On January 19, 2022, the U.S. Department of Health and Human Services (HHS) Office of the National Coordinator for Health Information Technology (ONC) published the Trusted Exchange Framework and Common Agreement (TEFCA) for health information exchange. The Trusted Exchange Framework established a set of non-binding, foundational principles for trust policies and practices to help facilitate exchange among health information networks (HINs). The Common Agreement under TEFCA developed the infrastructure model and governing approach for users in different networks to securely share basic clinical information with each other—all under commonly agreed-to expectations and rules, regardless of which network they happen to be in. TEFCA’s main goal is to encourage interoperability across the country by developing uniform policies and technical requirements to regulate data sharing and to ensure that all participants can access real-time health information. For a more detailed breakdown of the structure and function of TEFCA see Crowell’s previous post.

The development of TEFCA was mandated by the 21^st Century Cures Act. In 2019, the ONC issued a Notice of Funding Opportunity and ultimately appointed The Sequoia Project, Inc. to serve as the Recognized Coordinating Entity (RCE). About a year after the long-awaited TEFCA publication, ONC held an event on February 13^th, 2023 to recognize the first set of applicant organizations that were approved as qualified health information networks (QHINs). The approved HINs consist of CommonWell Health Alliance, eHealth Exchange, Epic TEFCA Interoperability Services, Health Gorilla, Kno2, and KONZA National Network. These six potential QHINs agreed to the same data sharing infrastructure, which allows them to connect to one another and enables their participants, including provides, payers, and public health agencies, to exchange health information nationwide. This first cohort of potential QHINs will undergo onboarding over the course of the year. The ONC plans to announce additional QHINs as they are approved by the RCE.

Since TEFCA participation is voluntary, the extent of its impact is limited by the number of entities that apply for QHIN designation. With widespread network participation, TEFCA is intended to:

• allow networks to securely share and access data
• make a core set of data available for networks under the Common Agreement
• curtail the need for entities to join multiple HINs and agreements which will decrease costs and improve efficiency
• create a common set of privacy and security requirements for HINs and IT developers to protect patient data

Crowell Health Solutions (CHS) recently hosted “Industry Views on the Trusted Exchange Framework and Common Agreement,” a podcast examining the advancement of information exchange governance in our healthcare landscape, the significance and potential impact of TEFCA, the participation of HINs in TEFCA, and the evolution of data sharing and interoperability in the next 10 years. While TEFCA is still in the early stages, CHS looks forward to tracking the progression of the framework and its impact on health information exchange.

To learn more about TEFCA, recent activities and future implications listen to Industry Views on the Trusted Exchange Framework and Common Agreement here.