How Can I Participate in TEFCA?​

The TEF and the Common Agreement follow a “network of networks” structure, which allows for multiple points of entry and is inclusive of many different types of health care stakeholders. 

Such stakeholders include, but are not limited to:

A Participant, Subparticipant, or an Individual User may leverage the “network of networks” to exchange health information by connecting via a QHIN.


The TEFCA Version 1 published in January 2022 includes updated criteria for QHINs. The draft QHIN Onboarding and Designation SOP and draft QHIN Application provide additional details regarding the process and requirements for becoming a QHIN. In order to apply for QHIN Designation, a Health Information Network (HIN) must meet certain prerequisites, including already operating a network that provides the ability to locate and transmit EHI between multiple persons or entities electronically, with existing persons or entities exchanging EHI in a live clinical environment; and providing the RCE with a written plan of how it will achieve all of the requirements of the Common Agreement within a specified time period.

A HIN must submit a QHIN Application to the RCE that documents that it meets these prerequisites, and the RCE must certify in writing that the HIN in question has satisfied these requirements.

Once the RCE has approved a QHIN Application, the HIN becomes a Provisional QHIN and is assigned to a Cohort to complete the remainder of the requirements in the Common Agreement and QTF.

A Provisional QHIN is only Designated a QHIN once the RCE has confirmed and documented that the Provisional QHIN in question has satisfied the requirements of the Common Agreement and the QTF.

The RCE will also be responsible for monitoring QHINs on an ongoing basis and adjudicating noncompliance with the Common Agreement up to and including removal of the QHIN from ONC’s public directory on, when necessary.

The RCE was seeking feedback on the draft QHIN Onboarding and Designation Standard Operating Procedure (SOP) and the draft QHIN Application released May 16, 2022. In addition to engaging the RCE through the public, virtual events, organizations and individuals may have chosen to submit written feedback using the online feedback forms until June 15, 2022. 

When the QHIN application package is finalized, it will be posted here.

Participants may include persons or entities that have entered into a contract to participate in a QHIN. Some examples of Participants could include, but are not limited to, a HIN, a health system, a health IT developer, a payer, or a federal agency.

See the Types of Entities That Can Be a Participant or Subparticipant in TEFCA SOP.

Subparticipants may include persons or entities that use the services of a Participant to send and receive EHI. For example, if a QHIN is composed of health information exchanges, the health information exchange would be the Participant, and those who use the health information exchange services, (such as health systems, ambulatory providers, health IT developers, payers, and others) are the subparticipants. Alternatively, a health IT developer could be a direct Participant of a QHIN, in which case, the Participant Members may be the provider practice that uses the health IT developer’s software or services.

See the Types of Entities That Can Be a Participant or Subparticipant in TEFCA SOP.

An Individual User represents an actual person who is the subject of the EHI, such as a patient, health plan member, or a patient representative. Individual Users may have a Direct Relationship with the QHIN, Participant, or Subparticipant, depending on the structure of the QHIN to which they belong, but they are not themselves considered Participants or Subparticipants.

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