TEFCA in Healthcare: A Complete Guide

Healthcare has long struggled with fragmented data systems. Patient records are often locked within isolated networks, making coordination between hospitals, payers, and digital health tools frustratingly slow. 

TEFCA is a federally backed framework designed to create a standardized, secure, and nationwide approach to health data exchange. It acts as a unified playbook for how healthcare organizations, regardless of size, type, or vendor, can share electronic health information (EHI) seamlessly across systems.

Why does it matter? Because better data sharing means better care. With TEFCA, a patient’s health history can follow them, whether visiting a specialist across the country or using a new virtual care platform. It lays the groundwork for true interoperability, enabling clinical insights, care coordination, and informed decision-making at scale.

Before TEFCA, the U.S. healthcare system relied on patchwork solutions. Standards like Direct Messaging, HL7, and IHE worked in silos. Networks like CommonWell and Carequality allowed limited data exchange but lacked a universal governance model. FHIR APIs brought modern flexibility, yet adoption remained uneven.

TEFCA builds on these earlier efforts, bringing structure, trust, and a national scope to the healthcare interoperability mission.

🤔 What is TEFCA?

TEFCA, or the Trusted Exchange Framework and Common Agreement, is a federally initiated framework designed to streamline and standardize how electronic health information (EHI) is shared nationwide. Its primary purpose is to establish a single, national network for health data exchange that allows hospitals, payers, public health agencies, and developers to securely share information, regardless of their existing systems or locations.

TEFCA was created to simplify health data exchange by replacing fragmented, regional systems with a unified, secure, and trusted structure. Instead of relying on custom integrations or limited vendor networks, TEFCA offers a common set of rules and technical guidelines that anyone in the network must follow. This allows patient data to flow across platforms and geographies without friction.

The framework enables consistent access to clinical and administrative data for treatment, care coordination, public health, and individual access. It is a foundational element in building a truly interoperable healthcare ecosystem.

Key Components of TEFCA

TEFCA is built on two primary pillars:

🔸 The Trusted Exchange Framework (TEF):
A set of non-binding principles that promote data sharing, transparency, privacy, and security. It outlines how organizations like EHR vendors, HIEs, and government agencies should collaborate and build trust in a national exchange system.

🔸 The Common Agreement (CA):
A legally enforceable agreement that QHINs must sign. It includes technical, legal, and operational policies that govern how data is accessed, used, and exchanged within the TEFCA network.

These components create a scalable model that supports query-based exchange, patient access services, and FHIR-based API access under a consistent governance structure.

Backed by the 21st Century Cures Act

TEFCA wasn’t built in isolation. Its foundation lies in the 21st Century Cures Act, passed by Congress in 2016. This legislation aimed to modernize the American healthcare system, and one of its key mandates was to improve interoperability and patient access to health data.

The Act directed the Office of the National Coordinator for Health IT (ONC) to develop a trusted framework for nationwide health data exchange. TEFCA is the direct result of that mandate. By aligning with the Cures Act, TEFCA supports the law’s broader goals: breaking down information silos, preventing information blocking, and giving patients easier access to their health records.

In short, TEFCA operationalizes the promise of the Cures Act, moving the industry closer to a connected and transparent healthcare system.

Related Read: Understanding Cures Act Compliance: A Modern Healthcare Imperative

What Are QHINs and Their Role in TEFCA?

Qualified Health Information Networks (QHINs) are central to how TEFCA operates. They form the core infrastructure that enables nationwide, TEFCA-based health data exchange by linking healthcare organizations, payers, and public health entities under a unified governance model.

Definition: QHINs as the Backbone of TEFCA

QHINs are officially designated networks authorized under TEFCA to exchange electronic health information (EHI) across systems and state lines. Acting as hubs, they connect different participants—providers, payers, public health agencies, and developers—using common technical standards and legal agreements outlined in the Common Agreement (CA).

In simple terms, QHINs are the trusted intermediaries that make national interoperability work.

👀 Responsibilities of QHINs

As part of the TEFCA network, QHINs have a critical set of responsibilities:

🔸 Interoperability Coordination: They facilitate data exchange between participating organizations, including hospitals, clinics, insurance providers, and third-party apps.

🔸 Secure and Compliant Data Sharing: QHINs must ensure that all data sharing aligns with HIPAA, privacy laws, and TEFCA’s security requirements.

🔸 Support for Use Cases: They help enable queries, document exchange, and FHIR-based APIs for treatment, payment, and individual access services.

🔸 Network Management: They oversee participant onboarding, manage identity verification processes, and monitor data flow quality and reliability.

📃 QHIN Eligibility and Certification

To become a QHIN, organizations must apply through the Recognized Coordinating Entity (RCE) managed by the Sequoia Project. The Office of the National Coordinator for Health IT (ONC) outlines strict eligibility criteria that include:

🔸 Demonstrating technical capability to support scalable, nationwide data exchange

🔸 Having strong privacy and security protocols in place

🔸 Accepting and agreeing to all terms of the Common Agreement

🔸 Proving neutrality and transparency in network governance

Once certified, QHINs gain the authority to connect to other QHINs and exchange data across the TEFCA ecosystem.

➕ Major EHR Vendors Participating in the TEFCA QHIN Program

Several industry leaders have stepped forward to either apply or be approved as QHINs under TEFCA:

🔸 Epic: One of the first to join, it enables its providers to access TEFCA-based data sharing via the Epic Interoperability Suite.

🔸 Oracle Health (Cerner): As of March 2025, Cerner by Oracle Health has filed its official application to become a QHIN, bringing its vast provider network into the fold.

🔸 Health Gorilla: A key player in health data exchange, it was among the earliest organizations designated as a QHIN, known for its developer-friendly APIs and public health use cases.

These organizations are helping pave the way for a more connected and efficient healthcare system through their QHIN status.

TEFCA in Action: How It Works

Once fully implemented, TEFCA enables a streamlined, secure, and standardized approach to health data exchange across organizations and state lines. Its architecture ensures that EHI flows where needed, without the usual delays or technical barriers.

⚙️ Technical Workflow

The technical flow begins with the EHR systems used by hospitals, clinics, and health apps. These systems connect to a QHIN—a trusted intermediary authorized under TEFCA.

Here’s a simplified breakdown of how the data exchange works:

1. A provider or payer initiates a data request—this could be for clinical records, test results, or treatment history.
2. The request is routed through their designated QHIN, which authenticates the sender and validates the purpose.
3. That QHIN communicates with other QHINs to locate the requested patient data across the national network.
4. The responding QHIN gathers the required data from its connected participants (e.g., other EHR systems).
5. Data is then sent back—securely and in real time—to the original requester via FHIR APIs or document-based exchange formats.

🛡️ Secure, FHIR-Enabled Exchange

TEFCA supports multiple exchange mechanisms, but its future-ready approach includes FHIR as a core standard. This ensures that data is:

🔸 Machine-readable for modern applications

🔸 Consistent across systems and organizations

🔸 Secure, following HIPAA and TEFCA-specific privacy and access control protocols

All data exchange is encrypted, logged, and governed by strict authentication requirements, helping maintain trust across every participant in the network.

This real-time, QHIN-to-QHIN communication forms the foundation of a scalable, nationwide health information highway, where interoperability is not just possible—it’s automatic.