What Is TEFCA?
TEFCA, short for the Trusted Exchange Framework and Common Agreement, is a national initiative led by the Office of the National Coordinator for Health Information Technology (ONC). Its goal is to create a standardized, secure and interoperable system for health data exchange across the United States.
But TEFCA isn’t a platform or a product. Instead, it’s a framework of policies, technical standards and agreements that guide how health information networks should operate and connect. The idea is to create a “network of networks”, enabling large health systems, payers and providers to share data across state lines and organizational boundaries.
How Does TEFCA Work?
Before TEFCA, many providers could only share data within their own networks or regions. This made it difficult to get a complete picture of a patient’s health history, especially if they received care in multiple states or systems.
TEFCA was created to solve this problem by:
- Standardizing data exchange across the country
- Reducing barriers to interoperability
- Improving patient care through better access to information
At the heart of TEFCA are Qualified Health Information Networks (QHINs). These are organizations that meet strict criteria to serve as trusted intermediaries for data exchange. QHINs connect to each other under the TEFCA framework, allowing their participants to share data nationally.
Here’s how it works:
- A healthcare provider connects to a QHIN
- That QHIN connects to other QHINs through TEFCA
- When a provider needs patient data, they send a query through their QHIN
- The QHIN retrieves the data from other networks and returns it to the provider
TEFCA enables query-based data exchange, which means health information is shared only when a specific request is made. For example, a healthcare provider can request (or ‘query’) a patient’s medical history from another healthcare system when needed.
Key Features of TEFCA
- Standardized Agreements: All QHINs and their participants follow the same legal and technical rules.
- Nationwide Reach: TEFCA is designed to connect systems across the country, not just within states or regions.
- Privacy and Security: TEFCA aligns with HIPAA and includes additional safeguards for data exchange.
Understanding TEFCA’s Role in Health Data Exchange
While TEFCA is a major step forward for national interoperability, it’s important to understand its scope and limitations:
- It’s not a centralized database: TEFCA doesn’t store data; it facilitates the exchange of data between systems.
- It doesn’t replace local or state-level solutions: TEFCA is designed to complement, not replace, existing health information exchanges (HIEs).
- It’s not a one-size-fits-all solution: TEFCA focuses on broad, standardized exchange, but may not meet every local or specialized need. Including state-specific consent laws, such as sensitive behavioral health, HIV and substance abuse information (e.g., 42 CFR Part 2).
TEFCA in 2025 and Beyond: What’s Next?
As TEFCA continues to evolve, the second half of 2025 brings a renewed focus on transparency, expanded use cases and deeper federal engagement.
Increasing Transparency
ONC is making TEFCA’s development more open and inclusive. Several aspects of TEFCA are now open for public comment, such as the QHIN Technical Framework (QTF) v2.1, allowing stakeholders across the healthcare ecosystem to weigh in. This move aims to foster trust and ensure that TEFCA reflects the needs of its diverse participants.
Expanding Participation and Use
TEFCA now supports additional exchange purposes beyond treatment and individual access, including payment, healthcare operations, public health and government benefits determination. With both document-based and FHIR®-based query capabilities in place, ONC is launching short-term connectivity pilots to help payers and providers move toward live production.
Activating Federal Partners
Federal agencies including the VA, CMS, CDC and SSA are being onboarded to TEFCA to support their mission-critical data exchange needs. This marks a significant step toward integrating public sector health systems into the national interoperability framework.
TEFCA’s Role in a Connected Future
TEFCA is not the final destination for interoperability, it’s a foundation. TEFCA is laying the groundwork for a more unified, efficient and secure health data exchange system, but it doesn’t replace the local expertise, real-time capabilities and community engagement offered by regional HIEs. As it expands into new use cases and brings more federal partners on board, its impact is becoming increasingly tangible.
While not a replacement for local innovation, TEFCA simplifies nationwide exchange by offering one set of policies, one connectivity model and one oversight approach. This reduces complexity and cost, making it easier for organizations to participate in secure, standardized data exchange at scale.
