure Future

Data privacy is the cornerstone of health information sharing. Without policies and regulations to uphold privacy standards, health information sharing becomes high risk. However, Yeager believes that it is possible to uphold data privacy standards while still granting patients easy access to their information.

“There are some concerns that there are risks for noncompliance, but we are experiencing tremendous momentum and growth in health information sharing in our day-to-day lives,” Yeager says. “I think we're going to see mounting progress, and we’ll start to see information exchanged more seamlessly. I would love for it to be easier for me to gain access to all of my health information.”

Yeager has immense pride for the work that has been done over the last decade through the Sequoia Project. Her ambitions to further improve the ecosystem stand to motivate her to make an impact in the decades to come.

“I love working on the next challenge. Just reflecting on the past 10 years, we came from humble beginnings and watched our community of stakeholders and leaders steadily expand,” Yeager says. “For me, the goal is to pave the way for better nationwide exchange of information at scale. That’s incredibly motivating and gratifying.”

Lauren Liacouras is an editor with the Journal of AHIMA.