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How Much was the 21st Century Cures “Trusted Exchange Framework,” Influenced by the 2016 ONC Blockchain Challenge?

Edward Bukstel
Feb 2, 2018 · 3 min read

When the ONC announced their Trusted Exchange Framework in accordance and compliance with the 21st Century Cures Act, the document seemed to SCREAM blockchain, or some technology that looked a hell of a lot like a public blockchain. Transparency, interoperability, security, and accessibility are fundamental precepts of the “Framework.”

Trusted Exchange Framework Principals

There have been times that I have questioned the wisdom of directions from HHS’s Office of National Coordinator (ONC), but in the case of the Trust Exchange Framework, it appears that ONC utilized competitive challenges in blockchain and data exchange to influence the creation of the health IT architecture solution for the 21st Century Cures Act. In September 2016, ONC launched the Blockchain Challenge with prizes as high as $5000. In May 2017, ONC helped select prizewinners that received up to $50,000 for innovations in health data exchange (Move Health Data Forward). It appears that ONC did an excellent job highlighting an architecture that has transparency built into the fabric of the system.

$155 Million Settlement Did not Erase the Questions about other EHR Vendors

The lack of transparency and fraudulent claims that plagues the Implementation of Meaningful Use requirements is a situation that must not be repeated. It is very possible that other vendors, beyond eClinicalWorks, have misrepresented their capabilities and functionality on government mandated requirements. The $155 million eClinicalWorks false claims settlement is only the first battle in the war for transparency and accountability in healthcare information technology. It is doubtful that in this day and age, that any vendor will succeed without implementing some form of public ledger technology (distributed or centralized). Experts including Jody Ranck and Soraya Ghbleh also believe that the ONC Trusted Exchange Framework was significantly influenced the document. In fact, Soraya was the first person that I know of to make this connection at the Princeton Technology Meetup.

Presenters at The Princeton Tech Meetup, Jan 30, 2018

Michael Sena and Evin McMullen were also at the Princeton Tech Meetup and discussed Consensys and uPort developments including a Diabetes Patient Blockchain in Saudi Arabia and interesting moves by the One World Identity collaboration.

It will be critical going forward to get the identity and transparency components of any Trusted Exchange Framework right this time around. People’s lives are at stake, and as stated by Gladiator, the time form half measures has passed, and it is time for everyone, patients, consumers, health systems, and even the vendors to comment on the ONC Trusted Exchange Framework by February 20, 2018.

Edward Bukstel


Clinical Blockchain

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