TEFCA
The Trusted Exchange Framework and Common Agreement™, known as TEFCA™, operates in the United States as a nationwide framework for health information sharing. TEFCA was created by the U.S. Department of Health & Human Services Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC) to remove barriers for sharing health records electronically among healthcare providers, patients, public health agencies, and payers.
A Nationwide Network-of-Networks for Health Information Exchange
In practice, TEFCA establishes a universal floor for interoperability – creating a path for data to be shared beyond proprietary boundaries. TEFCA, enables providers, payers, public health professionals, and patients to access and securely share health information regardless of where the information is stored. This helps providers coordinate patient care and ensures patient data follows the patient, even when switching providers, among a wide variety of additional benefits. TEFCA has matured rapidly since being formally announced in 2022. In December 2023, TEFCA surpassed a major milestone when the first Qualified Health Information Networks™ (QHINs™) were designated, and within days, health data began flowing among TEFCA QHINs.
Delivering Key Benefits
for Health Care
- Increase access to patient health data across care settings
- Ensure data will be available to support requests for treatment, patient access, public health, and other exchange purposes
- Decrease costs for providers by eliminating the need to join multiple networks or create one-off, point-to-point connections
- Strengthen data privacy and security by defining a common set of requirements for health information networks and health IT developers, regardless of status as a HIPAA-covered entity
TEFCA-Enabled Exchange
TEFCA is designed to support exchange for any purpose, but that purpose must be indicated in each request for data. Below are the initial use cases, known in TEFCA as Exchange Purposes, however, ONC and the RCE will expand the permissible purposes over time to support market needs raised by the QHIN Governing Council.
How TEFCA Works
Making TEFCA-based exchange a reality is a collaborative endeavor between public- and private-sector organizations.
ASTP/ONC
As the lead agency for health IT policy, ASTP/ONC is responsible for TEFCA overall, including:
- Setting TEFCA policy
- Supporting and guiding network governance
- Collaborating with the Recognized Coordinating Entity® (RCE™ industry needs) to expand TEFCA
- Collaborating with federal agency partners whose regulatory responsibilities intersect with health IT
Recognized Coordinating Entity (RCE)
The RCE develops, updates, implements, and maintains the Common Agreement. The RCE is also responsible for soliciting and reviewing applications from HINs seeking QHIN status and administering the QHIN designation and monitoring processes.
- Developing, implementing, and maintaining the Common Agreement
- Managing the QHIN application and designation process
- Monitoring designated QHINs
Updating the QHIN Technical Framework - Engaging with TEFCA stakeholders through routine public information sessions, ad hoc presentations, and other channels
The Sequoia Project currently serves as RCE under a 5-year contract with ONC awarded in August 2023.
Visit the RCE
Qualified Health Information Networks (QHIN)
QHINs are the individual networks that make up the backbone of TEFCA. Together, they create the network-of-networks that enables nationwide exchange of health information. QHINs use TEFCA’s technical standards and specifications to share electronic health information across the nation. QHINs are the central connection points within TEFCA.
To become a QHIN, a network must be a U.S. entity and must complete the QHIN application, onboarding, and designation process, and they must sign the Common Agreement. It typically takes about 12 months to complete the rigorous process.
Meet the QHINs
Apply to be a QHIN
Participants and Subparticipants
Participants are organizations that connect to QHINs. These are the hospitals, health systems, public health agencies, and other organizations that share patient data for treatment, public health, and other use cases. Some participants, such as regional health information exchanges (HIEs), may have subparticipants.
TEFCA Components
Published in January 2022 and updated in November 2023, TEFCA comprises three foundational documents.
Common Agreement
The Common Agreement is a legal contract signed by all QHINs. The Common Agreement defines and establishes:
Read the Common Agreement
Trusted Exchange Framework
The Trusted Exchange Framework (TEF) defines the principles, standards, and specifications, underpinning the TEFCA ecosystem. The principles underlying TEFCA include:
QHIN Technical Framework (QTF)
The QHIN Technical Framework (QTF) focuses on the technical components for exchange among QHINs, including patient identity resolution, authentication, and performance measurement. The QTF also includes requirements that flow-down to QHIN participants and subparticipants as they exchange with participants and subparticipants of other QHINs.
The QTF requirements are updated periodically and incorporated by reference into the Common Agreement.
