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What Is the ONC Trusted Exchange Framework and Common Agreement?

The Trusted Exchange Framework and Common Agreement, also known as TEFCA, outlines a common set of principles, terms, and conditions to support the development of a Common Agreement that would help enable nationwide exchange of electronic health information (EHI) across disparate health information networks (HINs). The TEFCA is designed to scale EHI exchange nationwide and help ensure that HINs, health care providers, health plans, individuals, and many more stakeholders have secure access to their electronic health information when and where it is needed.

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The TEFCA will enable the appropriate sharing of electronic health information between networks in order to:

  • Increase secure and appropriate access to data, which will better support existing use cases that HINs and health IT developers have enabled for their users.
  • Ensure that a core set of data will be available among networks connected through the Common Agreement for the following exchange purposes: treatment, individual access services, public health, benefits determination, a subset of the HIPAA-defined payment activities (utilization review), and a subset of the HIPAA-defined health care operations (quality assessment and improvement, business planning and development).
  • Decrease costs and improve efficiency by reducing or eliminating the need to join multiple HINs and multiple legal agreements, or the need to create one-off, point-to-point interfaces.
  • Provide HINs and health IT developers with a common set of privacy and security requirements for the purpose of protecting patient data, including requirements on identity proofing and authentication.

In January 2018, ONC released the first draft of the Trusted Exchange Framework (TEF Draft 1) for public comment. ONC reviewed all of the public comments on the TEF Draft 1 and released an updated draft package for comment in April 2019. This TEF Draft 2 package was developed by ONC with input from all of the public comments on the TEF Draft 1 and includes three components: (1) the TEF Draft 2; (2) the Minimum Required Terms and Conditions (MRTCs) Draft 2; and (3) the Qualified Health Information Network (QHIN) Technical Framework (QTF) Draft 1.

In January 2022, ONC and the RCE announced the publication of the Trusted Exchange Framework and the Common Agreement (TEFCA). Entities will soon be able to apply and be designated as Qualified Health Information Network.

The Trusted Exchange Framework describes high-level principles that networks should adhere to for trusted exchange. 

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The Common Agreement is a legal agreement that will enable network-to-network data sharing.

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This program is supported by the Office of the National Coordinator for Health Information Technology (ONC) of the U.S. Department of Health and Human Services (HHS) under grant number 90AX0026, Trusted Exchange Framework and Common Agreement – Recognized Coordinating Entity (RCE) Cooperative Agreement Program, in the amount of $5,101,000 with 100 percent funded by ONC/HHS. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by ONC, HHS or the U.S. Government.

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