EDITOR’S NOTE: In an earlier version of this article, which has since been corrected, two inaccuracies were noted. TEFCA was introduced by the U.S. Department of Health and Human Services Office of the National Coordinator for Health IT (ONC) not the Centers for Medicare & Medicaid Services, and TEFCA does not certify QHINs, but rather conducts evaluations. RACmonitor apologizes for the errors.
I recently saw a notable update on the Trusted Exchange Framework and Common Agreement or TEFCA, a federal program intended to improve health data interoperability across the healthcare industry.
It made me think about how quickly healthcare interoperability is advancing.
Interoperability touches nearly all stakeholders in the industry, most especially providers, and TEFCA’s nearly weekly developments are rapidly shaping the future of healthcare.
So, here’s a quick refresher on TEFCA, its status, and why it’s worth keeping an eye on.
The exchange of health information is crucial for delivering efficient and effective patient care. However, as you may know, interoperability challenges have hindered smooth data exchange among healthcare providers, which causes fragmented care and compromised patient outcomes.
To address these issues, TEFCA was introduced by the U.S. Department of Health and Human Services (HHS) Office of the National Coordinator for Health IT, or the ONC.
At its core, TEFCA is a set of principles and requirements for secure information-sharing among health information networks across the U.S., and it serves as an outline for establishing a common set of principles, terms, and conditions for the trusted exchange of electronic health information.
TEFCA’s outline of fundamental principles for achieving interoperability includes those for data standardization and privacy protections. TEFCA’s contracted Recognized Coordinating Entity (RCE) also evaluates health information networks for potential designation as TEFCA QHINs, or Qualified Health Information Networks, across the country, responsible for facilitating health information exchange among healthcare organizations.
Several key phases have shaped TEFCA’s trajectory, including pilot testing of the program’s concepts and functionalities, engaging stakeholders to ensure alignment with diverse needs and perspectives, and, since TEFCA intersects with existing regulations such as the 21st Century Cures Act and the Healthcare Insurance Portability and Accountability Act (HIPAA), it compels the streamlining of regulatory requirements and integration into the broader healthcare landscape.
Most recently, the ONC announced updates to TEFCA’s Common Agreement, which establishes the technical infrastructure and governing approach for QHINs and their users to securely share clinical information with each other.
The updates allow QHINS to begin the process of employing FHIR standards to meet data exchange requirements, serving as yet another example of the federal governments’ intent to move toward FHIR standards on many fronts in healthcare.
You may recall that CMS recently gave a nod to FHIR standards for use in generating the Advance Explanation of Benefits (AEOBs) and Good Faith Estimates (GFEs) that stem from the No Surprises Act. Further, health plans serving the Medicare, Medicaid, and Patient Protection and Affordable Care Act (PPACA) marketplace populations are already required to use FHIR standards for certain data exchange functions.
Not only does TEFCA represent a revolutionary initiative to promote nationwide interoperability and enhance health information exchange, but it also stands to be a key driver of impending interoperability efforts between payors and providers.
What’s more, it holds immense potential to revolutionize healthcare delivery, improve patient outcomes, and steer innovation across the healthcare ecosystem by enabling patient information to move quickly and seamlessly across the country, facilitated by local QHINs, moving patient data to the appropriate providers for continuous patient care and, most importantly, getting that same patient data in the hands of patients themselves.
Something with such sweeping implications for healthcare professionals, like many of you, is sure to make big waves. Arm yourself with awareness now.
TEFCA is paving the way for a more connected and patient-centric healthcare system. I suggest taking a look at the ONC’s website for more on TEFCA and its latest progress.
Welcome back everybody after the holidays. As a CPA, I have always been uncomfortable when the word “Audit” is used to describe activity since the term
I am going to start 2026 by doing something I rarely do, and that is compliment an insurance company, and United Healthcare at that. As you
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