Common Agreement for Nationwide Health Information Interoperability

Common Agreement

The 21st Century Cures Act, passed in 2016, calls for the development of a trusted exchange framework and a common agreement. The Trusted Exchange Framework is a set of non-binding but foundational principles for health information exchange, and the Common Agreement is a contract that advances those principles. The Common Agreement establishes the technical infrastructure model and governing approach for different health information networks and their users to securely share clinical information with each other – all under commonly agreed-to rules-of-the-road.

The Common Agreement supports multiple exchange purposes critical to improving health care and has the potential to benefit a wide variety of health care entities. This flexible structure allows stakeholders—such as health information networks, ambulatory practices, hospitals, health centers, federal government agencies, public health agencies, and payers—to benefit from TEFCA through improved access to health information. Individuals also benefit from TEFCA and seek access to their health information through entities that offer individual access services.


Key Concepts that have Evolved: Version 1.1 to Version 2.0

Common Agreement and QTF Version 1.1 Proposed Common Agreement and QTF Version 2.0
Fundamental requirements and components of TEFCA mostly included within Common Agreement and QTF Version 1.1 More details moved to SOPs
Model Participant/Subparticipant flow-down terms Static Participant/Subparticipant Terms of Participation
Exchange only occurs QHIN-to-QHIN via IHE protocols Facilitated FHIR available between Participants/Subparticipants
Exchange within QHINs not considered TEFCA exchange TEFCA Exchange identified by unique TEFCA code
Six (6) authorized Exchange Purposes (XPs) Six (6) authorized Exchange Purposes (XPs) with new sub exchange purposes and implementation guidance
Two (2) XPs require a response: Treatment and Individual Access Services (IAS) Three (3) XPs require a response: Treatment, IAS, and Health Care Operations SubXP-1 (FHIR only)
All QHINs, Participants, and Subparticipants must respond Introduction of Principal/Delegate roles and requirements
Participants and Subparticipants may not participate with more than one QHIN Participants and Subparticipants may conduct TEFCA Exchange in multiple QHINs using multiple Nodes
Privacy/security obligations apply to all  Privacy/security obligations apply to all 

Common Agreement for Nationwide Health Information Interoperability

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