How Can I Participate in TEFCA?​

The Trusted Exchange Framework and the Common Agreement (TEFCA) 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:

Individuals and organizations may leverage the “network of networks” to exchange health information by connecting to TEFCA exchange via a QHIN, Participant or Subparticipant.


TEFCA went live in December 2023. You can see the list of Designated QHINs here:

In order to be a Designated as a QHIN, a Health Information Network (HIN) must go through a rigorous Application and Onboarding and Designation process that ensures that they have the capabilities needed to serve in this crucial role.

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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