TEFCA is live and ready to exchange data, says HHS

The U.S. Department of Health and Human Services announced Tuesday that eHealth Exchange, Epic Nexus, Health Gorilla, KONZA and MedAllies can immediately begin exchanging data under the Trusted Exchange Framework and Common Agreement’s policies and technical requirements.


Nationwide health data exchange governed by TEFCA is now operational and as a result, patients will have increased access to their records while healthcare organizations that serve them can improve their secure exchange of electronic health information, according to the HHS announcement. 

The Office of the National Coordinator for Health Information Technology led a multi-year, public-private process with The Sequoia Project, the initiative’s recognized coordinating entity (RCE), to implement TEFCA under the vision of the 21st Century Cures Act. 

“This would not have happened without tremendous stakeholder support, considerable investment of resources and expertise by the QHINs, and the hard work of the RCE and ONC staffs,” said Micky Tripathi, national coordinator for health information technology.

The designated qualified health information networks – what ONC calls the pillars of TEFCA network-to-network exchange – that completed onboarding can immediately begin supporting data exchange under the policies and technical requirements. 

QHINs providing shared services and governance are intended to securely route queries, responses and messages across networks for eligible patients, providers, hospitals, health systems, payers and public health agencies.

eHealth Exchange, Epic Nexus, Health Gorilla, KONZA and MedAllies are operationally ready for exchange.

“eHealth Exchange was the nation’s first federally endorsed health information exchange,” said Jay Nakashima, executive director of eHealth Exchange, in a statement. “We are thrilled to see so many diverse health information networks achieve Designated QHIN status.”

As the largest public-private health information network, eHealth Exchange manages 20 billion data exchanges annually and said it provides connectivity for 60 regional and state health information exchanges, 75% of U.S. hospitals and many healthcare organizations across 30 different electronic medical record technologies via Carequality and now TEFCA. 

Organizations like CRISP Shared Services and ConnectVirginia are two of many HIEs that pledged to participate in QHIN-based exchange through the eHealth Exchange. 

Nakashima added that the Health Exchange Coordinating Committee put in “countless hours dedicated to meeting the stringent guidelines of TEFCA and successfully passing all conformance testing.” 

MedAllies, a direct secure messaging network, said in a statement that becoming operational under TEFCA will increase its reach and expand to additional healthcare stakeholder groups.

Dr. John Blair, MedAllies’ CEO, credited ONC and The Sequoia Project for their “vision and commitment” to expand the excellence of support services and apply lessons learned through the process.

Epic, whose customers, including 489 hospitals, are expected to join TEFCA, already exchanged data through the Care Everywhere interoperability platform and Carequality framework.

“We hope this public-private partnership will spur providers who have previously not participated in nationwide interoperability to join this initiative,” said Matt Doyle, Epic software developer.

The additional designated QHINs – Kno2, eClinicalWorks and Commonwell Health Alliance – have been accepted into the project planning and testing phase of the onboarding and designation process, according to the Sequoia Project website.

HHS noted in its announcement that TEFCA 2.0 – anticipated to include support for Health Level Seven Fast Healthcare Interoperability Resources-based transactions – is in development and scheduled to be adopted by the QHINs within the first quarter of 2024.


In addition to The Cures Act, the 2020 Interoperability and Patient Access final rule or consumer API rule articulated the roadmap and data standards. 

Together these two rules have laid the groundwork for how interoperability is expected to look, according to Jonathan Shannon, senior director of healthcare strategy at LexisNexis Risk Solutions.

HL7 FHIR standards, which include API specifications, enable healthcare organizations to easily store, retrieve, update and share patient data and have already gained wide support in the United States, as The Sequoia Project points out in its FHIR roadmap. 

Some industry experts say there are opportunities to align. 

The co-chairs of FAST, Deepak Sadagopan, chief operating officer for Providence, and Duncan Weatherston, chief executive officer of Smile CDR Inc., said FHIR standards provide a consistent pathway to address the variability and costs of payer and provider data exchange and achieve interoperability goals.

Others, like Don Rucker, chief strategy officer for 1upHealth, the former national coordinator for health IT, point to Cures Act info-blocking allowances for TEFCA – which relates more to providers and their IT vendors – and are concerned about the technical limitations in harnessing data outside of documents.

“TEFCA is in essence trading the Internet security model for a private security and privacy model,” Rucker told Healthcare IT News on HIMSSCast in September. 


“Designating these first QHINs is just the beginning,” Mariann Yeager, CEO of The Sequoia Project and RCE lead, said in the HHS announcement. “Now, we hope to see the rapid expansion of TEFCA exchange as these pioneering networks roll out the benefits of TEFCA to their customers and members, while additional QHINs continue to onboard.”

“Providers across the country already recognize the untapped potential and need to join TEFCA for the benefit of patients everywhere,” Craig Richardville, chief digital and information officer for Intermountain Health, said in Epic’s statement. 

Andrea Fox is senior editor of Healthcare IT News.
Email: [email protected]

Healthcare IT News is a HIMSS Media publication.


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