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Strong meme usage. Obscure and on point. Love the analysis!

Also, charge your phone if you’re texting the president!

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Hi Brendan. This article is so informative. Reading this, now in the age of TEFCA starting to provide some answers, any insights on what's up with too many QHINs ? What purpose does each have. I am sure there is but not super clear. Thank you.

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Why does each have to have a distinct purpose? Many QHINs leads to higher levels of competition and lower costs. You could choose the bougie QHIN with many bells and whistles or the cheap QHIN with no frills.

TEFCA forms a network. Visa forms a network. TEFCA has many QHINs. Visa has many payment processors/facilitators. As networks become ubiquitous, many on-ramps develop

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Got it. That simplifies. My next question, do QHINs with bells and whistles also mean wider geographic coverage for type of data (adts, labs, sdoh etc) ? or mostly modern on ramp capabilities like simplified API integration, faster cycle to implement. (sorry I can reach out to your email)

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Bells and whistles might be:

Data differentiators:

* Clinical data beyond TEFCA

* Medication history

* ADT notifications

* Lab history

* SDOH

Modalities - what options do they have for consuming data?

* API

* A proprietary API for CDA / raw content?

* A FHIR API?

* Standalone viewer

* Data export (SQL)

* EHR integration

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Brendan, thank you for the insightful analysis.

2 questions from an outsider trying to get up to speed:

1. Would you count Plaid as an on-ramp, a connector or a modern rail/network?

2. Where would you say Referrals sit within your analysis -- any noteworthy players you see as having made most progress here?

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1. Have a draft article on this very topic - send me an email at brendanjkeeler@gmail.com and I'll share

2. Referrals are still in "Gru's Master Plan" stage. DirectTrust sorta touches on them and is a ubiquitous network, but is not fit for purpose for referrals. Referrals also plays heavily with prior auth and scheduling, so progress will likely come for all three in tandem. There are a few players here like AristaMD and such that have tried to build out their network, but are fairly nascent.

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