TEFCA, the Trusted Exchange Framework and Common Agreement, creates a national network of networks for exchanging health information across the United States. Hospitals, practices, health plans, public health agencies and technology companies can connect through Qualified Health Information Networks, known as QHINs, to exchange data for defined purposes. Joining well requires choosing the right QHIN, understanding exchange purposes and preparing your systems for both document-based and FHIR-based exchange. Taction helps organizations plan, connect and operate TEFCA exchange, building on our EHR and EMR integration services. Start with a free TEFCA readiness assessment.
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TEFCA establishes common rules and technical requirements so organizations connected to different networks can exchange data with each other. Understanding its structure helps leaders decide how to participate, which partners to work with and what technical work their teams must complete.
The Recognized Coordinating Entity, operated by The Sequoia Project under contract with the federal health IT office, oversees TEFCA. It manages the Common Agreement, designates QHINs and publishes standard operating procedures that govern how exchange works across the network. Its documents define requirements.
QHINs connect Participants, which in turn can connect Subparticipants such as providers, health plans and technology partners. Participants sign agreements directly with a QHIN, while Subparticipants connect through a Participant. Both agree to the same terms governing exchange. Choose your position carefully.
Every TEFCA exchange must specify an Exchange Purpose, such as treatment, payment, health care operations, public health, government benefits determination or individual access services. Exchange Purposes define why data is requested and which organizations must respond, shaping technical and policy requirements.
The first QHINs were designated in December 2023, including eHealth Exchange, Epic Nexus, Health Gorilla, KONZA and MedAllies. Additional organizations have since been designated, including eClinicalWorks, Surescripts and Netsmart. Check the RCE’s current list when evaluating options. The list continues to grow.
TEFCA promises broader data access through fewer connections. Instead of building separate interfaces with every partner, organizations connect once through a QHIN and reach many others. The benefits depend on use case, organization type and how well systems use the data received.
Providers can retrieve records from organizations across different networks, supporting care transitions, referrals and emergency treatment. Access to outside history reduces duplicate testing and improves clinical decisions, especially for patients who receive care from many unaffiliated providers. Clinicians gain more complete patient histories.
Connecting through a QHIN can replace many individual connections with partners. This reduces interface maintenance, onboarding effort and legal agreements. Organizations still need integration work, but it concentrates on one well-defined connection rather than dozens of custom interfaces. Savings grow with network size.
TEFCA includes individual access services, allowing patients to retrieve their records through approved applications. Digital health companies building consumer apps can explore this path. Strict identity verification and privacy requirements apply, so plan these capabilities carefully before launching. Review requirements in detail.
Exchange Purposes beyond treatment support public health reporting, payment and operations. Health plans and public health agencies can use TEFCA for appropriate data access. Each purpose carries specific requirements, so confirm details in the relevant standard operating procedures. Requirements differ by purpose.
TEFCA began with document-based exchange using established IHE protocols, and is moving toward FHIR-based exchange through a published roadmap. Technical teams should prepare for both, because many partners will use document exchange for years while FHIR capabilities expand.
Much current TEFCA exchange uses IHE-based query and retrieve of clinical documents, such as C-CDA summaries. Systems must request, receive and process these documents effectively. Parsing and reconciling documents into useful clinical data remains a major integration task. Plan this processing work early.
The RCE’s FHIR roadmap describes stages moving from QHIN-brokered exchange of FHIR content to facilitated FHIR exchange and eventually broader FHIR-based exchange. Facilitated FHIR lets Participants and Subparticipants exchange data using FHIR APIs with QHIN support. Track roadmap updates from the RCE.
RCE materials state that, after January 1, 2026, TEFCA exchange using FHIR follows the HL7 security for registration, authentication and authorization implementation guide, and US Core version 4.0.0. Confirm current requirements in the latest RCE documents before building. Plan security work early.
Prepare to handle both documents and FHIR resources, including identity matching, consent, terminology and storage. Our FHIR and HL7 integration services help organizations build flexible integration layers that support current and future exchange methods. Flexible designs reduce rework as TEFCA evolves.
Joining TEFCA involves strategic, legal and technical steps. Organizations that plan carefully choose the right QHIN, understand obligations and prepare systems before go-live. The steps below reflect how we guide organizations through participation from initial assessment to production exchange.
Clarify why you want to join, which Exchange Purposes you need and what data you expect to send and receive. Clear goals guide QHIN selection, technical scope and internal policies, preventing costly changes after agreements are signed. Document goals for leadership approval.
Evaluate QHINs and existing Participants based on supported Exchange Purposes, technical capabilities, pricing, support and existing relationships. Your EHR vendor may already offer connectivity. Compare options carefully, because changing networks later involves new agreements and technical work. Ask for references from current participants.
Review the Terms of Participation, privacy, security and response obligations with legal and compliance teams. TEFCA includes requirements for responding to requests, reporting security incidents and handling individual access. Update internal policies to meet these commitments. Train staff on new obligations.
Implement connectivity, identity matching, document handling, FHIR capabilities and security requirements. Test with your QHIN or Participant in non-production environments. Validate how received data appears to clinicians and how your systems respond to incoming requests. Document every configuration decision clearly.
Launch exchange in production, monitor request volumes, response times, errors and data quality, and gather user feedback. Track TEFCA updates and new standard operating procedures, adjusting systems and policies as requirements evolve over time. Share results with leadership and clinicians regularly.
TEFCA reduces some integration burdens but introduces new responsibilities. Organizations that anticipate these challenges avoid surprises after go-live and get more value from the data they receive through the network.
Exchanging data across networks depends on accurate patient matching. Weak demographics or inconsistent identifiers lead to missed records or incorrect matches. Invest in data quality and matching processes before joining, because poor matching undermines trust in exchanged data. Measure match rates over time.
Participation includes obligations to respond to valid requests for certain Exchange Purposes. Systems and staff must handle incoming queries reliably. Plan capacity, automation and monitoring so response obligations do not create operational strain after go-live. Document response procedures for staff.
Receiving outside documents is only valuable if clinicians can find and use them. Integrate retrieved data into workflows, reconcile medications and problems, and avoid overwhelming users with duplicate documents. Usability work often determines real clinical value. Gather clinician feedback regularly.
TEFCA continues to evolve through new standard operating procedures, FHIR requirements and policy updates. Assign responsibility for tracking changes and updating systems. Organizations that treat TEFCA as a one-time project quickly fall out of step with requirements. Review updates quarterly.
Taction has delivered 200+ healthcare projects, including HIE connectivity, national network integrations and FHIR platforms. We help providers, health plans and technology companies join TEFCA efficiently and turn exchanged data into real clinical and operational value.
Share your goals, systems and current exchange connections. We assess readiness, recommend Exchange Purposes and network options, and outline technical and policy work. You receive a clear participation plan. Request your free assessment. We also identify quick wins using your existing network connections.
We build connections to national networks and HIEs, including Carequality and CommonWell, applying that experience to TEFCA document and FHIR exchange. We understand document exchange, patient matching and network onboarding, so your TEFCA connection benefits from proven patterns rather than experimentation.
Our HIE integration services cover regional and national exchange, while our Health Gorilla integration work supports organizations connecting through one of the designated QHINs. We help organizations compare network options objectively, choosing the connection path that best fits their goals, systems and budget.
Need extra expertise? Hire healthcare interoperability engineers experienced with IHE profiles, FHIR, patient matching and network onboarding. They join your team quickly and document integrations thoroughly. Engagements scale with your roadmap, from initial TEFCA onboarding to ongoing exchange operations and optimization.
These answers address common questions about TEFCA and QHIN integration. Because TEFCA requirements and designated QHINs continue to evolve, confirm current details with the RCE and your chosen network before making decisions.
TEFCA, the Trusted Exchange Framework and Common Agreement, is a national framework for health information exchange in the United States. It connects organizations through Qualified Health Information Networks under common rules, enabling exchange for defined purposes such as treatment and individual access.
A QHIN, or Qualified Health Information Network, is a network designated to exchange data under TEFCA. QHINs connect Participants, which may connect Subparticipants. Designated QHINs include eHealth Exchange, Epic Nexus, Health Gorilla and others listed by the RCE. Check the current list.
Participation is voluntary. Organizations join to gain broader data access, reduce point-to-point connections and support specific Exchange Purposes. Evaluate benefits against obligations, costs and technical work, considering whether existing networks already meet your needs. A readiness assessment helps decide. Weigh both carefully.
Yes. TEFCA follows a FHIR roadmap moving from document-based exchange toward FHIR-based exchange, including facilitated FHIR. RCE materials specify security and US Core requirements for FHIR exchange. Confirm current requirements in the latest RCE documents before building. Requirements continue evolving.
Timelines depend on your chosen QHIN or Participant, agreements, technical readiness and testing. Organizations already connected through an EHR vendor or network may move faster. A readiness assessment clarifies effort and helps set realistic expectations. Planning early shortens timelines. Start conversations early.
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