Frequently Asked Questions

The 21st Century Cures Act, signed by President Obama in 2016, calls on ONC to “develop or support a trusted exchange framework, including a common agreement among health information networks nationally.”

The overall goal for the Trusted Exchange Framework and Common Agreement (TEFCA) is to establish a floor of universal interoperability across the country. The Common Agreement will establish the infrastructure model and the governing approach for users in different networks to securely share basic clinical information with each other—all under commonly agreed-to expectations and rules and regardless of which network they happen to be in.

These Frequently Asked Questions address common stakeholder questions and will be updated regularly. You may submit a question to rce@sequoiaproject.org.

Overall Process and Timeline

What is the purpose of the Trusted Exchange Framework and Common Agreement (TEFCA)?

TEFCA will provide value by supporting exchange of health information across stakeholders, consistent with applicable law. It will advance the following opportunities:
  • Providers’ ability to get the data they need to provide the best care possible for patients.
  • People will have easier access to their complete health history in one place.
  • Health plans and providers will face fewer burdens when sharing information to support care coordination, case management, and health plan operations.
  • Public health departments will have more nimble access to the information they need, while providers that currently expend tremendous resources connecting to numerous single-purpose public health reporting channels or report through non-digital means will have simpler connectivity.

What is the role of the ONC TEFCA Recognized Coordinating Entity (RCE)?

Under a Cooperative Agreement with the Office of the National Coordinator (ONC) for Health Information Technology, the RCE will:
  • Work with ONC to develop, update, implement, and maintain the Common Agreement and Qualified Health Information Network (QHIN) Technical Framework;
  • Engage with stakeholders to obtain feedback;
  • Designate and monitor QHINs for compliance with the Common Agreement; and
  • Develop and maintain the governing approach to maintain and update Common Agreement, including sustainability.

What is a Qualified Health Information Network (QHIN)?

Qualified Health Information Networks (QHINs) are networks that agree to the common terms and conditions of exchange with each other (as specified in the Common Agreement) and to the functional and technical requirements for exchange (as specified in the QHIN Technical Framework or QTF). QHINs will be the central connection points within the TEFCA ecosystem. They will route queries, responses and messages among entities and individuals sharing information.

What is the Common Agreement?

The Common Agreement will provide the governing approach necessary to scale a functioning system of interconnected QHINs. The Common Agreement will be a legal agreement that the RCE and QHINs will sign. Some provisions of the Common Agreement will flow down to other entities, such as a QHIN’s participant, via contracts.

What is the QHIN Technical Framework?

The QHIN Technical Framework (QTF) will describe the technical and functional requirements for electronic health information exchange between QHINs. Additionally, some functional requirements flow down to the QHINs’ participants and subparticipants for proper operations of the QHIN Exchange Network.  The QTF will be referenced in the Common Agreement.

When will the Common Agreement and QHIN Technical Framework be published?

The RCE has created a plan to facilitate stakeholder input to inform the Common Agreement and QHIN Technical Framework (QTF).  Throughout Summer and Fall 2021, the RCE will lead several stakeholder opportunities where interested parties can share their input on the policies to be included in the final version of the Common Agreement Version 1, including, for example, policies regarding required and optional exchange purposes, privacy and security policies, required and optional exchange patterns, and incorporation of HL7® FHIR® in the QTF roadmap. The RCE will also publish an updated QTF for stakeholder input. This is a technical document that details the functional and technical requirements that QHINs must support. Our goal is to open up participation in the Common Agreement by Q1 of calendar year 2022.

What are the requirements to be a Qualified Health Information Network (QHIN)?

QHINs are expected to have key infrastructure and will be the backbone of nationwide exchange under TEFCA. They will be highly reliable and secure central nodes to support a network of networks. The specific final requirements to be a QHIN have yet to be developed.

How will QHINs be designated?

The RCE is establishing an application and assessment process to designate QHINs. It will do so based on the eligibility criteria and process to be specified in the Common Agreement and accompanying Standard Operating Procedures (SOPs).

Are there any Qualified Health Information Networks (QHINs) in existence today?

No. Only the RCE can designate a QHIN under TEFCA. The RCE has not yet designated any QHINs. It will begin doing so in 2022, after the Common Agreement Version 1 Final and QHIN Technical Framework Version 1 Final are finalized.

Does TEFCA change the technical approach a QHIN uses to share information with its Participants?

The QHIN Technical Framework establishes technical and functional requirements for electronic exchange of information among QHINs. Certain elements are so fundamental that they are specified within QHINs. For example, all communications are expected to use transport layer security (TLS) with mutual authentication.  Beyond these types of elements, each QHIN will be free to choose how it shares information with its participants.

How does TEFCA support consumers’ access to their information?

Ultimately, TEFCA is about people. When TEFCA is implemented, it will be easier for individuals to ask for and see their health information on their smartphones or via their portals. TEFCA will provide the infrastructure to more readily enable individuals to access their information, from every connected provider and health plan, in one place.

TEFCA starts with document-based query and message delivery; what about of Health Level Seven (HL7®) International Fast Healthcare Interoperability Resources (FHIR®) standard?

FHIR® is not expected to be part of the first production version of the QHIN Technical Framework, as the FHIR® RESTful application programming interface (API) currently supports point-to-point exchange in most cases. The RCE is evaluating the FHIR® RESTful API carefully and is considering how the standard can be piloted in a network-to-network environment. The RCE is learning from activities to deploy FHIR® at scale (such as the FAST Initiative), which will inform future versions of the QTF.

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