TEFCA: Building a Nationwide Health Information Exchange Framework
What is TEFCA?
The Trusted Exchange Framework and Common Agreement™ (TEFCA™) is a federal initiative which was mandated by Congress’ 21st Century Cures Act, designed, to create a nationwide network “on ramp” for health information interoperability across all healthcare constituents including patients, providers, payers and public health agencies. Supported by the U.S. Department of Health & Human Services (HHS) through the Assistant Secretary for Technology Policy (ASTP), formerly ONC, TEFCA was designed to eliminate barriers to electronic health data sharing and ensure that data is shared appropriately while maintaining the highest standards of privacy and security.
TEFCA’s goal is to establish a universal floor for interoperability across the country by developing the infrastructure model and governing approach for users in different QHIN networks to securely share clinical information with each other. Importantly, this would happen under commonly agreed-to expectations and rules – regardless of which QHIN network a healthcare organization participates in.
The TEFCA Framework has delivered a unique opportunity for the U.S. healthcare system by creating a healthcare information interoperability internet that connects healthcare constituents, including providers, providers’ delegates, public health groups, payers, and healthcare consumers. TEFCA’s rules and non-binding principles bring the potential to expand care coordination and interoperability while decreasing delays in patient data exchange – finally delivering on interoperability’s potential to deliver the trusted and actionable information on the right patient to the right health care constituent at the right time – including ensuring healthcare consumers access to their own health data.
For more detailed information about TEFCA, you can visit the Office of the National Coordinator for Health Information Technology (ONC) website.
What is a QHIN?
TEFCA establishes a ‘network-of-networks’ model, enabling health information networks, called Qualified Health Information Networks® (QHINs™), to securely exchange data across disparate healthcare constituent systems. TEFCA sets both technical as well as common legal and governance standards to ensure interoperability, privacy, and security.
To become a QHIN, an organization must complete a rigorous application, pass technology and security testing and sign the Common Agreement, which is countersigned by the Recognized Coordinating Entity (RCE).
QHINs connect all TEFCA participating organizations. QHINs route queries and responses among participating healthcare constituents. Any organization, or patient, connected to one QHIN can exchange data with TEFCA participants connected to any other QHIN. QHINs are vital for creating a seamless flow of health information, reducing data silos, and enabling more coordinated patient care.
There are currently ten designated QHINs. The original five QHINs were designated by the U.S. Department of Health and Human Services (HHS) and the Office of the National Coordinator for Health Information Technology (ONC), following arduous testing and onboarding and their signing of the Common Agreement.
MedAllies was one of the original five QHINs and has been in operation since December of 2023.
What is the RCE?
The Regional Coordinating Entity (RCE) was selected by ONC (now ASTP) through a competitive application process. The nonprofit Sequoia Project was chosen. The RCE is responsible for reviewing QHIN applications, overseeing the rigorous QHIN technical testing, determining when a QHIN is ready to be designated, supporting QHIN governance, maintaining the Common Agreement and technical framework and monitoring TEFCA performance and compliance.
MedAllies’ Dr. John Blair has been the Co-Chair of the QHIN Governance body since its inception.
What are the TEFCA Exchange Purposes?
Within the role of the RCE is oversight of the process of defining the guides for the TEFCA exchange purposes (use cases) which include Treatment, Individual Access Services (IAS), Payment, Health Care Operations, Public Health and Government Benefits Determination.
To date, MedAllies’ leadership has been actively involved in this work.
TEFCA and the CMS Interoperability Framework
In August of 2025 CMS organized an event, which included an exclusive group of invited health technology leaders, senior CMS, DOGE Service, and HHS leadership as well as the President of the United States, for a day of meetings to Make Health Technology Great Again.
MedAllies’ Dr. John Blair was one of the invited technology leaders to participate in this event and to pledge to support the CMS’ Aligned Network Framework. TEFCA will be an essential part of the government vision providing a tested infrastructure for data exchange to meet the goals of this Framework.
TEFCA represents a transformative step for nationwide health data interoperability over a Trusted Exchange Framework where all share a Common Agreement. TEFCA is bridging gaps in health information exchange, aligning with CMS goals, and enabling more efficient, secure, and patient-centered care.
Useful websites for further information:
FHIR Roadmap for TEFCA Exchange V.2: FHIR APIs are on their Way into TEFCA Exchange – Health IT Buzz
FAQs
Healthcare providers interested in joining a QHIN can start by contacting an approved QHIN organization, such as MedAllies. They will need to undergo a rigorous application and onboarding process to ensure they meet the necessary standards for data sharing and interoperability.
A variety of healthcare-related organizations can become QHINs, including healthcare providers, payers, public health agencies, and health information exchanges. These organizations must meet specific criteria and undergo a thorough vetting process to be designated as a QHIN.
Being part of a QHIN allows healthcare providers to access a nationwide network of health information, improving patient care by providing comprehensive data from multiple sources. This access enhances clinical decision-making and facilitates better patient outcomes.
QHINs must support various technology standards such as FHIR, HL7, C-CDA, and IHE Profiles. These standards ensure that data can be exchanged seamlessly and securely between different healthcare systems and organizations.
TEFCA establishes strict guidelines and policies for QHINs to follow, ensuring that health information is exchanged securely. This includes data encryption, access controls, and regular security audits to protect sensitive health data.